The Role of Stress-Related Biomarkers, Immune-Inflammatory Pathways, and Genetic Polymorphisms in Cognitive-Behavioral Therapies for Chronic Low Back Pain and Depression: Results From a Randomized Controlled Trial (The IMPACT Study).
Adrián Pérez-Aranda, Carla Rodríguez-Freire, Juan P Sanabria-Mazo et al.
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In 30 seconds
This randomized controlled trial examined whether Acceptance and Commitment Therapy (ACT) or Behavioral Activation Therapy for Depression (BATD), each added to usual care, affected biomarkers or clinical outcomes in 114 women with chronic low back pain and comorbid depression (mean age 57.5 years). Neither therapy significantly changed biomarker levels compared with usual care. Both improved some clinical outcomes, including pain interference, depressive symptoms, anxiety, and pain catastrophizing. Baseline biomarkers and FKBP5 genotype predicted treatment response, although some associations were exploratory or differed by therapy.
Key findings
- ACT and BATD did not significantly change measured biomarker levels compared with treatment-as-usual.
- Both therapies improved some clinical outcomes, including pain interference, depressive symptoms, anxiety, and pain catastrophizing.
- Baseline biomarkers and FKBP5 genotype predicted treatment response; some biomarker associations were therapy-specific, while others were observed across groups.
Why it matters
The findings suggest that clinical improvement with these psychological therapies need not be accompanied by measurable changes in the assessed immune-inflammatory or stress-related biomarkers. Baseline biological measures and genetic factors may help explain variation in response, but their predictive role requires further study before they can guide treatment selection.
What to keep in mind
Participants were all women, limiting generalizability to other populations. Biomarkers were assessed at baseline and post-treatment, and some associations with responder status were exploratory or descriptive.