Re: New research on Fibromyalgia and the brain

[Guest guest]

Hi,I checked out the youtube videos and it was very interesting. Does anyone

know how to find a doctor in your area that does that brain therapy

>

> For those who are interested in learning more about fibromyalgia pain, here is

an interesting article on the connectivity in the brain in fibromyalgia

patients. If you would like to read the complete paper, here is the URL:

http://www.nmr.mgh.harvard.edu/~vitaly/PDF/napadow_A & R_2010.pdf

>

> NEW RESEARCH ON FIBRO. AND THE BRAIN

> by Prives Golburgh

>

> That Pain Levels in Patients With Fibromyalgia Are Linked to Resting Brain

Connectivity

> A new study published in the August 2010 Arthritis & Rheumatism by Vitaly

Napadow, Ph.D. and colleagues has shown that patients with fibromyalgia (FM)

have a different degree of connectivity between specific brain networks as

compared with healthy controls. The study, entitled “Intrinsic Brain

Connectivity in Fibromyalgia Is Associated With Chronic Pain Intensity,†also

demonstrated a relationship between the activity in these brain networks and

perceived levels of spontaneous pain in those with FM.

> Functional magnetic resonance imaging (FMRI) was used to gather information

about the resting brain activity in 18 female patients with FM and 18 female

age-matched healthy control subjects between the ages of 18 and 75. Subjects

were first asked to rate the degree of pain they were in just prior to the FMRI

and then “to rest comfortably without falling asleep†while FMRI data was

gathered.

> The researchers chose to examine the resting state of the brain because they

were looking for neural correlates of the chronic endogenous pain or

“spontaneous pain†that is characteristic of FM as opposed to the

hypersensitivity that FM patients exhibit to external sources of pain (also

known as hyperalgesia). Therefore, the researchers measured intrinsic brain

connectivity which is the basic “ongoing neural and metabolic activity†that

occurs while the brain is at rest and not responding to stimuli.

> The researchers hypothesized that FM patients would have an altered level of

resting-state connectivity in the default mode network (DMN) and the executive

attention network (EAN) while the connectivity of the medial visual network

(MVN) would be comparable to that in healthy controls. The DMN and EAN are both

involved in cognitive processes that can be impaired in those with FM. The DMN

is believed to be involved in self-referential thinking and is comprised of

brain regions that have been shown to be deactivated by experimental pain, while

the EAN is involved in working memory and attention. Conversely, the MVN is made

up of the primary visual processing areas that are not known to be affected by

FM. Thus, the MVN served as a negative control.

> The researchers also controlled for age (as age and spontaneous pain were

significantly positively correlated) and for physiological factors such as

cardiorespiratory fluctuations, which can affect FMRI measurements of intrinsic

connectivity.

> In keeping with the given hypothesis, patients with FM exhibited greater DMN

and EAN (specifically the right half of the EAN) connectivity than healthy

controls. As predicted, there was no significant difference between the MVN

connectivity levels in the FM patients and healthy controls. Patients with FM

had a higher intrinsic DMN connectivity to other parts of the brain that are

involved in pain processing such as the left anterior, middle, and posterior

insula. Meanwhile, the FMRI results showed that these same patients also had

greater intranetwork connectivity within the right EAN. Additionally, the

researchers found that increased levels of connectivity between both the DMN and

the right EAN and the insula were positively correlated with higher

patient-reported pain levels.

> These neural disparities between FM patients and healthy controls could serve

as biomarkers that in turn could aid in diagnosis, help to validate chronic pain

symptoms, and further our understanding of the physiological basis for these

symptoms. For instance, the researchers speculated that the increased

connectivity between the insula and the EAN during increased subjective feelings

of pain could be causing interruption of the normal functions of the EAN

(working memory and attention), which could help to explain some of the

cognitive deficits (also known as “fibro fogâ€) experienced by patients with

FM. Moreover, the abnormal functioning of these brain networks adds credence to

the burgeoning theory that spontaneous pain associated with FM may be more

closely linked to central nervous system hyperexcitability than to pathology of

the nerves outside of the brain and spinal cord.

> Interestingly, the authors, in this small study, attempted to separate out the

potential overlap of depression with the pain associated with FM:

> “In order to test for the influence of depression on any of our pain-related

results, we also evaluated whether patients with FM classified as having a high

level of depression…had greater ICN connectivity in any of the regions

implicated…Based on our criteria, 7 patients had a high level of depression,

while the remaining 11 patients were classified as having a low level of

depression. We found no significant differences (all P>0.2) between these two FM

subpopulations…in terms of ICN connectivity to regions of interest…Of

particular interest, cognitive deficits in patients with FM are correlated more

with their level of pain than with psychiatric comorbidities (e.g., depression,

anxiety, or sleep disruption)…â€

> The importance of this study is summed up by the authors:

> “In this study, we present the first direct evidence between elevated

intrinsic brain connectivity and spontaneous pain intensity in patients with

FM…Furthermore, our data directly link ratings of self-reported spontaneous

pain at the time of the scan to the degree of both right EAN and DMN

connectivity to the insula. Our findings have implications for a better

understanding of the underlying brain mechanisms of endogenous clinical pain in

FM, potentially pointing toward biomarkers of disease progression…â€

>

>

>