Science proves it's not all in our heads, long article inside!!!

[Guest guest]

See they finally have proof we really hurt, so don't let anyone tell

you it's all in your head! You can find this article, originally

published in Arthritis and Rheumatism, in Medscape for the

professional.

Physiologic Factors Involved in Fibromyalgia, Contradicting

Psychogenic Attribution

NEW YORK (Reuters Health) Jun 19 - Functional magnetic resonance

imaging (fMRI) and neuroendocrine studies of people with fibromyalgia

reinforce the notion that altered responses to pain and exercise are

physiologically based.

" When patients with fibromyalgia tell us that they're tender, that

they're experiencing pain at a much lower [pressure] level than

people without the condition, they are in fact experiencing that

pain, " Dr. J. Clauw, of the University of Michigan Medical

Center in Ann Arbor, told Reuters Health.

Two reports in the May issue of Arthritis and Rheumatism are

the " first neurobiological evidence of the veracity of their pain, "

he added, referring to another study in which responses to exercise

were measured in fibromyalgia patients.

Dr. Clauw and colleagues studied 16 people who had been diagnosed

with fibromyalgia and 16 healthy control subjects. All underwent fMRI

while a piston-controlled device applied precisely calibrated

pressure to the base of their left thumbnail.

Fibromyalgia patients reported pain at about half the level of

pressure that caused the same feelings of pain among the healthy

controls (p<0.005).

When all study participants received the same level of mild pressure,

which was painful to the fibromyalgia patients, 12 brain areas were

activated in patients with fibromyalgia, but only two were activated

in the control group. Increased blood flow--a surrogate measure of

nerve activity, according to Dr. Clauw--occurred in the primary and

secondary somatosensory cortex, the insula, the putamen, and

cerebellum.

Moreover, pain in the control group activated regions in the

thalamus, the anterior cingulate cortex and other regions involved in

motor responses, which were not activated in the patient group. The

investigators attribute these differences to " tonic inhibition

maintained by persistent excitatory input associated with ongoing and

spontaneous pain " in fibromyalgia patients.

Dr. Clauw said the findings suggest that something is awry with the

way the central nervous system processes painful stimuli in

fibromyalgia patients, resulting in a lowered pain threshold. Future

research should be aimed at identifying the problem and working to

develop better treatments, he added.

In the second report, Dr. M. and colleagues of the

Oregon Health Sciences University in Portland showed that 20 female

fibromyalgia patients exhibited reduced growth hormone and cortisol

responses to an acute exercise stressor, compared with 10 healthy

female control subjects (p=0.003).

The growth hormone response was restored in the patients, but not

increased in the control subjects, by administration of the potent

cholinergic agent pyridostigmine bromide 1 hour before exercise.

Dr. and his associates conclude that patients with

fibromyalgia have an increased hypothalamic somatostatin tone. They

would like to see if long-term treatment with pyridostigmine would

improve growth hormone production in fibromyalgia.

Both studies imply that regulatory mechanisms localized to the

central nervous system are altered in fibromyalgia, note Drs. Clauw

and J. Crofford, also of the University of Michigan, in an

editorial. " Purely behavioral or psychological factors are not

primarily responsible for the pain and tenderness seen in

fibromyalgia, " they assert.

While behavioral factors likely play a role in symptom expression in

many of these patients, resulting in poor role functioning, the

commentators note that this phenomenon is similar for all rheumatic

diseases.

Arthritis Rheum 2002;46:1136-1138,1333-1350.

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Reuters Health Information 2002. © 2002 Reuters Ltd