Altered Pain in the Brainstem and Spinal Cord of Fibromyalgia Patients During the Anticipation and Experience of Experimental Pain

Ioachim, Gabriela; Warren, Howard J M; Powers, Jocelyn M.; Staud, Roland; Pukall, Caroline F.; Stroman, Patrick W.

doi:10.3389/fneur.2022.862976

Cited by 19 publications

(28 citation statements)

References 73 publications

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“…13 Functional magnetic resonance imaging (fMRI) of the brain has demonstrated reduced functional connectivity in the descending pain-modulating system and a hyperexcitability in the pain matrix related to central sensitization. [14][15][16] It is believed that maintaining central sensitization requires continual noxious peripheral signals, even in syndromes like fibromyalgia, which are characterized by the absence of identifiable peripheral lesions. 17 Over the years, peripheral origins of pain have also been recognized as a possible cause of FM.…”

Section: Discussionmentioning

confidence: 99%

Cervical Spondylosis as a Hidden Contributing Factor to Fibromyalgia: A Case Report

Chu¹,

Lee²

2022

IMCRJ

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The present case study describes the long-term symptomatic remission in a patient with fibromyalgia (FM) after multimodal spinal manipulation. A 44-year-old woman presented with a chronic headache, severe neck pain, shoulder pain, and back pain lasting for 2 years after experiencing domestic violence. She had sleep disorders, fatigue, and depressive mood. Her primary care physician diagnosed her with FM and comorbid depression. Despite treatment with non-steroidal anti-inflammatory drugs, muscle relaxants, anti-depressants, anti-epileptics, acupuncture, and aqua-therapy, she experienced no appreciable relief from her symptoms. The patient then sought a chiropractic evaluation and potential treatment for her symptoms. At presentation, widespread tenderness was palpable over the neck, shoulder, back, anterior chest, abdominal wall, and buttock. Radiographs showed loss of cervical lordosis, widespread degenerative spondylosis, and osteitis pubis. Surface electromyography (sEMG) revealed neck and thoracic paraspinal muscular spasms. The patient was diagnosed with FM based on the American College of Rheumatology diagnostic criteria and the associated comorbidities. Multimodal chiropractic approaches, which consisted of spinal manipulation, massage, and intermittent motorized cervical traction, were used twice weekly to relieve soft-tissues and intervertebral joints and stretch core musculatures. The patient's physical and mental complaints were mostly resolved near the end of 9 months of treatment. Her symptom alleviation was associated with corresponding change in normalized sEMG signal and cervical spine realignment at the 16th-and 26th-month followups. Widespread pain in FM can lead to confused thinking and a lack of awareness of cervical spondylosis. In this example, it is assumed that the noxious cervical inputs triggered an ongoing FM process. Chiropractic treatment blocked noxious inputs coming from pain sources, corrected pain thresholds, and lowered excitability, thereby eradicating FM symptoms.

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Section: Discussionmentioning

confidence: 99%

Cervical Spondylosis as a Hidden Contributing Factor to Fibromyalgia: A Case Report

Chu¹,

Lee²

2022

IMCRJ

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“…Similarly, cognitive and emotional manipulations have failed to modulate the brain response after nociceptive stimulation in fibromyalgia (Kamping et al, 2013;Loggia et al, 2014), indicating the existence of an endogenous pain modulation disturbance. From this point of view, decrements of neural correlates of pain expectation in fibromyalgia have been associated with an alteration of descending pain modulation mechanisms (de Souza et al, 2009;Goffaux et al, 2009;Burgmer et al, 2011;Fields, 2018;Ioachim et al, 2022), which could be related to the absence of expectative modulation of the neural response to pain.…”

Section: Discussionmentioning

confidence: 99%

Electrophysiological indices of pain expectation abnormalities in fibromyalgia patients

Barjola

Peláez²,

Ferrera³

et al. 2022

Front. Hum. Neurosci.

