Relieving Chronic Pain: Psychosomatic Mechanisms and Psychological Interventions in Fibromyalgia and Chronic Headache

NCT06652724 | Recruiting DMC

• 1 other identifier: 20229NZEKP
• Study Type: interventional
• Target: 400
• Locations: 1 country
• Sites: 2

Brief Summary

Pain is one of the most important manifestations of the disease state and significantly affects people\'s quality of life. According to the International Association for the Study of Pain (IASP), pain is not only a sensory experience related to the activation of the somato-sensory nervous system, but also an emotional experience, resulting from the cortical and emotional processing of nociceptive signals. This means that perceived pain is the result of a complex interaction between physical sensations and emotional responses. Pain is classified according to two main criteria: duration and pathophysiological mechanism. In terms of duration, pain can be transient, acute, chronic, or persistent. In terms of pathophysiology, pain can be nociceptive, inflammatory, neuropathic, or nociplastic. The latter, in particular, is characterized by altered nociceptive function, without obvious peripheral damage, and is seen in conditions such as fibromyalgia and chronic migraine. Chronic pain affects a significant proportion of the population, with estimated prevalence rates between 11% and 40%. According to the US Centers for Disease Control and Prevention, about 20.4 percent of adults suffer from chronic pain. This type of pain is more common in women, people of advanced age, and people with low socioeconomic status. In addition to its physical effects, chronic pain has a major psychological impact, increasing the risk of depression, anxiety, and social isolation. Socially and economically, the costs associated with the treatment and management of chronic pain are high. Nociplastic pain (DN) refers to a chronic pain state that is not related to visible tissue damage or overt neuropathy, but in which there are alterations in the function of pain sensory pathways. The concept of central sensitization (CS), introduced in the 1990s, describes the amplification of pain signals at the level of the central nervous system, leading to increased sensitivity to pain (hyperalgesia) or pain in response to normally non-painful stimuli (allodynia). This central sensitization has been observed in conditions such as fibromyalgia and chronic migraine. Fibromyalgia (FM) is a syndrome characterized by widespread musculoskeletal pain associated with fatigue, sleep disturbances, and cognitive deficits. The prevalence of FM is higher among women and tends to be associated with a high level of psychological distress, with anxiety symptoms and depression very common among patients. Although the precise cause of fibromyalgia is still unclear, studies suggest that central sensitization plays a central role in its etiology. Patients with fibromyalgia also have high levels of alexithymia, or the difficulty of identifying and describing emotions, and personality disorders such as avoidant or obsessive-compulsive. Migraine (CM) affects about 15 percent of the world\'s population and is characterized by severe headache attacks, often associated with nausea, vomiting, and hypersensitivity to light and sound. Chronic migraine occurs when symptoms occur for at least 15 days per month. Several genetic and environmental factors contribute to the development of migraine, and there is growing evidence indicating a bidirectional relationship between migraine and depression. Anxiety and depression are also risk factors for migraine chronification. The comorbidity between fibromyalgia and chronic migraine has been the subject of numerous studies. About 45%-80% of patients with fibromyalgia also have migraine, while 20%-36% of patients with migraine also have fibromyalgia. This high incidence of comorbidity suggests that there are common pathophysiological mechanisms between the two conditions, probably related to central sensitization and alterations in nociceptive pain pathways. Recent studies have confirmed that patients with both conditions (FibroMig) may have specific psychological and neurofunctional patterns that distinguish them from those with only one of the two diseases. This study aims to explore the differences between people with fibromyalgia and chronic migraine, with the goal of identifying distinctive psychological and neurofunctional patterns that could help improve treatments for chronic pain management. An innovative aspect of the project is the identification of the FibroMig sub-population, namely those who suffer from both conditions. These patients might exhibit unique neurophysiological and psychological mechanisms that could be used to develop more targeted treatment strategies.

Conditions

Fibromyalgia (FM); Chronic Migraine Headache

Keywords

fibromyalgia; chronic migraine; fmri; psychology; chronic pain; functional magnetic resonance; psychotherapy

Outcome Measures

Primary Outcomes (7)

• severity of pain

  To assess the severity of pain, the Visual analogue scales (VAS; Kane, 2005) will be used: it allows pain intensity to be assessed by a ten-point scale with two perpendicular ends: the first end (zero) means no pain, and the second end (ten) means the worst pain.

  An initial survey at the time of enrollment (T0) then one immediately after the end of the planned interventions (T1, after 4 months of the first one) and finally a survey at 6 months of the end of the intervention (T2).

• severity of symptoms

  To assess symptom severity, the Revised Fibromyalgia Impact Questionnaire (FIQR, Benneet et al., 2009; Salaffi et al., 2013) will be used: it detects the functioning of the person with fibromyalgia by assessing the impairment of functioning and quality of life given by fibromyalgia symptoms.

