The effect of guided imagery and amitriptyline on daily fibromyalgia pain: a prospective, randomized, controlled trial

Objective: The effectiveness of an attention distracting and an attention focusing guided imagery as well as the effect of amitriptyline on fibromyalgic pain was studied prospectively. Methods: Fifty-five women with previously diagnosed fibromyalgia were monitored for daily pain (VAS) in a randomized. controlled clinical trial. One group received relaxation training and guided instruction in "pleasant imagery" (PI) in order to distract from the pain experience (n = 17). Another group received relaxation training and attention imagery upon the "active workings of the internal pain control systems", "attention imagery" (AI) (n=21). The control group (CG) received treatment its usual (n=17). Patients were also randomly assigned to 50-mg amitriptyline/day or placebo. Some psychological and socio-demographic variables were also measured initially. The slopes of diary pain ratings over a 4-week period were used as the outcome measures. Results: We found significant differences of the pain-slopes between the three psychological conditions (P=0.0001). The pleasant imagery, (P<0.005), but not the attention imagery group's slope. declined significantly when compared with the control group (P>0.05). There was neither a difference between the amitriptyline and placebo slopes (main effects. P=0.98) nor a significant amitriptyline x psychological interaction (P=0.76). Conclusion: Pleasant imagery (PI) was an effective intervention in reducing fibromyalgic pain during the 28-day study period. Amitriptyline had no significant advantage over placebo during the study period. (C) 2002 Elsevier Science Ltd. All rights reserved.