RELIEVING CHRONIC PAIN: PSYCHOSOMATIC MECHANISMS AND PSYCHOLOGICAL INTERVENTIONS IN FIBROMYALGIA ...- Finanziamento dell’Unione Europea – NextGenerationEU – missione 4, componente 2, investimento 1.1.

Chronic pain (CP) is a substantial healthcare challenge with considerable economic costs. Recently, the term of Nociplastic Pain (NP) has been advanced as a third descriptor of mechanisms related to CP. NP describes all the conditions that arise from altered nociception without no clear evidence of actual or threatened tissue damage. It is a new way of describing somatoform painful conditions, originating from altered central-nervous pathways (e.g. central sensitization), with the important involvement of clinical psychological factors. Among nociplastic chronic syndromes have been included fibromyalgia (FM) and chronic migraine (CM). These two CP disorders have been usually studied as two separate diseases, although the comorbidity rate ranges from 40% to 60%. Much studies evidenced the role of depression, anxiety, alexithymia, personality, childhood traumatic events, dissociation, emotion dysregulation (and so on) in both disorders, but very few studies compared them or considered CM and FM as likely sharing the same pathophysiological mechanism(s) with a close relationship with clinical psychological factors. First aim of this study will be comparing patients with comorbid FM and CM (FibroMIg group) with forms of "pure" FM and migraine. Our hypothesis is that the FibroMig group shows a more complex psychological mieliu than "pure" forms of FM and migraine. The related hypothesis if that the FibroMig group is expression of nociplastic mechanisms (that means for example a close interplay of depression and central pathways) that should be taken into consideration in planning the psychological interventions. Patients will be recruited at Headache Science Center (Mondino, Pavia) and Fibromyalgia Integrated Outpatient Unit of the Hospital of Turin and assessed with a wide battery of psychometric tests. A selection from this group will be enrolled for a psychotherapeutic intervention. The overall evidence on the efficacy of psychological interventions on FM and CM is low. In this perspective, the second aim of our proposal is aimed to evaluate the efficacy of the Dynamic interpersonal therapy (DIT) on FibroMig, pure FM and CM groups (vs a group with depression), in a single-blind randomized controlled trial: the primary outcome will be the improvement of depression and the second one the improvement in CP and quality of life. The third aim will be realising a fMRI study on patients assigned to DIT both on a basal level (to detect possible specific features of the FibroMig group) and pre-post DIT (to detect predictors of efficacy of the psychological intervention). We hypothesize that the FibroMig group show features related to NP mechanisms and a different answer on DIT Ministero dell'Università e della Ricerca MUR - BANDO 2022 compared to pure forms. The new era of personalised medicine calls to the importance of tailoring medical and psychological interventions on the individual patient characteristics. It is progressively clear that clinical psychology is called to take a strong action on its side.