Fibromyalgia(FM) – Guided Imagary Treatment Not So Good By Self

Though results have varied, latest studies show little benefit of guided imagery in FM.

 Health Psychol. 2013 Mar 21. [Epub ahead of print]
Guided imagery in people with fibromyalgia: A randomized clinical trial of effects on pain, functional status and self-efficacy.
Verkaik R, Busch M, Koeneman T, Van den Berg R, Spreeuwenberg P, Francke AL.  abstract here

  • “two 1.5-hour group sessions, including group discussion, instruction about Guided imagery(GI) as well as a compact disc with GI exercises.”
  • as to perform it 1-2 times/day for a month
  • Results showed no change in Visual Analog Scale of Pain.

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First study on this topic was in 2000:

Fors EA and Götestam KG
Patient education, guided imagery, and pain related talk in fibromyalgia coping.
European Journal of Psychiatry 2000; 14: 233–240.  abstract here

It showed “reduced both the patients’ current pain and anxiety levels”. Article was a foreign language older article and not accessible to me.

Second article , by same author was:
Fors EA, Sexton H and Götestam KG
The effect of guided imagery and amitriptyline on daily fibromyalgia pain: A prospective, randomized, controlled trial.
Journal of Psychiatric Research 2002,  36: 179–187.

  • Used a pleasant event audiotape – 30 min daily – without any description of what it entailed – absolutely useless
  • There was a control group and a group with imagery over controlling pain pathways (an attention imagery group)

Results: – looks like a 28% improvement in imagery group over 1 month:

 

3rd study:
Menzies V, Taylor AG and Bourguignon C
Effects of guided imagery on outcomes of pain, functional status, and self-efficacy in persons diagnosed with fibromyalgia.
Journal of Alternative and Complementary Medicine 2006. 12: 23–30. abstract here

Program:

  • 20 minute tapes
  • Program was more than guided imagery – they started out with progressive muscular relaxation and suggestions of wellbeing- “Participants were guided through muscle relaxation and release of tension, and encouraged to experience an overall sense of well-being.”
  • They worked on relaxation response through breath – “Study participants also were trained to learn a conditioned response, the signal breath, to elicit relaxation.”
  • “The first tape was practiced daily for 2 weeks (weeks 1 and2).”
  • The imagery was to some degree , self-developed and included visions of being strong and healthy – ” The second tape was a shortened version of the signal breath relaxation script, followed by imagery of a pleasant scene. Participants were encouraged to become familiar with the surroundings of their imagery (elicit sensory involvement), imagine themselves strong and healthy, and emerge from their imagery with a sense of well-being. “
  • “The second tape was practiced daily for 2 weeks (weeks 3 and 4). “
  • “The third tape also reinforced the signal breath conditioning for relaxation. The tape reminded participants that they could imagine anything they wanted; therefore, they were instructed to imagine themselves walking onto a theater stage
    where they were to perform actions and behaviors that represented how they would most like to be were they free of all symptoms of FM (end state imagery).”
  • “The third tape was practiced daily for 2 weeks (weeks 5 and 6).”
  •  “Participants were instructed to use tapes as frequently as they wished in any week and at least daily for 6 weeks. During a 4-week follow-up (weeks 7–10), participants could choose to use  any of the three tapes in any order and were requested to
    use at least one of the tapes once daily”

Results:  Did not help pain but improved self-efficacy some.

Lastest Menzies study in press:

J Health Psychol. 2013 Mar 21.in press.
Guided imagery in people with fibromyalgia: A randomized clinical trial of effects on pain, functional status and self-efficacy. 
Verkaik R et al, Busch M, Koeneman T, Van den Berg R, Spreeuwenberg P, Francke AL.   abstract here

  • 34 active cases; 30 controls
  • 1 st 2 weeks – guided relaxation to release tension – listen at least daily to a CD
  • 2 nd 2 weeks – “was a pleasant scene imagery script, instructing listeners to imagine they felt better and better within a pleasant scene of their own choosing. In this
    imagined place of feeling better and better, participants were encouraged to become familiar with the surroundings of their imagery (elicit sensory involvement), imagine
    themselves in a place of safety and security where it was possible to rest fully and completely, and emerge from their imagery with a sense of feeling refreshed and rejuvenated.”
  • last 2 weeks – “guided the participant on an imaginary journey through their immune system. The imagery script suggested ‘‘this is an imaginary journey through your immune system … your immune system has but one mission … to provide your body with enhanced wellness…imagine now that your immune system is doing what it does best … and knowing how to do it well … ’’
    The goal of the imagery was to bring participants to the end”.
  • “Each script contained cues to facilitate symptom improvement and to promote wellbeing;
    for example, ‘‘feeling better and better’’; ‘‘feeling relaxed and refreshed’ state of living with enhanced wellness (end state imagery).

Results:

They said this was a p<0.01 but it certainly isn’t clinically relevant .

 Comment –

  • I did hypnosis for many years and can tell you that CD’s are no way equivalent to an actual session that is taped.
  • Most first two weeks was mostly progressive muscular relaxation. Thereafter visualizing a safe relaxing place is typical hypnotic technique. I was always partial to a technique where you submerge in a hot tub of blue liquid – the pain is leaches out of the body, changing the blue liquid to a darker hue. I also liked to add suggestion that whatever aches were left were not important weren’t worth attention.
  • Re visualizations –  it works better for those who can actually visualize. Some that are poor visualizers I would give a relaxation countdown(as I count down you go deeper and deeper) coupled with lots of “peace and calm” and “arms are heavy” matra-like repetitions.
  • Re 4-6 weeks for results – I think the times involved are way to short; I do meditation and can tell you it took me 6 months to be any good at it. 
  • As with all measures in chronic pain, it does not work well alone, but might help as an add-on.
  • If you do it actively in office with a patient, it brings you closer to them and you develop more of a therapeutic alliance.

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