Fibromyalgia (FM) is a generalized, widespread chronic pain disorder affecting 2.7% of the general population. In recent years, different studies have observed a strong association between FM and ...psychological trauma. Therefore, a trauma-focused psychotherapy, such as eye movement desensitization and reprocessing (EMDR), combined with a non-invasive brain stimulation technique, such as multifocal transcranial current stimulation (MtCS), could be an innovative adjunctive treatment option. This double-blind randomized controlled trial (RCT) analyzes if EMDR therapy is effective in the reduction of pain symptoms in FM patients and if its potential is boosted with the addition of MtCS.
Forty-five patients with FM and a history of traumatic events will be randomly allocated to Waiting List, EMDR + active-MtCS, or EMDR + sham-MtCS. Therapists and patients will be kept blind to MtCS conditions, and raters will be kept blind to both EMDR and MtCS. All patients will be evaluated at baseline, post-treatment, and follow-up at 6 months after post-treatment. Evaluations will assess the following variables: sociodemographic data, pain, psychological trauma, sleep disturbance, anxiety and affective symptoms, and wellbeing.
This study will provide evidence of whether EMDR therapy is effective in reducing pain symptoms in FM patients, and whether the effect of EMDR can be enhanced by MtCS.
ClinicalTrials.gov NCT04084795 . Registered on 2 August 2019.
Introduction On the basis of neuroimaging (fMRI) and electrophysiological (EEG) evidence, the cascade-of-control model developed for executive processing predicts an early involvement of the ...dorsolateral prefrontal cortex (DLPFC) in selecting task relevant information, whereas the dorsal anterior cingulate cortex would be involved at later-stages on response related processes. Notwithstanding, the time course of the functional recruitment of the DLPFC has not been causally verified. Here, we applied TMS to interfere DLPFC activity during top-down processing at different temporal windows. Objective To assess the critical time epochs characterizing the recruitment of DLPFC during interference control. Materials and methods On-line TMS was applied over left DLPFC or vertex of 19 healthy controls while performing a computerized Stroop task. TMS trains of 4 pulses every 50 ms (20 Hz) were delivered post-stimulus onset, at one of 3 different time points (50 ms, 250 ms or 450 ms). The active stimulation trials were interleaved with no TMS trials. The four pulses trains were selected to interfere with cognitive processing during a 200 ms critical period defined by prior EEG literature using a similar task. Three types of visual stimuli were presented: congruent (matching color-word), incongruent (non-matching color-word) and neutral (a series of X). Results On the left DLPFC, when TMS bursts were delivered at 250 and 450 ms after the onset of incongruent stimuli, reaction times were significantly longer compared to when these same patterns were applied 50 ms post stimulus onset. No other significant differences were observed when stimulation was applied on this site. In the vertex TMS condition we found significant differences for neutral stimuli when pulses where delivered 450 ms following stimulus onset, as compared to the other time windows and to no TMS stimulation trials. Conclusions In agreement with the cascade-of-control model and correlational EEG evidence, the DLPFC contributes causally to the management of cognitive conflict at early stages of processing (250 ms). Nevertheless, our results suggest that the DLPFC activity is also relevant 450 ms following the presentation of the stimulus. Stimulation over the vertex induced an interference likely on the execution of motor responses to neutral stimulus.
Introduction Theta burst stimulation (TBS) protocols hold high promise in neuropsychological rehabilitation thanks to its ability to induce lasting effects on cortical excitability following a short ...delivery time. Nevertheless, its ability to inhibit (continuous protocol, cTBS) or facilitate (intermittent, iTBS) brain function from cortical areas other than the motor cortex remains to be fully established. The behavioral effects of TBS over the dorsolateral prefrontal cortex (DLPFC) are particularly interesting given its involvement in working memory and executive processing, often impaired after brain injury, and also due to its role of hub of frontal areas, for which it is frequently chosen as a target for treatment and rehabilitation. Objective To explore the ability of cTBS and iTBS to modulate working memory and executive functions assessed with clinical neuropsychological tasks. Materials and methods 36 healthy participants performed 3 clinical neuropsychological tasks: Digits Backward, Stroop test and Tower of Hanoi (Fig. 1). Subjects were assessed twice, first at baseline 1 week prior to stimulation and immediately following a single session of either active cTBS, active iTBS or sham TBS, delivered to the left DLPFC. Results Following sham TBS participants’ performance improved in the Stroop test, with higher scores in Color and Color-Word conditions, as well as lower interference scores (Fig. 2), likely caused by practice effects. Both, iTBS and cTBS, yielded improvements in the Digits Backward task and the Word score of the Stroop test. Moreover, similarly to the sham group, following iTBS participants showed lower Interference scores. In contrast, expected improvements in color score were not induced. Finally, cTBS decreased the number of movements necessary to complete the Tower of Hanoi. Nonetheless, at difference with the sham group, no improvements were observed in the Interference score of Stroop test. Conclusions TBS over DLPFC modulates working memory performance and executive processes. Both protocols resulted in similar working memory and information processing speed outcomes, whereas their effect on executive functions differed: cTBS impaired inhibitory control but improved planning abilities in a spatial task, meanwhile, no specific effects were observed following iTBS.
