Cost-utility and biological underpinnings of Mindfulness-Based Stress Reduction (MBSR) versus a psychoeducational programme (FibroQoL) for fibromyalgia: a 12-month randomised controlled trial (EUDAIMON study)

Author: Albert Feliu-Soler 1 2, Xavier Borràs 3, María T. Peñarrubia-María 4 5, Antoni Rozadilla-Sacanell 6, Francesco D’Amico 7, Rona Moss-Morris 8, Matthew A. Howard 9, Nicolás Fayed 10, Carles Soriano-Mas 11 12 2, Marta Puebla-Guedea13 5, Antoni Serrano-Blanco 15, Adrián Pérez-Aranda 1, Raffaele Tuccillo 14 and Juan V. Luciano 15*
Corresponding author: Juan V Luciano Author Affiliations 1 Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, C/Dr. Antoni Pujadas 42, 08830, Sant Boi de Llobregat, Barcelona, Spain 2 Centre for Biomedical Research in Mental Health, CIBERSAM, Madrid, Spain 3 Stress and Health Research Group, Faculty of Psychology, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain 4 Primary Health Centre Bartomeu Fabrés Anglada, DAP Delta Llobregat, Unitat Docent Costa de Ponent, Institut Català de la Salut, Gavà, Spain 5 Primary Care Prevention and Health Promotion Research Network (RedIAPP), Madrid, Spain 6 Rheumatology Service, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain 7 Personal Social Services Research Unit, London School of Economics and Political Science, London, UK 8 Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology, & Neuroscience, King’s College London, London, UK 9 Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK 10 Magnetic Resonance Unit, Department of Radiology, Hospital Quironsalud Zaragoza, Zaragoza, Spain 11 Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain 12 Department of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona, Barcelona, Spain 13 Aragon Institute of Health Sciences (I+CS), Zaragoza, Spain 14 Hospital de Sant Pau, Barcelona, Spain
Conference/Journal: BMC Complementary and Alternative Medicine
Date published: 2016
Other: Volume ID: 16 , Pages: 81 , Special Notes: doi:10.1186/s12906-016-1068-2 , Word Count: 371

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The EUDAIMON study focuses on fibromyalgia syndrome (FMS), a prevalent chronic condition characterized by pain, fatigue, cognitive problems and distress. According to recent reviews and meta-analyses, Mindfulness-Based Stress Reduction (MBSR) is a promising therapeutic approach for patients with FMS. The measurement of biomarkers as part of the analysis of MBSR effects would help to identify the neurobiological underpinnings of MBSR and increase our knowledge of FMS pathophysiology. The main objectives of this 12-month RCT are: firstly, to examine the effectiveness and cost-utility for FMS patients of MBSR as an add-on to treatment as usual (TAU) versus TAU + the psychoeducational programme FibroQoL, and versus TAU only; secondly, to examine pre-post differences in brain structure and function, as well as levels of specific inflammatory markers in the three study arms and; thirdly, to analyse the role of some psychological variables as mediators of 12-month clinical outcomes.

Effectiveness, cost-utility, and neurobiological analyses performed alongside a 12-month RCT. The participants will be 180 adult patients with FMS recruited at the Sant Joan de Déu hospital (St. Boi de Llobregat, Spain), randomly allocated to one of the three study arms: TAU + MBSR vs. TAU + FibroQol vs. TAU. A comprehensive assessment to collect functional, quality of life, distress, costs, and psychological variables will be conducted pre-, post-intervention, and at 12-month post-intervention. Fifty per cent of study participants will be evaluated at pre- and post-treatment using Voxel-Based Morphometry, Diffusion Tensor Imaging, pseudo-continuous Arterial Spin Labeling, and resting state fMRI. A cytokine multiplex kit of high-sensitivity will be applied (cytokines IL-6, IL-8, IL-10 + high-sensitivity CRP test).

The findings obtained from this RCT will indicate whether MBSR is potentially cost-effective for FMS and contribute to knowledge of any brain and inflammatory changes associated with MBSR in FMS patients. Specifically, we will determine whether there are morphometric and functional changes associated with participation in MBSR in brain regions related to meta-awareness, body awareness, memory consolidation-reconsolidation, emotion regulation and in networks postulated to underpin the sensory-discriminative, cognitive-evaluative and affective-motivational aspects of the pain experience.

Trial registration
NCT02561416. Registered 23 September 2015.

Keywords: Fibromyalgia; Mindfulness-Based Stress Reduction; Psychoeducation; Neuroimaging; Cytokines; Cost-utility