  An initial survey at the time of enrollment (T0) then one immediately after the end of the planned interventions (T1, after 4 months of the first one) and finally a survey at 6 months of the end of the intervention (T2).

• mental pain

  To measure mental pain, the Mental Pain Questionnaire (MPQ; Svicher et al., 2019) will be used: it investigates ten aspects of mental pain identified through the literature, namely: presence of mental pain, feeling of helplessness and hopelessness, duration of pain, irreversibility of pain, and intolerance to suffering.

  An initial survey at the time of enrollment (T0) then one immediately after the end of the planned interventions (T1, after 4 months of the first one) and finally a survey at 6 months of the end of the intervention (T2).

• level of central sensitization

  To measure the level of central sensitization, the Central Sensitivity Inventory (CSI; Chiarotto et al., 2018) will be used: it was developed to assess some psychological symptoms referable to the central sensitivity syndrome. The CSI is intended as a supportive tool to help the clinician identify the presence of the syndrome at the stage of diagnosis that focuses on the person\'s psychological and emotional experience.

  An initial survey at the time of enrollment (T0) then one immediately after the end of the planned interventions (T1, after 4 months of the first one) and finally a survey at 6 months of the end of the intervention (T2).

• psychopathological symptoms related to anxiety and depression

  Psychopathological symptoms related to anxiety and depression will be detected using: Generalized Anxiety Disorder (GAD-7; Spitzer et al., 2006): for assessing the presence and severity of anxiety symptomatology according to DSM-IV diagnostic criteria Hamilton Depression Rating Scale (HDRS; Hamilton, 1960): for assessing the presence and severity of depressive symptomatology Patient Health Questionnaire (PHQ-9; Kroenke 2001): for assessing the presence and severity of depressive symptomatology according to the DSM-IV diagnostic criteria

  An initial survey at the time of enrollment (T0) then one immediately after the end of the planned interventions (T1, after 4 months of the first one) and finally a survey at 6 months of the end of the intervention (T2).

• alexithymia level

  To assess the level of alexithymia, the Toronto Alexithymia Scale (TAS-20; Bagby et al., 1994) will be used: this is a self-administered questionnaire consisting of 20 questions that measures difficulty in identifying and describing emotions.

  An initial survey at the time of enrollment (T0) then one immediately after the end of the planned interventions (T1, after 4 months of the first one) and finally a survey at 6 months of the end of the intervention (T2).

• quality of life

  To measure quality of life, the SF-12 - Quality of Life Assessment (SF-12; Apolone et al., 2001) will be used: this is a generic health survey developed that produces two measures for assessing self-perceived physical and mental health.

  An initial survey at the time of enrollment (T0) then one immediately after the end of the planned interventions (T1, after 4 months of the first one) and finally a survey at 6 months of the end of the intervention (T2).

Secondary Outcomes (7)

• traumatic experiences

  baseline, pre-intervention

• highly sensitivity

  baseline, pre-intervention

• personality traits

  baseline, pre-intervention

• defensive functioning

  baseline, pre-intervention

• psychopathological symptoms

  baseline, pre-intervention

Study Arms (3)

Dynamic interpersonal therapy (DIT)

EXPERIMENTAL

A total of 54 patients (18 FM, 18 CM, and 18 FibroMig) will receive a brief psychotherapy intervention of 16 sessions (one per week) for a total of 4 months.

Behavioral: Dynamic interpersonal therapy (DIT)

technique of expressive writing (TSE)

ACTIVE COMPARATOR

A total of 54 patients (18 FM, 18 CM, and 18 FibroMig) will receive an expressive writing therapy intervention of 8 meetings (one every fortnight) for a total of 4 months.

Behavioral: technique of expressive writing (TSE)

treatment as usual (TAU)

OTHER

A total of 54 patients (18 FM, 18 CM, and 18 FibroMig) will be part of the active control group, planned to monitor specific aspects of the psychotherapeutic intervention, which aims to equate a good standard of primary care.

Other: Treatment as Usual (TAU)

Interventions

Dynamic interpersonal therapy (DIT) BEHAVIORAL

Dynamic interpersonal therapy (DIT) is a dynamically oriented brief psychotherapeutic intervention based on attachment and mentalization theory that views symptoms of depression and anxiety as responses to interpersonal difficulties. This intervention helps patients to understand the connection between their symptoms and their relationships by identifying a core, non-conscious, repetitive pattern of relating. Previous studies have shown positive results: significant reductions have been observed for the variables somatic symptom severity, depression, anxiety, and general psychiatric symptoms. It consists of 16 sessions (one per week) for a total of 4 months.

