Inflammation and Cognitive Behavioral Therapy

Lasselin et al. Low-grade inflammation may moderate the effect of behavioral treatment for chronic pain in adults. J. Behav Med 2016

  • 20-30% of people in the US and Europe suffer from chronic pain. The use of cognitive behavioral therapy (CBT) is supported by several studies, however, effect sizes are modest. Tailoring treatment to match specific subgroups may improve outcomes
  • The authors propose that one potential factor that could modulate the effect of CBT for chronic pain is inflammation. Based on numerous previous studies, it is accepted that alterations in the inflammatory process and inflammatory mediators can be a contributor to pain.
  • Inflammatory markers such as Il-6 and tumor necrosis factor (TNF) have been observed in pts with chronic pain. To the authors' knowledge, no study to date has investigated whether he inflammatory status before treatment modulates the effect of behavioral intervention.
  • An RCT design was used to evaluate the effects of two behavioral interventions: (ACT and AR). Each treatment followed 12 weekly group sessions 90 min each
  • Blood samples were taken during the pre-treatment assessment and immediately after the last session on all participants
  • Medication, (p!, psychiatric, and anti-inflammatory drugs) and self-report psychological measurements (pain intensity, disability, psychological inflexibility, health-related quality of life, and mood state) were assessed in all pts. 
  • Behavioral treatment significantly reduced serum TNF-a concentrations but not IL-6 or IL-8 concentrations. The effect of behavioral treatment was not significant on any of the self-report variables although there was a tendency towards improvement in psychological inflexibility and physical health-related quality of life. 
  • In the group with lower pre-treatment inflammatory scores, behavioral treatment significantly reduced psychological inflexbility and improved mental health-related quality of life. 
  • The authors argue that this study suggests that pre-treatment inflammatory status modulates the effect of behavioral therapy on adults with chronic pain and provides a possible explanation of the heterogeneity in treatment response that is commonly seen in pts suffering from chronic pain.
  • Inflammation may be one of the mechanisms that aids in the persistence of behavioral alterations in pts who do not respond to treatment.