The effect of guided imagery and amitriptyline on daily fibromyalgia pain: a prospective, randomized, controlled trial

• Published in: Journal of psychiatric research Vol. 36; no. 3; pp. 179 - 187
• Main Authors: Fors, Egil A, Sexton, Harold, Götestam, K.Gunnar
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01-05-2002; Elsevier
• Subjects: Adult; Amitriptyline; Amitriptyline - pharmacology; Amitriptyline - therapeutic use; Analgesics, Non-Narcotic - pharmacology; Analgesics, Non-Narcotic - therapeutic use; Associated treatments; Biological and medical sciences; Female; Fibromyalgia; Fibromyalgia - drug therapy; Fibromyalgia - psychology; Guided imagery; Humans; Imagery (Psychotherapy); Medical sciences; Middle Aged; Pain; Pain - drug therapy; Pain - etiology; Pain - psychology; Placebos; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Treatment Outcome; Treatments; Fibromyalgia; Amitriptyline; Pain; Guided imagery; Mood disorder; Human; Mental imagery; Cognitive therapy; Psychotropic; Treatment efficiency; Subjective experience; Diseases of the osteoarticular system; Attention; Depression; Tricyclic compound; Striated muscle disease; Chemotherapy; Treatment; Follow up study; Distraction; Antidepressant agent; Female; Combined treatment; Comparative study
• ISSN: 0022-3956; 1879-1379
• DOI: 10.1016/S0022-3956(02)00003-1

Objective: The effectiveness of an attention distracting and an attention focusing guided imagery as well as the effect of amitriptyline on fibromyalgic pain was studied prospectively.
Methods: Fifty-five women with previously diagnosed fibromyalgia were monitored for daily pain (VAS) in a randomized, controlled clinical trial. One group received relaxation training and guided instruction in “pleasant imagery” (PI) in order to distract from the pain experience (
n=17). Another group received relaxation training and attention imagery upon the “active workings of the internal pain control systems”, “attention imagery” (AI) (
n=21). The control group (CG) received treatment as usual (
n=17). Patients were also randomly assigned to 50-mg amitriptyline/day or placebo. Some psychological and socio-demographic variables were also measured initially. The slopes of diary pain ratings over a 4-week period were used as the outcome measures.
Results: We found significant differences of the pain-slopes between the three psychological conditions (
P=0.0001). The
pleasant imagery (
P<0.005), but not the
attention imagery group’s slope, declined significantly when compared with the
control group (
P>0.05). There was neither a difference between the amitriptyline and placebo slopes (main effects,
P=0.98) nor a significant amitriptyline × psychological interaction (
P=0.76).
Conclusion: Pleasant imagery (PI) was an effective intervention in reducing fibromyalgic pain during the 28-day study period. Amitriptyline had no significant advantage over placebo during the study period.