Brief pain reprocessing therapy for fibromyalgia: a feasibility, acceptability, and preliminary efficacy pilot

Fibromyalgia (FM) is a common, disabling condition characterized by nociplastic pain—where amplified pain signals originate in the nervous system rather than from tissue damage. Current treatments show modest effectiveness, likely because they don't target the brain-based threat processing mechanisms underlying FM. This study explores whether Brief Pain Reprocessing Therapy (BPRT), a three-session telehealth intervention based on principles from successful pain reprocessing approaches, could address this gap by specifically targeting how the brain processes pain signals.

The researchers conducted a single-arm, open-label pilot study with 35 adults diagnosed with FM who received three weekly one-hour telehealth sessions delivered by a pain psychologist. BPRT incorporated pain neuroscience education, mindfulness and somatic tracking techniques, positive emotion-boosting strategies (guided imagery), cognitive reappraisal of pain's meaning, and graded exposure to painful stimuli. Participants completed questionnaires measuring pain intensity, pain interference, pain-related fear, and treatment acceptability at baseline and at 1, 2, and 3 months post-intervention.

Results were promising: 33 of 35 participants (94%) completed all three sessions, indicating high feasibility. Treatment acceptability ratings were high (62/70 on the acceptability scale). Among completers, significant reductions were observed across all three outcomes, with effect sizes growing from moderate at 1 month to large at 2-3 months. Pain intensity decreased substantially, with 24-37% of participants reporting 50% or greater pain reduction at follow-up visits, and 42% reporting being "much improved" or "very much improved" by 3 months. Adverse events were rare and unrelated to the intervention.

These findings suggest that brief, telehealth-delivered behavioral interventions targeting nociplastic pain mechanisms may fill an important gap in FM treatment, particularly for patients unable to access specialty care due to geographic, financial, or time constraints. The intervention's brevity and accessibility could substantially reduce patient burden compared to longer traditional therapies. However, the authors emphasize these are preliminary results from a pilot study without a control group; larger randomized controlled trials are needed to confirm efficacy and rule out placebo effects. Future research should also examine whether treatment benefits persist long-term and identify which patients respond best to this approach.