Does practice make perfect? Functional connectivity of the salience network and somatosensory network predicts response to mind-body treatments for fibromyalgia

Sonia Medina; Owen O'Daly; Matthew A Howard; Albert Feliu-Soler; Juan V Luciano

doi:10.3389/fpain.2024.1245235

Does practice make perfect? Functional connectivity of the salience network and somatosensory network predicts response to mind-body treatments for fibromyalgia

Front Pain Res (Lausanne). 2024 Sep 5:5:1245235. doi: 10.3389/fpain.2024.1245235. eCollection 2024.

Authors

Sonia Medina^{1

2}, Owen O'Daly¹, Matthew A Howard¹, Albert Feliu-Soler^{3

4}, Juan V Luciano^{3

4

5}

Affiliations

¹ Department of Neuroimaging, King's College London, London, United Kingdom.
² Department of Health and Biomedical Sciences, University of Exeter, Exeter, United Kingdom.
³ Department of Clinical & Health Psychology, Autonomous University of Barcelona, Barcelona, Spain.
⁴ CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
⁵ Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain.

Abstract

Background: Mind-body treatments can improve coping mechanisms to deal with pain, improve the quality of life of patients with fibromyalgia syndrome (FMS), and reduce perceived pain in some cases. However, responses to these treatments are highly variable, the mechanisms underpinning them remain unclear, and reliable predictors of treatment response are lacking. We employed resting-state blood oxygen level-dependent (rsBOLD) functional magnetic resonance imaging (fMRI) to examine changes in brain functional connectivity (FC) following mind-body treatment that may relate to and predict pain relief.

Methods: We recruited patients with FMS who underwent either mindfulness-based stress reduction (MBSR; n = 18) or a psychoeducational program (FibroQoL; n = 22) and a treatment-as-usual FMS group (TAU; n = 18). We collected rsBOLD data, alongside subjective pain, anxiety, depression, and catastrophizing measures prior to and following treatments. We examined behavioral changes and FC changes in the salience network (SN) and sensorimotor network (SMN) and performed regression analyses to identify predictors for treatment response.

Results: The MBSR and FibroQoL groups experienced significant reductions in pain catastrophizing. After treatment, the FC of the sensorimotor cortex with the rest of the SMN became significantly reduced in the MBSR group compared to the TAU group. The FC between the SN and the SMN at baseline was negatively correlated with pain reductions following MBSR but positively correlated with pain reductions in the FibroQoL group. These results yielded large to very large effect sizes. Following MBSR, only for those patients with lower baseline SMN-SN FC, minutes of mindfulness practice were positively associated with clinical improvement (small to medium effect size).

Conclusions: Different mind-body treatments are underpinned by discrete brain networks. Measures of the functional interplay between SN and SMN have the potential as predictors of mind-body treatment response in patients with FMS.

Keywords: brain biomarker; fibromyalgia; functional connectivity; mindfulness; rsBOLD.

Grants and funding

SM and MH are funded by a Medical Research Council Experimental Medicine Challenge Grant (MR/N026969/1). SM, MH, and OOD are also supported by the NIHR Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Trust. AF-S acknowledges the funding from the Serra Húnter program (Generalitat de Catalunya; Reference Number UAB-LE-8015). JL had a “Miguel Servet” research contract from the ISCIII (CPII19/00003) when this study was conducted.