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Efficacy of Systolic Extinction Training in Fibromyalgia Patients With Elevated Blood Pressure Response to Stress: A Tailored Randomized Controlled Trial
Author(s) -
Thieme Kati,
Meller Tina,
Evermann Ulrika,
Malinowski Robert,
Mathys Marc G.,
Graceley Richard H.,
Maixner William,
Turk Dennis C.
Publication year - 2019
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.23615
Subject(s) - medicine , blood pressure , transcutaneous electrical nerve stimulation , baroreflex , baroreceptor , fibromyalgia , randomized controlled trial , anesthesia , bradycardia , diastole , threshold of pain , cardiology , heart rate , alternative medicine , pathology
Objective An intrinsic pain regulatory system is modulated by both cardiovascular dynamics that influence baroreflex sensitivity ( BRS ) and is diminished in fibromyalgia ( FM ). Baroreceptors relay cardiovascular output to the dorsal medial nucleus tractus solitarius reflex arcs that regulate pain, sleep, anxiety, and blood pressure. The aim of this study was to evaluate the effects of systolic extinction training ( SET ), which combines operant treatment ( OT ) with baroreflex training ( BRT ). BRT delivers peripheral electrical stimulation within a few milliseconds of the systolic or diastolic peak in the cardiac cycle. In addition, we compared SET to OT –transcutaneous electrical stimulation ( TENS ) independent of the cardiac cycle and aerobic exercise ( AE )– BRT in FM patients with elevated blood pressure responses to stress. Methods Sixty‐two female patients with FM were randomized to receive either SET (n = 21), OT ‐ TENS (n = 20), or AE ‐ BRT (n = 21). Outcome assessments were performed before treatment (T1), after 5 weeks of treatment (T2), and after the 12‐month follow‐up (T3). Results In contrast to patients receiving OT ‐ TENS or AE ‐ BRT , those receiving SET reported a significantly greater reduction in pain and pain interference (all P < 0.01) that was maintained at the 12‐month follow‐up. Clinically meaningful pain reduction at T3 was achieved in 82% of patients in the SET group, 39% of those in the OT ‐ TENS group, and only 14% of those in the AE ‐ BRT group. Patients in the SET group showed a significant increase (57%) in BRS following treatment, while neither the AE ‐ BRT group or the OT ‐ TENS group showed significant changes over time. Conclusion SET resulted in statistically significant, clinically meaningful, and long‐lasting pain remission and interference compared to OT ‐ TENS and AE ‐ BRT . These results suggest that BRS modification is the primary mechanism of improvement. Replication of our results using larger samples and extension to other chronic pain conditions appear to be warranted.