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Arthritis Care Res (Hoboken). 2018 Jun 8. doi: 10.1002/acr.23615. [Epub ahead of print]

Efficacy of Systolic Extinction Training (SET) in Fibromyalgia Patients with elevated Blood Pressure Response to Stress - A Tailored RCT Study.

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Institute of Medical Psychology at Philipps University, Marburg, Germany.
Center for Pain Research and Innovation, University of North Carolina, Chapel Hill, USA.
Center for Translational Science, Duke University, Durham, USA.
Center for Pain Research on Impact, Measurement& Effectiveness (C-PRIME), Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, USA.



An intrinsic pain regulatory system is modulated by both cardiovascular dynamics that influence baroreflex sensitivity (BRS) and 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. This study evaluated the effects of Systolic Extinction Training (SET), which combines operant treatment (OT) with BaroReflexTraining (BRT). BRT delivers peripheral electrical stimulation within a few milliseconds of the systolic or diastolic peak of the cardiac cycle. This study compared SET to (1) OT-TENS, transcutaneous electrical stimulation independent of cardiac cycle, and (2) aerobic exercise (AE)-BRT in FM patients with elevated blood pressure stress responses.


Seventy-two female FM patients were randomized to receive either SET (n=21), OT-TENS (n=20), or AE-BRT (n=21). Outcome assessments occurred before (T1), after 5 weeks of treatment (T2), and 12-month follow-up (T3).


In contrast to OT-TENS and AE-BRT, patients receiving SET reported a significantly greater reduction in pain and interference (all Ps<0.01) that were maintained at the 12-month follow-up period. Clinically meaningful pain reduction at T3 (100%) was achieved in 82% of SET, 39% of OT-TENS, and 14% of AE-BRT treated patients. BRS increased 57% after SET, compared to OT-TENS and AE-BRT (Ps<0.01).


SET resulted in statistically significant, clinically meaningful, and long-lasting pain remission and interference compared to the OT-TENS and AE-BRT. These results suggest that BRS modification was the primary mechanism of improvement. Replication with larger samples and extension to other chronic pain conditions appears to be warranted. This article is protected by copyright. All rights reserved.


Baroreflex Sensitivity; Blood Pressure; Fibromyalgia; Operant Behavioral Therapy; Systolic Extinction Training


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