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Understanding and restoring dopaminergic function in Fibromyalgia patients using a mindfulness- based psychological intervention: A raclopride PET-study

English title Understanding and restoring dopaminergic function in Fibromyalgia patients using a mindfulness- based psychological intervention: A raclopride PET-study
Applicant Martin Sölch Chantal
Number 182766
Funding scheme Project funding (Div. I-III)
Research institution Département de Psychologie Université de Fribourg
Institution of higher education University of Fribourg - FR
Main discipline Neurology, Psychiatry
Start/End 01.10.2019 - 30.09.2023
Approved amount 700'000.00
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All Disciplines (2)

Discipline
Neurology, Psychiatry
Psychology

Keywords (5)

dopamine; reward; fibromyalgia; mindfulness; pain

Lay Summary (French)

Lead
Investigation des effets d'un traitement psychologique de groupe intégrant des éléments de pleine conscience pour améliorer les symptômes douloureux et rétablir la fonction de la dopamine dans le cerveau chez des personnes souffrant de fibromyalgie
Lay summary
La fibromyalgie est un problème de douleur chronique les plus fréquent, mais on connaît encore peu de choses sur ses causes. Une meilleure compréhension de cette maladie permettra aussi de mieux la soigner. Récemment une nouvelle forme d'intervention, appelée ""Mindfulness-Oriented Recovery Enhancement (MORE) a fait ses preuves dans le traitement de personnes souffrant de douleurs chroniques et ayant des problèmes de dépendance aux médicaments antalgiques.  Cette intervention est une intervention de groupe d'orientation cognitivo-comportementale avec des éléments de pleine conscience et dure 8 semaines. Notre projet de recherche se base sur une étude précédente de notre groupe qui a montré que les personnes souffrant de fibromyalgie présentent des altérations du système dopaminergique et des réponses à la récompense dans le cerveau. Le projet actuel a pour but d'investiguer si le programme MORE permet de diminuer les douleurs chez des personnes souffrant de fibromyalgie et de restructurer le système dopaminergique et les réponses du cerveau à la récompense. De plus, nous allons faire des mesures au quotidien pour évaluer si les bienfaits attendus se manifestent aussi dans le quotidien des personnes touchées par le fibromyalgie et pas seulement dans des situations de laboratoire. Pour cela, nous planifions de tester 80 femmes souffrant de fibromyalgie qui participeront ou non au programme MORE de manière randomisée et de les comparer avant le programme à un groupe de femmes contrôles. Nous ferons de mesures avec un scanner TEP (tomographe à emission de protons) pour mesurer les changements dopaminergiques. Nous utiliserons des mesures cliniques de la douleur, de l'humeur et du sommeil à l'aide de questionnaires standardisés et recommandés pour les études dans le champ de la rheumatologie. Nous ferons toutes les mesures chez les particpantes ayant et n'ayant pas participé au traitement avant et après le traitement pour voir les effets à court-terme de celui-ci.  Ce projet est innovateur du point de vue de l'association des méthodes choisies et est particulièrement relevant au niveau clinique puisque le programme MORE est facile à apprendre et à implémenter et pourrait donc être utilisée à large échelle pour ces patientes s'il s'avère efficace.
Direct link to Lay Summary Last update: 03.05.2019

Responsible applicant and co-applicants

Employees

Name Institute

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Associated projects

Number Title Start Funding scheme
127629 Dopamine activity, pain perception and reward processes in patients with Fibromyalgia 01.08.2010 Project funding (Div. I-III)

Abstract

Chronic pain, defined as a pain lasting for more than 6 months, is regarded as a major health problem in western European countries. Fibromyalgia Syndrome (FMS) is one of the most prevalent chronic pain conditions, with a widely unknown etiology and is difficult to treat. A better understanding of FMS and the development of new treatment strategies for this disease are therefore very relevant issues in healthcare. The current guidelines for the treatment of fibromyalgia consider psychological interventions, in particular cognitive-behavioral methods a treatment of choice. Mindfulness is regarded as an interesting approach for FMS, however without conclusive empirical evidence so far. A recent promising intervention, the Mindfulness-Oriented Recovery Enhancement (MORE) intervention that was originally developed to treat substance dependence has shown beneficial effects in chronic pain patients with opioid abuse. The MORE intervention is a cognitive-behavioral and mindfulness based group training of 8 weeks. Interestingly, preliminary results indicate that this intervention is able to restore the neurophysiological and behavioral responses to reward. The present project is a continuation of a previous SNF-funded project of the PI on FMS that evidenced impaired dopamine (DA) function and altered DA response to reward in FMS in comparison to age and gender matched healthy participants. This innovative new project aims to build on these previous findings and to generate additional important clinical and scientific knowledge by investigating the ability of MORE to restore the DA function in FMS patients, in particular with regard to the DA responses to reward, and to reduce pain and mood symptoms in FMS. More specifically, we expect the FMS participants to show altered DA responses to reward before MORE; and we expect these alterations to be reduced after the MORE intervention compared to a wait-list group. In addition, we expect the MORE intervention to reduce clinical pain and FMS symptoms. Finally we expect a significant reduction of negative effects and stress and a significant increase of reward experience and positive affects in the daily life after the MORE intervention. To test these hypotheses, we will include 80 women with FMS, who will be randomly assigned to the MORE intervention or to a wait-list control group. The FMS participants will be compared at baseline with a group of age-matched healthy women. Before and after the intervention, participants will undergo [11C] Raclopride Positron Emission Tomography (PET) while they perform a reward monetary task. [11C] Raclopride PET measures are sensitive to endogeneous DA changes. With this method, we were able in our previous project to evidence significant differences in DA responses between FMS and healthy women. To measure pain and FMS-related outcomes, we will use standardized clinical measures related to pain intensity, sleep quality, level of functioning, depressive and anxiety symptoms as defined in the Outcome Measures in Rheumatology Clinical Trials recommendations before and after the intervention. Finally, we will test whether the MORE intervention can change self-reported measures of momentary pain, mood, stress and reward experience in everyday life measured by the Experience Sampling method (ESM) as well as biopsychological measures of stress, including cortisol and alpha-amylase. Pain and FMS outcomes will be repeated after 3 months to assess the short-term effects of the intervention. This innovative project aiming at investigating the effects of a newly validated intervention combining CBT and mindfulness for the first time in FMS, and at measuring its ability to restore DA function at a neurochemical level and to reduce FMS symptoms at behavioral level is very timely and relevant for the treatment and understanding of FMS. At a clinical level, the MORE intervention is an easy to learn group therapy and could therefore be used in several clinical settings and at a larger scale. The use of standardized outcomes will allow us to compare our results with other RCT’s and increase the validity of our results for comparisons in future meta-analyses. At a scientific level, a further cutting-edge aspect is the use of multidisciplinary methods, combining specific neural measures with clinical outcomes and measures in everyday life. This combination will allow us to understand basic mechanisms underlying the clinical changes associated with the MORE intervention on one hand and to investigate the transfer of these changes in everyday life of the patients. Finally, these state-of-the art methods will permit to explore the relationship between neural processes and the psychological and subjective experience of the participants, by linking for instance the DA responses to monetary reward with the daily experience of reward. Measures in everyday life of the participants will increase the ecological validity of the results, and allow us to test the transfer of the intervention’s effect in the daily life of participants. Finally, this highly multidisciplinary project combining psychological, and medical sciences with neurosciences will promote young researchers and give them access to very innovative methods and train them at a scientific and clinical level.
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