Reconsolidation blockade with propranolol as a novel treatment for fibromyalgia: A double-blind, randomized placebo-controlled feasibility study

This is the authors' abstract. We don't add key points for this paper.

Nociplastic pain conditions such as fibromyalgia are characterized by changes in the central nervous system similar to those observed in post-traumatic stress disorder (PTSD). Reconsolidation therapy is a treatment for PTSD consisting in reactivating synapses underlying the excessive threat response and blocking their reconsolidation using propranolol. This double-blind, randomized pilot feasibility study aimed to assess the feasibility and acceptability of reconsolidation therapy with propranolol or a placebo in individuals with fibromyalgia, and to gather preliminary data regarding treatment effect on pain-related outcomes. The sample consisted of 24 adults with fibromyalgia with stable medication, no contraindication to propranolol, and no comorbid PTSD. The experimental intervention consisted of 6 weekly sessions of reconsolidation therapy (reactivation through narrative descriptions and mental imagery) with oral propranolol (40-80 mg) or placebo; all participants also watched ten 2-4 min videos on pain education. Feasibility outcomes included recruitment, intervention completion, and adverse events. Measures of treatment effect were evaluated at baseline and follow-up (4 weeks post-intervention) using self-reported questionnaires assessing pain-related outcomes (e.g., pain interference and emotional functioning). Recruitment took 7 months; 98 potential participants were excluded (most common exclusion criteria: contraindication to propranolol; recent change in treatment). Four participants withdrew. Adverse events were mild and similar across groups. The propranolol group improved more than the placebo group on pain interference (p=.032) after the last visit but not at follow-up, and on emotional functioning (p=.006) at follow-up. Reconsolidation therapy as a treatment for fibromyalgia appears feasible; treatment effect should be assessed in a large-scale trial. NCT05085782 (nov. 7th 2021) https://clinicaltrials.gov/study/NCT05085782. PERSPECTIVE: This study investigates the feasibility of reconsolidation therapy with propranolol, a treatment for PTSD, as a possible treatment for fibromyalgia. This article documents the feasibility of the intervention, highlights some promising treatment effects, and describes considerations for further investigation of this novel therapeutic approach.