Reconsolidation blockade with propranolol as a novel treatment for fibromyalgia: A double-blind, randomized...

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.