Background. Preliminary evidence suggests that psychological trauma, especially childhood trauma, is a risk factor for the onset of fibromyalgia (FM). Objective. The main objective of this study ...consisted of evaluating the prevalence and detailed characteristics of psychological trauma in a sample of patients with FM, the chronology of trauma across the lifespan, and its clinical symptoms. We also calculated whether childhood trauma could predict the relationship with different clinical variables. Method. Eighty-eight females underwent an interview to assess sociodemographic data, psychiatric comorbidities, level of pain, FM impact, clinical symptoms of anxiety, depression, insomnia, quality of life, and psychological trauma. Results. The majority of participants (71.5%) met the diagnostic criteria for current post-traumatic stress disorder (PTSD). Participants reported having suffered traumatic events throughout their lifespan, especially in childhood and early adolescence, in the form of emotional abuse, emotional neglect, sexual abuse, and physical abuse. Traumatic events predict both poor quality of life and a level of pain in adulthood. All patients showed clinically relevant levels of anxiety, depression, insomnia, suicidal thoughts, and pain, as well as somatic comorbidities and poor quality of life. Pain levels predicted anxiety, depression, dissociation, and insomnia symptoms. 84% of the sample suffered one or more traumatic events prior to the onset of pain. Conclusions. Our data highlight the clinical complexity of patients with FM and the role of childhood trauma in the onset and maintenance of FM, as well as the high comorbidity between anxiety, depression, somatic symptoms, and FM. Our data also supports FM patients experiencing further retraumatization as they age, with an extremely high prevalence of current PTSD in our sample. These findings underscore the need for multidisciplinary programs for FM patients to address their physical pain and their psychiatric and somatic conditions, pay special attention to the assessment of psychological trauma, and provide trauma-focused interventions. Trial registration: ClinicalTrials.gov NCT04476316. Registered on July 20th, 2020.
Abstract Learning and memory improvement by post-training intracranial self-stimulation has been observed mostly in implicit tasks, such as active avoidance, which are acquired with multiple trials ...and originate rigid behavioral responses, in rats. Here we wanted to know whether post-training self-stimulation is also able to facilitate a spatial task which requires a flexible behavioral response in the Morris water maze. Three experiments were run with Wistar rats. In each of them subjects were given at least five acquisition sessions, one daily, consisting of 2-min trials. Starting from a random variable position, rats had to swim in a pool until they located a hidden platform with a cue located on its opposite site. Each daily session was followed by an immediate treatment of intracranial self-stimulation. Control subjects did not receive the self-stimulation treatment but were instead placed in the self-stimulation box for 45 min after each training session. In the three successive experiments, independent groups of rats were given five, three and one trial per session, respectively. Temporal latencies and trajectories to locate the platform were measured for each subject. Three days after the last acquisition session, the animals were placed again in the pool for 60 s but without the platform and the time spent in each quadrant and the swim trajectories were registered for each subject. A strong and consistent improvement of performance was observed in the self-stimulated rats when they were given only one trial per session, i.e. when learning was more difficult. These findings agree with our previous data showing the capacity of post-training self-stimulation to improve memory especially in rats with little training or low conditioning levels, and clearly prove that post-training self-stimulation can also improve spatial learning and memory.
Post-training intracranial electrical self-stimulation can improve learning and memory consolidation in rats. However, the molecular mechanisms involved are not known yet. Since previous paradigms of ...this kind of facilitation are relatively unsuitable to try a molecular approach, here we develop a single and short model of learning and memory facilitation by post-training self-stimulation that could make easier the research of its neural and molecular basis. Thus, three consecutive experiments were carried out to ascertain whether post-training self-stimulation is able to facilitate memory when learning consists of only a brief (5 trials) two-way active avoidance conditioning session. The results of Experiment 1 showed that it is actually possible, and that 48
h after the acquisition session is a very good time to observe the memory improvement. As a way to probe the retroactive effect of self-stimulation, in Experiment 2 we observed that the same self-stimulation treatment given to the subjects not post-training but 48
h before a single two-way active avoidance session does not improve the acquisition of conditioning. In Experiment 3, we showed that the SS facilitative effect observed 48
h after the acquisition session in Experiment 1 was still maintained one week later. We concluded that post-training intracranial self-stimulation can consistently improve memory consolidation even when little acquisition training is given to the animals in a single training session.
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