Targeted Limbic Self-Neuromodulation for Alleviating Central Sensitization Symptoms in Fibromyalgia

Background Fibromyalgia (FM), involving somatic, cognitive, and affective domains is often regarded as a hallmark central sensitization syndrome. Despite limited current therapeutic options, emerging understanding of its neural underpinnings offers the potential of applying novel neuromodulation strategies. Specifically, limbic dysregulation underlying abnormalities in pain modulation and somatic-affective processing, has been shown to play a key role in FM. Here, we assessed the long-term efficacy of targeted limbic self-neuromodulation for improving clinical disease burden in FM. Method Forty-seven FM patients participated in a double-blind, randomized, dual-control study employing a novel specialized neurofeedback probe representing amygdala activity. Patients underwent 10 sessions of either genuine (NFT = 21) or sham (NFS = 13) training, or treatment as usual (TAU = 13). Disease burden was assessed using the Symptom Severity Score (SSS), alongside other questionnaires pre- and post-treatment. Clinical follow-up was performed 10–12 months post-intervention. Results NFT resulted in significant immediate and long-term reduction in SSS (F _(2,40)  = 7.32, p  = 0.00, ηp2 = 0.27) and the FIQ (F _(2,40)  = 9.85, p  = 0.00, ηp2 = 0.33), alongside multidomain short and long-term clinical benefits. NFS resulted in a long-term decrease in pain, but not in other disease measures or overall disease burden. The TAU group exhibited no clinical improvements. Conclusions Our findings support the intimate involvement of limbic brain areas in the pathophysiology of FM and suggest that targeted neuromodulation offers a novel mechanism-based approach to managing multidomain symptoms in FM. Trial registration This study was preregistered with the National Institutes of Health (NIH). Registration number NCT02146495. Name of trial registry Targeted Limbic Selfmodulation as a Potential Treatment for Patients Suffering From Fibromyalgia. https://clinicaltrials.gov/study/NCT02146495