The study was led by Marina López-Solà, professor at the UB’s Faculty of Medicine and Health Sciences and researcher at the Institute of Neurosciences (UBneuro) and the August Pi i Sunyer Biomedical Research Institute (IDIBAPS). Researchers from her team, Saül Pascual Diaz and Maria Suñol, first author of the article, have participated. Experts from the University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center and the University of Chicago Medical Center (United States) also collaborated in the study.
A pioneering study with adolescents
The study was based on the analysis of resilience and brain function in 41 girls with juvenile fibromyalgia and 40 girls without pain. “Until now, most of the research on resilience in chronic pain contexts has focused on adults and tended to define resilience as a stable trait or as the absence of psychopathology”, explain Marina López-Solà and Maria Suñol. According to the UB researchers, this passive and binary view (having symptoms versus not having symptoms) is particularly problematic in people with fibromyalgia, as it prevents them from studying how they adapt to persistent physical pain symptoms. “Moreover, it does not allow us to identify which psychological skills promote better adaptation and this makes it difficult to develop specific interventions to promote them”, they add.
In this study, researchers have adopted a functional definition of resilience, understood as the presence of psychological resources that allow adolescent girls to adapt despite chronic pain. “It is a more active view of resilience in adolescents, as a trainable capacity and one that could protect against the emotional suffering associated with chronic pain from the early stages of illness. This methodological choice has allowed us to characterize different profiles of resilience within the sample and to analyse how these profiles relate to specific patterns of brain connectivity”, stresses López-Solà.
To measure resilience, researchers have used surveys of two skills: the ability to reinterpret difficult situations more positively and the tendency to stay purposeful and persevere despite obstacles.
The results show that adolescents with juvenile fibromyalgia and high resilience have fewer emotional symptoms, such as depression and anxiety, and a higher level of self-compassion — that is, they treat and talk to themselves better during difficult times — despite experiencing a similar degree of physical pain and other physical symptoms. “This suggests that, in juvenile fibromyalgia, a resilient profile may not reduce physical symptoms, but may reduce the associated suffering”, the researchers note.
Different functional connection patterns
To study brain function, the researchers analysed functional neuroimaging at rest, a technique that allows them to observe how different areas of the brain interact when the person is not doing anything special. With this approach, they found that the group of patients with high resilience showed higher functional connectivity than those with low resilience, especially in the default mode network (DMN). These brain circuits are involved in self-referential thinking and cognitive flexibility. “Greater connectivity may indicate greater coordination between brain regions, which could contribute to greater cognitive flexibility and thus a greater ability to adapt to adverse situations”, the researchers explain.
In addition, the study also shows that the brain functioning pattern of the most resilient patients is similar to that of pain-free adolescents, with differences limited to a brain region involved in the more purely sensory aspects of pain. In contrast, patients with low resilience show a broader pattern of brain disconnection, affecting networks related to attention, perception and thinking about oneself. “These findings suggest that resilience may act as a protective factor against brain alterations associated with juvenile fibromyalgia and also that patterns of functional brain connectivity have the potential to be used as biomarkers to identify adolescents with chronic pain who are more vulnerable”, say the researchers.
Increasing self-compassion and flexibility
Although this is an observational study that cannot establish causal relationships, and therefore further longitudinal research and controlled interventions will still be needed to confirm its validity, these findings have potential biomedical implications. Firstly, in the design of therapeutic interventions, as the results suggest that enhancing resilience could have therapeutic benefits in juvenile fibromyalgia. In particular, the researchers point to the reinforcement of psychological interventions that contribute “to increasing people’s self-compassion, or ability to treat themselves with care and kindness in difficult times”.
“These skills can be trained through third-generation therapies, such as acceptance and commitment therapy, compassion-based therapy or mindfulness-based cognitive therapy, which emphasize acceptance of distress, commitment to values and personal psychological skills. These approaches have the potential to reduce the emotional distress associated with chronic pain and contribute to promoting more adaptive and resilient brain functioning”, the researchers note.
Moreover, these therapies could be “the first step towards personalized prevention strategies that act in early stages of development to avoid the chronification of emotional suffering and neurofunctional alterations associated with chronic pain”, they add.
Deepening the understanding of brain mechanisms in fibromyalgia
The researchers’ next challenge is to gain a more in-depth understanding of the brain mechanisms that explain why some adolescent girls with chronic pain cope better emotionally despite the presence of persistent symptoms. In this sense, they are already designing a study with a larger sample of adolescents with musculoskeletal pain to analyse, firstly, whether the results observed in juvenile fibromyalgia are replicated in other chronic pain conditions and, secondly, whether functional connectivity at rest can predict trajectories of resilience or vulnerability. “Identifying these predictor profiles could allow early risk stratification and guide therapeutic intervention”, the researchers conclude.