CBT Linked to Reduced Pain, Less Catastrophizing in Fibromyalgia

Pauline Anderson

October 02, 2023


In patients with fibromyalgia, cognitive behavior therapy (CBT) can reduce pain through its effect on pain-related catastrophizing, which involves intensified cognitive and emotional responses to things like intrusive thoughts, a new study suggests.


  • The study included 98 female patients with fibromyalgia (FM), mean age about 42 years, who underwent a baseline neuroimaging assessment and were randomly assigned to CBT (where patients learned to identify negative thoughts and use cognitive restructuring to diminish pain-related distress) or a matched educational intervention (where patients learned about fibromyalgia and chronic pain); both groups had eight weekly individual 60- to 75-minute visits.

  • The primary outcome was the pain interference subscale of the Brief Pain Inventory (BPI); secondary outcomes included the BPI pain severity subscale, the Fibromyalgia Impact Questionnaire–Revised (FIQR), and the Pain Catastrophizing Scale (PCS), which includes subscales of rumination, magnification, and helplessness.

  • Researchers used functional magnetic resonance imaging (fMRI)-adapted task to investigate the neural circuitry supporting pain catastrophizing.


  • After controlling for baseline values, BPI pain interference scores were significantly reduced, with a larger reduction in the CBT group compared with the education group (P = .03), which was also the case for FIQR scores (P = .05) and pain catastrophizing (P = .04).

  • There were larger reductions in pain-related symptomatology in the CBT group, but they did not reach statistical significance.

  • Following CBT treatment, the study showed reduced connectivity between regions of the brain associated with self-awareness, pain, and emotional processing.


The results "highlight the important role of targeting pain catastrophizing with psychotherapy, particularly for patients reporting high levels of catastrophizing cognitions" write the authors, adding that altered network connectivity identified by the study "may emerge as a valuable biomarker of catastrophizing-related cognitive and affective processes."


The study was carried out by Jeungchan Lee, PhD, Department of Radiology, Center for Biomedical Imaging, Massachusetts General Hospital, and Discovery Center for Recovery from Chronic Pain, Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, and colleagues. It was published September 20 in Arthritis & Rheumatology.


Findings were limited to female participants. CBT for chronic pain includes different therapeutic modules, and the study can't draw definitive conclusions regarding which CBT skills were most beneficial to patients in reducing catastrophizing. Baseline symptom severity was higher for the CBT group, which may complicate interpretation of the findings.


The study received support from the National Institutes of Health: National Center for Complementary and Integrative Health, National Institute of Arthritis and Musculoskeletal and Skin Diseases and the National Center for Research Resources. The authors have disclosed no relevant financial relationships.

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