{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T03:58:28Z","timestamp":1781323108051,"version":"3.54.1"},"reference-count":50,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2019,4,25]],"date-time":"2019-04-25T00:00:00Z","timestamp":1556150400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001659","name":"Deutsche Forschungsgemeinschaft","doi-asserted-by":"publisher","award":["Th 877\/7\u20101"],"award-info":[{"award-number":["Th 877\/7\u20101"]}],"id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis Care &amp; Research"],"published-print":{"date-parts":[[2019,5]]},"abstract":"Objective<\/jats:title>An intrinsic pain regulatory system is modulated by both cardiovascular dynamics that influence baroreflex sensitivity (BRS<\/jats:styled-content>) and is diminished in fibromyalgia (FM<\/jats:styled-content>). Baroreceptors relay cardiovascular output to the dorsal medial nucleus tractus solitarius reflex arcs that regulate pain, sleep, anxiety, and blood pressure. The aim of this study was to evaluate the effects of systolic extinction training (SET<\/jats:styled-content>), which combines operant treatment (OT<\/jats:styled-content>) with baroreflex training (BRT<\/jats:styled-content>). BRT<\/jats:styled-content> delivers peripheral electrical stimulation within a few milliseconds of the systolic or diastolic peak in the cardiac cycle. In addition, we compared SET<\/jats:styled-content> to OT<\/jats:styled-content>\u2013transcutaneous electrical stimulation (TENS<\/jats:styled-content>) independent of the cardiac cycle and aerobic exercise (AE<\/jats:styled-content>)\u2013BRT<\/jats:styled-content> in FM<\/jats:styled-content> patients with elevated blood pressure responses to stress.<\/jats:p><\/jats:sec>Methods<\/jats:title>Sixty\u2010two female patients with FM<\/jats:styled-content> were randomized to receive either SET<\/jats:styled-content> (n = 21), OT<\/jats:styled-content>\u2010TENS<\/jats:styled-content> (n = 20), or AE<\/jats:styled-content>\u2010BRT<\/jats:styled-content> (n = 21). Outcome assessments were performed before treatment (T1), after 5 weeks of treatment (T2), and after the 12\u2010month follow\u2010up (T3).<\/jats:p><\/jats:sec>Results<\/jats:title>In contrast to patients receiving OT<\/jats:styled-content>\u2010TENS<\/jats:styled-content> or AE<\/jats:styled-content>\u2010BRT<\/jats:styled-content>, those receiving SET<\/jats:styled-content> reported a significantly greater reduction in pain and pain interference (all P<\/jats:italic> < 0.01) that was maintained at the 12\u2010month follow\u2010up. Clinically meaningful pain reduction at T3 was achieved in 82% of patients in the SET<\/jats:styled-content> group, 39% of those in the OT<\/jats:styled-content>\u2010TENS<\/jats:styled-content> group, and only 14% of those in the AE<\/jats:styled-content>\u2010BRT<\/jats:styled-content> group. Patients in the SET<\/jats:styled-content> group showed a significant increase (57%) in BRS<\/jats:styled-content> following treatment, while neither the AE<\/jats:styled-content>\u2010BRT<\/jats:styled-content> group or the OT<\/jats:styled-content>\u2010TENS<\/jats:styled-content> group showed significant changes over time.<\/jats:p><\/jats:sec>Conclusion<\/jats:title>SET<\/jats:styled-content> resulted in statistically significant, clinically meaningful, and long\u2010lasting pain remission and interference compared to OT<\/jats:styled-content>\u2010TENS<\/jats:styled-content> and AE<\/jats:styled-content>\u2010BRT<\/jats:styled-content>. These results suggest that BRS<\/jats:styled-content> modification is the primary mechanism of improvement. Replication of our results using larger samples and extension to other chronic pain conditions appear to be warranted.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acr.23615","type":"journal-article","created":{"date-parts":[[2018,6,8]],"date-time":"2018-06-08T07:56:22Z","timestamp":1528444582000},"page":"678-688","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Efficacy of Systolic Extinction Training in Fibromyalgia Patients With Elevated Blood Pressure Response to Stress: A Tailored Randomized Controlled Trial"],"prefix":"10.1002","volume":"71","author":[{"given":"Kati","family":"Thieme","sequence":"first","affiliation":[{"name":"Institute of Medical Psychology at Philipps\u2010University Marburg Marburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tina","family":"Meller","sequence":"additional","affiliation":[{"name":"Institute of Medical Psychology at Philipps\u2010University Marburg 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