More Clues To Fibromyalgia Pain08/05/10
THURSDAY, Aug. 5 (HealthDay News) -- Fibromyalgia patients have
more "connectivity" between brain networks and regions of the brain
involved in pain processing, which may help explain why sufferers
feel pain even when there is no obvious cause, a new study
Researchers had 18 women with fibromyalgia undergo six-minute
fMRI brain scans, and compared their results to women without the
Participants were asked to rate the intensity of the pain they
were feeling at the time of the test. Some people reported feeling
little pain, while others reported feeling more intense pain.
Brain scans showed the connectivity, or neural activity, between
certain brain networks and the insular cortex, a region of the
brain involved in pain processing, was heightened in women with
fibromyalgia compared to those without the condition.
The connectivity to the insular cortex was even stronger in
participants who reported feeling more intense pain compared to
milder pain, said study author Vitaly Napadow, a neuroscientist at
Massachusetts General Hospital.
"We took advantage of the fact that there is a large discrepancy in the amount of pain patients happen to be in at the time they come in. Unfortunately some patients come in, and they are in a lot of pain. Other patients come in and they are not in pain," Napadow said.
The study, by researchers from Massachusetts General Hospital
and the University of Michigan, is published in the August issue of
Arthritis & Rheumatism.
Fibromyalgia is a chronic pain syndrome that's characterized by
widespread pain, fatigue, insomnia, and the presence of multiple
tender points. The syndrome can also cause psychological issues,
including anxiety, depression and memory and concentration
problems, sometimes called the "fibromyalgia fog."
Prior research has shown that people with fibromyalgia feel a
given amount of pain more intensely than others, Napadow explained.
In other words, studies have shown a typical person might rate a
painful stimuli a "one" on a scale or one to 10, while a person
with fibromyalgia might rate the pain a 5 or higher.
The new study is different in that fibromyalgia patients' pain
responses were measured while they were at rest and not being
exposed to anything painful, Napadow said.
The brain networks involved were the default mode network (DMN)
and the right executive attention network (EAN). The DMN is
involved in "self-referential thinking," when you think about
yourself or what's happening to you, Napadow explained.
The EAN is involved in working memory and attention. When that
brain network is occupied, or distracted, by pain, it may explain
some of the cognitive issues that fibromyalgia patients experience,
Dr. Philip Mease, director of rheumatology research at Swedish
Medical Center in Seattle and a member of the National Fibromyalgia
Association medical advisory board, said the study provides insight
into what may be going on in the brains of people with
"This work shows there is increased connectivity between different brain centers that connect the purely sensory pain processing centers of the brain with some of the emotional and evaluative parts of the brain, or areas of the brain that take a sensory stimulus and say, "How do I interpret this? How do I feel about this'?" Mease said.
For years, fibromyalgia has been a highly misunderstood
syndrome, with some doctors doubting it even existed, and others
attributing the pain to depression or other psychological
That began to change early this decade, when brain scans showed
pain-processing abnormalities in fibromyalgia patients, Mease
"That first neuroimaging study really demonstrated fibromyalgia patients were different than normal individuals, and at a neurobiological level, were truly experiencing more pain at lower intensities," Mease said.
The new research moves understanding of the condition a step
further, by exploring what's happening in the brain during a
"Regardless of poking or prodding them, this study is trying to get at an understanding of what is crackling in the brain, intrinsically, such that they have this higher sensitivity," Mease said.
About 10 million Americans are believed to have fibromyalgia,
almost 90 percent of whom are women, according to the National
Fibromyalgia Association. Sufferers report a history of widespread
pain in all four quadrants of the body for at least three months,
and pain in at least 11 of 18 "tender points."
Read more about fibromyalgia at the
National Fibromyalgia Association.
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