Dynamic interpersonal therapy (DIT)

technique of expressive writing (TSE) BEHAVIORAL

The expressive writing technique created by Pennebaker has shown beneficial health effects in different contexts since, through writing, it is possible to mentally reorganize a difficult event, allowing the mind to find meaning to what has happened or is happening. This technique can be a resource that can promote activation from the ability to recognize, express, and process the unspoken emotional, psychological, and relational, helping to achieve emotional and physiological feedback. Although the application of expressive writing in patients with fibromyalgia is an under-explored area of investigation in the international literature, several studies have shown its effectiveness in some chronic syndromes. It consists of 8 meetings (one every fortnight) for a total of 4 months.

technique of expressive writing (TSE)

Treatment as Usual (TAU) OTHER

The usual treatment involves two contacts by a rheumatologist/neurologist (depending on the clinical condition of the patient) during a four-month period, lasting about 10-15 minutes each, in which patients will be followed up medically. This treatment represents the active control group, planned to monitor specific aspects of the psychotherapeutic intervention, which aims to equate a good standard of primary care.

treatment as usual (TAU)

Eligibility Criteria

• Age: 18 Years - 50 Years
• Sex: female
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64)

You may qualify if:

• minimum age of 18 years;
• at least 5 years of education;
• FM diagnosis according to the criteria reported by Wolfe (2016) for the FM group;
• CM diagnosis according to Olesen (2018) for the CM group;
• medical certification for FM and CM diagnosis for FibroMig group.

You may not qualify if:

• severe psychiatric disorders and/or cognitive impairment;
• difficulty understanding/expressing in Italian;
• history of other disorders characterized by chronic pain for FM and CM;
• history of other neurological disorders besides migraine for CM and FibroMig;
• history of other rheumatological disorders besides fibromyalgia for FM and FibroMig;
• For the healthy control group: no diagnosis of FM or CM; no severe psychiatric disorders/cognitive impairment; no or low levels of depression; no history of rheumatological and/or neurological disorders.

Sponsors & Collaborators

• University of Roma La Sapienza: lead
• University of Pavia: collaborator
• Azienda Policlinico Umberto I: collaborator
• Fondazione Mondino: collaborator
• University of Turin, Italy: collaborator
• I.R.C.C.S Ospedale Galeazzi-Sant'Ambrogio: collaborator

Study Sites (2)

Sapienza University of Rome

Rome, RM, 00100, Italy

ENROLLING BY INVITATION

Department of Dynamic and Clinical Psychology and Health Studies

Rome, RM, 00185, Italy

RECRUITING

Related Publications (14)

• Olesen J. International Classification of Headache Disorders. Lancet Neurol. 2018 May;17(5):396-397. doi: 10.1016/S1474-4422(18)30085-1. Epub 2018 Mar 14. No abstract available.

  PMID: 29550365 BACKGROUND

• Abbass A, Town J, Holmes H, Luyten P, Cooper A, Russell L, Lumley MA, Schubiner H, Allinson J, Bernier D, De Meulemeester C, Kroenke K, Kisely S. Short-Term Psychodynamic Psychotherapy for Functional Somatic Disorders: A Meta-Analysis of Randomized Controlled Trials. Psychother Psychosom. 2020;89(6):363-370. doi: 10.1159/000507738. Epub 2020 May 19.

  PMID: 32428905 BACKGROUND

• Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Hauser W, Katz RL, Mease PJ, Russell AS, Russell IJ, Walitt B. 2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria. Semin Arthritis Rheum. 2016 Dec;46(3):319-329. doi: 10.1016/j.semarthrit.2016.08.012. Epub 2016 Aug 30.

  PMID: 27916278 BACKGROUND

• Penn IW, Chuang E, Chuang TY, Lin CL, Kao CH. Bidirectional association between migraine and fibromyalgia: retrospective cohort analyses of two populations. BMJ Open. 2019 Apr 8;9(4):e026581. doi: 10.1136/bmjopen-2018-026581.

  PMID: 30962236 BACKGROUND

• Nimbi FM, Renzi A, Limoncin E, Bongiovanni SF, Sarzi-Puttini P, Galli F. Central sensitivity in fibromyalgia: testing a model to explain the role of psychological factors on functioning and quality of life. Clin Exp Rheumatol. 2024 Jun;42(6):1187-1197. doi: 10.55563/clinexprheumatol/h8jgv3. Epub 2024 Apr 8.

  PMID: 38607679 BACKGROUND

• Kleykamp BA, Ferguson MC, McNicol E, Bixho I, Arnold LM, Edwards RR, Fillingim R, Grol-Prokopczyk H, Turk DC, Dworkin RH. The Prevalence of Psychiatric and Chronic Pain Comorbidities in Fibromyalgia: an ACTTION systematic review. Semin Arthritis Rheum. 2021 Feb;51(1):166-174. doi: 10.1016/j.semarthrit.2020.10.006. Epub 2020 Dec 29.

