Yoga, Cognitive Behavioral Therapy Improved Patient-Reported Outcomes in Fibromyalgia, IBS

Mind-body interventions (MBIs), specifically cognitive behavioral therapy (CBT) and yoga, were shown to improve patient-reported outcome measures in patients with fibromyalgia (FM) and irritable bowel syndrome (IBS), according to a study published in Frontiers in Psychiatry.¹ Investigators note that the limited available data in co-diagnosed patients necessitate more high-quality trials that can better personalize programs to patient needs.

“Irritable bowel syndrome and fibromyalgia share similar pathophysiologic mechanisms including sensitization of peripheral and central pain pathways, autonomic dysfunction, and are often co-diagnosed,” investigators explained. “Co-diagnosed patients experience increased symptom severity, mental health comorbidities, and decreased quality of life. The role of mind-body interventions, which have significant effects on central pain syndromes and autonomic dysregulation, have not been well-described in co-diagnosed patients.”

PubMed was utilized to identify studies analyzing fibromyalgia, irritable bowel syndrome, cognitive behavioral therapy, yoga, mind-body interventions, and mindfulness-based stress reduction (MBSR).

A systematic review of 14 studies showed that the prevalence of IBS in patients with FM was approximately 32.5%, while 73% of patients with FM experienced altered bowel habits, including bloating (65.4%), abdominal pain (57.1%), fecal incontinence (56%), and constipation (52.9%). Both conditions affect women more than men and patients are more likely to experience anxiety and depression. Further, 38% of patients with IBS report suicidal thoughts.

The review focused on MBIs including MBSRs, Mindfulness-Based Cognitive Therapy, Mindful Socioemotional Regulation Intervention, and Tai Chi, as well as yoga and CBT.

Improved patient-reported outcomes were observed in patients who took part in mind-body interventions, defined as introspective practices using alternative treatment options that allow for patients to be active participants in their health, which were effective for managing IBS and fibromyalgia, individually. CBT and yoga were shown to decrease symptom severity and improve mental health, quality of life, and sleep for both conditions. CBT focuses on altering cognitive bias to alleviate stress and improve self-regulation, which in turn reduces catastrophic thinking and enhances quality of life. Additionally, yoga improved physical outcomes, including pain/tenderness scores, insomnia, physical functioning, and gastrointestinal symptoms, mental health outcomes, such as anxiety, depression, catastrophizing, and gastrointestinal-specific anxiety, and quality of life. This may be due in part to alterations to autonomic activity.

Limitations included the heterogeneity of the MBIs analyzed, as they only included the most commonly investigated interventions for IBS and FM. Efficacy was difficult to evaluate considering the included studies substantially differed in their methodologies. This also limits the generalizability of results as well as the specific recommendations for patients with co-diagnosed IBS and FM. Studies that analyze the potential mechanisms of action of MBIs are needed. Regardless, yoga practice (30 minutes performed 5 times a week) in co-diagnosed patients is recommended until future data from other high-quality trails are available.

“MBIs, such as CBT and yoga, are impactful and leverage one of many potential pathophysiological mechanisms,” investigators concluded. “Future interventions should aim toward tailoring yoga programs in combination with other MBIs to meet the needs of IBS and FM patients.”

Reference:

Islam Z, D'Silva A, Raman M, Nasser Y. The role of mind body interventions in the treatment of irritable bowel syndrome and fibromyalgia. Front Psychiatry. 2022;13:1076763. Published 2022 Dec 22. doi:10.3389/fpsyt.2022.1076763