191: Treatment Response of Long COVID and Fibromyalgia to Systolic Extinction Training.

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic pain related to Long COVID, Psychology, Neuromodulation (e.g. TMS, TDCS, FUS, SCS, MCS, DBS, vagus nerve stimulation), Treatment/management

Background and Aims: Both Long COVID (LCOV) and fibromyalgia (FM) share common symptoms (e.g., pain, fatigue, cognitive impairment) although the mechanisms involved my vary. Systolic Extinction Therapy [SET] treatment combines operant-behavioral pain therapy and baroreceptor-training (BRT). SET has been shown to be effective in treating patients with FM. Thus, we hypothesized that SET could be extended to treat symptoms of LCOV.

Methods: Method. Twenty LCOV patients reporting CNS manifestation (e.g., fatigue, musculoskeletal pain, cardiovascular dysregulation) were compared to 20 sex- and age- matched FM patients with comparable symptoms to receive SET in a randomized controlled trial. Standardized questionnaires were used to measure pain, interference, fatigue, and sleep as well as ECG, systolic (SBP) and diastolic (DBP) BP, heart rate, Baroreflex Sensitivity (BRS) and HR-variability (HRV). All patients underwent a neuropsychological assessment to evaluate concentration, memory, and cognitive interference. The SET treatment consisted twice weekly sessions of 1 hour of operant behavioral pain therapy and 1 hour of BRT as no n-invasive neuromodulation.

Results: Results. Nineteen of 20 Long-COVID patients and 16 of 20 FM patients reported being pain-free (P<0.001), significantly improved sleep (P=0.002), and reduced fatigue (P=0.003) after SET. They also reported statistically significant neuropsychological improvements (P=0.013). These results were maintained at 12-month follow-up. Neuropsychological impairments in LCOV were mild in contrast to FM patients (P<0.001). In contrast to FM patients, the physiological responses in LCOV displayed a significantly increased BRS by 117%, reduction of SBP and DBP by 56 and 38 mmHg respectively, and HR by 49 bpm (all Ps < 0.01).

Conclusions: Conclusion. The results suggest that although different mechanisms may account for LCOV and FM, SET may be a useful treatment for both disorders.

References: Thieme K, Turk DC, Gracely RH, Flor H. Differential psychophysiological effects of operant and cognitive behavioural treatments in women with fibromyalgia. Eur J Pain. 2016 Jun 15. doi: 10.1002/ejp.872.

Thieme K, Meller T, Evermann U, Malinowski R, Mathys M, Gracely RH, Maixner W, Turk DC. Efficacy of Systolic Extinction Training (SET) in Fibromyalgia Patients with elevated Blood Pressure Response to Stress - A Tailored RCT Study. Arthritis Care Res (Hoboken). 2019 71(5):678-688. doi:10.1002/acr.23615.

Thieme K, Jung K, Mathys MG, Gracely RH, Turk DC. Cardiac-Gated Neuromodulation Increased Baroreflex Sensitivity and Reduced Pain Sensitivity in Female Fibromyalgia Patients. J Clin Med. 2022 Oct 21;11(20):6220. doi: 10.3390/jcm11206220.

Presenting Author: Kati Thieme
Submitting Author: Kati Thieme

Senior Author: Dennis C Turk

IASP 2026 Global Year theme of Neuropathic Pain: No

• Dennis C Turk: PhD - Center for Pain Research on Impact, Measurement, & Effectiveness (C-PRIME), Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, USA