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Fibromyalgia is a chronic pain syndrome characterized by dysfunctional processing of nociceptive stimulation. Neuroimaging studies have pointed out that pain-related network functioning seems to be altered in these patients. It is thought that this clinical symptomatology may be maintained or even strengthened because of an enhanced expectancy for painful stimuli or its forthcoming appearance. However, neural electrophysiological correlates associated with such attentional mechanisms have been scarcely explored. In the current study, expectancy processes of upcoming laser stimulation (painful and non-painful) and its further processing were explored by event-related potentials (ERPs). Nineteen fibromyalgia patients and twenty healthy control volunteers took part in the experiment. Behavioral measures (reaction times and subjective pain perception) were also collected. We manipulated the pain/no pain expectancy through an S1–S2 paradigm (cue-target). S1 (image: triangle or square) predicted the S2 appearance (laser stimulation: warmth or pinprick sensation). Laser stimuli were delivered using a CO2 laser device. Temporal and spatial principal component analyses were employed to define and quantify the ERP component reliability. Statistical analyses revealed the existence of an abnormal pattern of pain expectancy in patients with fibromyalgia. Specifically, our results showed attenuated amplitudes at posterior lCNV component in anticipation of painful stimulation that was not found in healthy participants. In contrast, although larger P2 amplitudes to painful compared to innocuous events were shown, patients did not show any amplitude change in this laser-evoked response as a function of pain predictive cues (as occurred in the healthy control group). Additionally, analyses of the subjective perception of pain and reaction time indicated that laser stimuli preceded by pain cues were rated as more painful than those signaling non-pain expectancy and were associated with faster responses. Differences between groups were not found. The present findings suggest the presence of dysfunction in pain expectation mechanisms in fibromyalgia that eventually may make it difficult for patients to correctly interpret signs that prevent pain symptoms. Furthermore, the abnormal pattern in pain expectancy displayed by fibromyalgia patients could result in ineffective pain coping strategies. Understanding the neural correlates of pain processing and its modulatory factors is crucial to identify treatments for chronic pain syndromes.

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“…Similarly, some authors have focused on the role of fMRI in the peripheral assessment of the brainstem and spinal cord [ 23 ], describing significant differences in brainstem/spinal cord network connectivity between the FM and healthy controls, which correlated with subjective differences in pain responses. Other authors used fMRI to study brainstem and spinal cord activation during temporal summation of second pain (TSSP), characterizing the time course of spinal cord and brainstem BOLD activity during TSSP; an alteration in brainstem activity was reported in patients with FM, possibly caused by deficient pain modulation [ 24 ].…”

Section: Novel Imaging Approaches To Fibromyalgiamentioning

confidence: 99%

Novel Approaches in Molecular Imaging and Neuroimaging of Fibromyalgia

Ricci

Cimini

Fojaja

et al. 2022

IJMS

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Fibromyalgia (FM) represents a condition that is still controversial in its entity, pathophysiology, diagnosis and management. The aim of this review is to focus on imaging aspects of FM, especially on novel approaches in molecular imaging, with a special focus on neuroimaging. Novel functional and molecular imaging findings may represent, eventually, future biomarkers both in research settings and in terms of clinical practice. Several imaging techniques have already been tested in clinical trials in the FM field, including functional MRI, positron emission tomography (PET) imaging with 18F-FDG in FM, PET imaging of the dopaminergic system, PET imaging of the GABAergic system, PET imaging with neuroinflammation and neuroimmune parameters, PET imaging of the opioid system and H215O-PET activation studies. Therefore, the potential role in the FM field of fMRI and different PET tracers has been discussed in different settings, serving as a comprehensive guide of novel imaging options both in research and in the clinical field.

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Altered Pain in the Brainstem and Spinal Cord of Fibromyalgia Patients During the Anticipation and Experience of Experimental Pain

Cited by 19 publications

References 73 publications

Cervical Spondylosis as a Hidden Contributing Factor to Fibromyalgia: A Case Report

Cervical Spondylosis as a Hidden Contributing Factor to Fibromyalgia: A Case Report

Electrophysiological indices of pain expectation abnormalities in fibromyalgia patients

Novel Approaches in Molecular Imaging and Neuroimaging of Fibromyalgia

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