Cost-utility and Biological Underpinnings of MBSR in Fibromyalgia Syndrome
Condition: Fibromyalgia Syndrome
MeSH terms: Fibromyalgia; Myofascial Pain Syndromes; Syndrome
Study type: Interventional
Phase: Phase 3

Summary: 
      Purpose:

      Fibromyalgia syndrome (FMS) is a disabling condition mainly characterized by chronic
      widespread pain, disturbed sleep, fatigue, and distress. The estimated overall prevalence of
      FMS in Europe is 2.9% and it incurs in high personal, social and healthcare costs. Available
      treatments in FMS are not curative and there is some evidence of positive effects of
      mindfulness-based stress reduction (MBSR) in patients with chronic pain and FMS.
      Nevertheless, although promising, the positive findings obtained in previous studies
      implementing mindfulness-based interventions in patients with FMS have to be interpreted with
      caution due to important methodological limitations (e.g. absence of randomization, high
      attrition rates, or small sample sizes). Therefore, further research in larger studies using
      more adequate methodologies is warranted. Furthermore, little is known about putative
      neurobiological processes underpinning the effects of mindfulness training in patients with
      chronic pain.

      Aims: The aim of this randomized, controlled trial (RCT) is two-fold: firstly, to assess the
      effectiveness and cost-utility of MBSR added to treatment as usual (TAU); and secondly, to
      evaluate the effects of the compared interventions on neurobiological parameters.
      Specifically, MBSR will be compared to an active control which was previously reported as a
      cost-effective intervention (TAU + FibroQol psycho-educational program; Luciano et al., 2013)
      and also vs. TAU alone (in a 12-month follow-up RCT). Brain structure and function of
      pain-relevant areas and levels of inflammation markers (cytokines) will be assessed pre-post
      interventions in half of the study participants.

      Methods:

      Design: RCT with three arms:

        1. TAU + MBSR,

        2. TAU + FibroQoL and

        3. TAU.

      Sample: 180 adults with FMS according to the ACR 1990 criteria (N=60 for each study arm) will
      be recruited from from the Parc Sanitari Sant Joan de Déu Rheumatology Service, Sant Boi de
      Llobregat, Spain. Half of the participants will be randomly selected to participate in the
      neurobiological pre-post evaluation (N= 30 each group). All patients will be assessed at
      baseline, post-intervention and 12-month follow-up for clinical variables, prep-post
      intervention for biomarkers study, and baseline and 12-month follow-up for cost-related
      variables.
    

Detailed description: 
      Detailed description of the study protocol has been published elsewhere (in an open-access
      journal):

      http://bmccomplementalternmed.biomedcentral.com/articles/10.1186/s12906-016-1068-2
    

Intervention name(s): MBSR; FibroQol; TAU
Intervention type(s): Behavioral; Behavioral; Drug
Intervention description(s): Session 1: Recognising the present moment Session 2: Engaging with the breath Session 3: Practice, practice, practice Session 4: Stress and the flow of emotions Session 5: Stress and thoughts: finding another place to stand Session 6: Interpersonal mindfulness / mindful communication. Session 7: Applying mindfulness Session 8: Making mindfulness a part of your life; Session 1: General information. Expectations of the patients. History of the illness. Principal and secondary symptoms in FM. Physiological mechanisms involved in the genesis of pain.
Session 2: Relaxation training-I. Session 3: Diagnosis. Pharmacological and non-pharmacological treatments. Prognosis. Current model of health care in Catalonia. Units specialized in the treatment of FM.
Session 4: Relaxation training-II. Session 5: Strategies to increase self-esteem and regulate emotions. Pain experience and recurrent invalidation. Social support (family and friends).
Session 6: Relaxation training-III Session 7: Benefits of physical exercise in FM. Session 8: Relaxation training-IV.; In Spain the treatment as usual provided in FMS is mainly pharmacological and adjusted to the symptomatic profile of the patient. Counselling about aerobic exercise adjusted to patients' physical limitations is usually also provided.
Other intervention name(s): Usual care
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Fibromyalgia syndrome; Mindfulness (MBSR); Neuroimaging; Cytokines; Randomized Controlled Trial; Cost-effectiveness; Psychoeducation (FibroQol)