Belief in ones ability to control pain through personal effort is associated with better pain management, higher functional status, and better long-term adherence to treatment regimens. While beliefs in pain control appear to be low and stable over time in patients with Fibromyalgia Syndrome (FMS), recent literature and our own pilot investigations suggest that these beliefs may be malleable through behavioral interventions. Theoretically, any change in belief will need to be predicated upon experiencing newfound personal control; thus patients must actually experience successful personal pain control before such beliefs can change. Relatedly, we possess pilot data using functional MRI (fMRI) suggesting that patients with FMS who espouse a strong internal versus external locus of pain control process painful stimuli differently in the cortical brain regions responsible for the experience of pain. To date no clinical studies have specifically focused on beliefs in pain control as a target of treatment nor have studies been conducted that seek the most parsimonious behavioral approach for modifying these beliefs. Similarly, no studies to date have explored whether changing beliefs in pain control will alter central pain processing. Using a randomized controlled design, the proposed study seeks to test the effectiveness of two single modality non-pharmacological methods for modifying beliefs in personal pain control in patients with FMS: prescribed aerobic fitness, and relaxation training. These interventions will be compared to a standard care control condition. Based upon previous literature, both of these interventions should provide a foundation of success experiences attributable to personal effort that would facilitate changing beliefs in pain control. We posit that both interventions will be superior to a standard care only control condition. Moreover, we intend to confirm and extend our pilot fMRI imaging findings suggesting that different neural networks are used by individuals with varying loci of pain control, and then demonstrate that individuals who, through therapy, change their locus of control also have changes in their fMRI patterns of central pain processing. These findings will add to the emerging information on affective and cognitive involvement in higher order pain processing and begin to explain the mechanisms involved in the effectiveness of non-pharmacological interventions that modify beliefs about control. ? ?
