Differential Brain Perfusion Changes Following Two Mind-Body Interventions for Fibromyalgia Patients: an Arterial Spin Labelling fMRI Study

Sonia Medina, Owen G O'Daly, Matthew A Howard, Albert Feliu-Soler, Juan V Luciano, Sonia Medina, Owen G O'Daly, Matthew A Howard, Albert Feliu-Soler, Juan V Luciano

Abstract

Objectives: Further mechanistic insight on mind-body techniques for fibromyalgia (FMS) is needed. Arterial spin labelling (ASL) imaging can capture changes in regional cerebral blood flow (rCBF) that relate to spontaneous pain.

Methods: We recruited FMS patients undergoing either mindfulness-based stress reduction training (MBSR, n = 14) or a psychoeducational programme (FibroQoL, n = 18), and a control FMS group with no add-on treatment (n = 14). We acquired whole-brain rCBF maps and self-report measures at baseline and following treatment and explored interaction effects in brain perfusion between the treatment group and session with a focus on the amygdala, the insula and the anterior cingulate cortex (ACC).

Results: We identified a significant interaction effect in the amygdala, which corresponded with rCBF decreases following FibroQoL specifically. At baseline, rCBF in the amygdala for the FibroQoL group correlated with pain catastrophizing and anxiety scores, but not after treatment, suggesting a decoupling between activity in the amygdala and negative emotional symptoms of FMS as a consequence of treatment. Baseline rCBF correlated positively with pain symptoms in the ACC and the anterior insula across all patients; moreover, the correlation between rCBF changes post intervention in the insula and pain improvement was negative for both treatments and significantly different from the control group. We suggest that there is disruption of the typical relationship between clinical pain and activity as a product of these two nonpharmacological therapies.

Conclusions: We have demonstrated that different mind-to-body treatments correspond to differential changes in clinical symptoms and brain activity patterns, which encourages future research investigating predictors of treatment response.

Trial registration: NCT02561416.

Supplementary information: The online version contains supplementary material available at 10.1007/s12671-021-01806-2.

Keywords: Fibromyalgia; Meditation, pCASL fMRI; Mindfulness.

Conflict of interest statement

Conflict of InterestThe authors declare no competing interests.

© Crown 2021.

Figures

Fig. 1
Fig. 1
Flowchart of experimental design for the EUDAIMON neuroimaging substudy. Figure adapted from EUDAIMON study protocol
Fig. 2
Fig. 2
Results from mixed 3 by 2 ANOVA and post hoc pairwise comparisons. Initial cluster-forming threshold = 0.005. Results are significant at peak level after family-wise error correction at alpha = 0.05 post SVC in the amygdala
Fig. 3
Fig. 3
Summary of results from correlation analyses between rCBF in the amygdala bilaterally and behavioural measures for TAU + FibroQoL group. ROI, region of interest. TAU, treatment as usual; FibroQoL, psychoeducational programme; HADS, hospital anxiety and depression scale; PCS, pain catastrophising scale; VAS, visual analogue scale. Alpha = 0.05
Fig. 4
Fig. 4
Results from voxel-wise correlation analysis between whole-brain baseline perfusion and baseline VAS scores. Initial height threshold = 0.005. Results are significant at peak level after family-wise error correction at alpha = 0.05 post small volume correction in the subgenual ACC (top panel) and the anterior insula (bottom panel)
Fig. 5
Fig. 5
Comparison of regression slopes between delta VAS scores and delta CBF across treatment groups. Initial height threshold = 0.005. Results are significant at peak level after family-wise error correction at alpha = 0.05 post small volume correction in the anterior insula

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