  PMID: 33383293 BACKGROUND

• Karsan N, Goadsby PJ. Migraine Is More Than Just Headache: Is the Link to Chronic Fatigue and Mood Disorders Simply Due to Shared Biological Systems? Front Hum Neurosci. 2021 Jun 3;15:646692. doi: 10.3389/fnhum.2021.646692. eCollection 2021.

  PMID: 34149377 BACKGROUND

• Geisser ME, Strader Donnell C, Petzke F, Gracely RH, Clauw DJ, Williams DA. Comorbid somatic symptoms and functional status in patients with fibromyalgia and chronic fatigue syndrome: sensory amplification as a common mechanism. Psychosomatics. 2008 May-Jun;49(3):235-42. doi: 10.1176/appi.psy.49.3.235.

  PMID: 18448779 BACKGROUND

• Galli F, Caputi M, Sances G, Vegni E, Bottiroli S, Nappi G, Tassorelli C. Alexithymia in chronic and episodic migraine: a comparative study. J Ment Health. 2017 Jun;26(3):192-196. doi: 10.3109/09638237.2015.1124404. Epub 2016 Jan 6.

  PMID: 26732465 BACKGROUND

• Fitzcharles MA, Cohen SP, Clauw DJ, Littlejohn G, Usui C, Hauser W. Nociplastic pain: towards an understanding of prevalent pain conditions. Lancet. 2021 May 29;397(10289):2098-2110. doi: 10.1016/S0140-6736(21)00392-5.

  PMID: 34062144 BACKGROUND

• Ferrari MD, Goadsby PJ, Burstein R, Kurth T, Ayata C, Charles A, Ashina M, van den Maagdenberg AMJM, Dodick DW. Migraine. Nat Rev Dis Primers. 2022 Jan 13;8(1):2. doi: 10.1038/s41572-021-00328-4.

  PMID: 35027572 BACKGROUND

• de Tommaso M, Sciruicchio V. Migraine and Central Sensitization: Clinical Features, Main Comorbidities and Therapeutic Perspectives. Curr Rheumatol Rev. 2016;12(2):113-26. doi: 10.2174/1573397112666151231110813.

  PMID: 26717950 BACKGROUND

• Cho SJ, Perrot S, Sohn JH, Bae JS, Chu MK. Validity and Reliability of the Fibromyalgia Rapid Screening Tool Among Individuals with Chronic Daily Headache: A Clinic-Based Study. Pain Med. 2019 Jun 1;20(6):1193-1201. doi: 10.1093/pm/pny216.

  PMID: 30566656 BACKGROUND

• Bottiroli S, Galli F, Viana M, De Icco R, Bitetto V, Allena M, Pazzi S, Sances G, Tassorelli C. Negative Short-Term Outcome of Detoxification Therapy in Chronic Migraine With Medication Overuse Headache: Role for Early Life Traumatic Experiences and Recent Stressful Events. Front Neurol. 2019 Mar 7;10:173. doi: 10.3389/fneur.2019.00173. eCollection 2019.

  PMID: 30899242 BACKGROUND

MeSH Terms

Conditions

Fibromyalgia; Chronic Pain

Interventions

Therapeutics

Condition Hierarchy (Ancestors)

Muscular Diseases; Musculoskeletal Diseases; Rheumatic Diseases; Neuromuscular Diseases; Nervous System Diseases; Pain; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Study Officials

• Federica Galli, Professor

  University of Roma La Sapienza

  PRINCIPAL INVESTIGATOR

• Lorys Castelli, Professor

  University of Turin, Italy

  STUDY DIRECTOR

• Sara Bottiroli, Professor

  Università di Pavia

  STUDY DIRECTOR

• Piercarlo Sarzi-Puttini, MD, Professor

  University of Milan

  STUDY DIRECTOR

• Cristina Iannuccelli, Dr

  Policlinico Umberto I

  STUDY DIRECTOR

Central Study Contacts

Federica Galli, Professor

CONTACT

3355492778; f.galli@uniroma1.it

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor

Model Details: All participants will be fully aware of the purposes of the research and written informed consent will be obtained from all subjects. All recruited participants will undergo a baseline assessment (T0) using the tests listed in the next section. Patients who meet the inclusion criteria will be enrolled and randomized sequentially into one of three groups: brief psychodynamic therapy (DIT), Expressive Writing Therapy (EST) and controls (TAU). The group selected for the DIT intervention will conduct 16 sessions (one per week) and the group for TSE 8 meetings (one every fortnight) (see description of interventions) for a total intervention time of 4 months.

Study Record Dates

• First Submitted: September 29, 2024
• First Posted: October 22, 2024
• Study Start: September 17, 2024
• Primary Completion: September 30, 2025
• Study Completion: September 30, 2025
• Last Updated: October 22, 2024

Record last verified: 2024-10

Data Sharing

• IPD Sharing: Will not share

Locations

IT (2)