Self-regulation of Real-time fMRI Brain Activity in Chronic Pain

This study aims to explore the usefulness of self-regulation of brain activity in patients with fibromyalgia. Patients will use real-time functional magnetic resonance imaging (fMRI) neurofeedback to observe and regulate their own brain activity while applying mental strategies to reduce fibromyalgia pain. The study consists of 2 magnetic resonance imaging (MRI) visits that involve brain neuroimaging for fMRI neurofeedback tasks, as well as 8 weekly intervention sessions with a pain psychologist. Patients will be randomized to either Cognitive Behavioral Therapy (CBT) or Fibromyalgia Education groups.

Inclusion Criteria: 1. Aged 18-65 2. Meet the Wolfe et al 2011 research criteria for fibromyalgia for at least one year 3. On stable doses of medication prior to entering the study and agree not to change medications or dosages (or CAM treatments) during the trial 4. Baseline pain intensity of at least 4/10 on average and pain report for at least 50% of days 5. Able to provide written consent and fluent in English Exclusion Criteria: 1. Comorbid acute pain condition 2. Comorbid chronic pain condition that is rated by the subject as more painful than fibromyalgia 3. Stimulant medications for the fatigue associated with sleep apnea or shift work (e.g., modafinil), 4. Pregnant or nursing 5. Any psychiatric disorder involving a history of psychosis (e. g schizophrenia, severe personality disorders) 6. History of anxiety disorders or significant anxiety symptoms interfering with fMRI procedures (e.g., panic) 7. Contraindication to MRI (e.g., implanted ferrous metal) 8. History of significant head injury (e.g., with substantial loss of consciousness) 9. Psychiatric hospitalization in the past 6 months 10. Other contraindications to MRI 11. Participating in other therapeutic trials 12. Active suicidal ideation 13. Documented peripheral neuropathy of known cause (e.g diabetic neuropathy, chemotherapy-induced neuropathy, guillain-barre) 14. Routine or daily use of narcotics or substances of abuse 15. Autoimmune or inflammatory disease (RA, SLE, IBD) that causes pain 16. Lower Limb Vascular Surgery or Current Lower Limb Vascular Dysfunction 17. Any impairment, activity or situation that in the judgment of the Study Coordinator or Principal Investigator that would prevent satisfactory completion of the study protocol. This includes unreliable, or inconsistent pain scores as deemed by the principal investigator.