Metabolic Abnormalities in Pain-Processing Regions of Patients with Fibromyalgia: A 3T MR Spectroscopy Study

Feraco, Paola; Bacci, A.; Pedrabissi, Fab; Passamonti, Luca; Zampogna, Giuseppe; Pedrabissi, Fed; Malavolta, N; Leonardi, Marco

doi:10.3174/ajnr.a2550

Cited by 51 publications

(48 citation statements)

References 37 publications

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“…Given the role of the lateral prefrontal cortex in high-level pain-modulatory mechanisms, our findings suggest the possibility that catastrophizing induces hyperalgesia by disrupting the adaptive recruitment of vIPFC/alPFC-dependent pain-inhibitory processes, which normally attenuate the effects of incoming painful stimulation. Of note, altered vIPFC physiology in FM has also been reported using magnetic resonance spectroscopy, which demonstrated neurochemical alterations (i.e., increased glutamate/glutamine concentration) in this region 9 . Thus, our results provide further evidence implicating lateral prefrontal cortex in FM pathophysiology.…”

Section: Discussionmentioning

confidence: 65%

The Lateral Prefrontal Cortex Mediates the Hyperalgesic Effects of Negative Cognitions in Chronic Pain Patients

Loggia¹,

Berna²,

Kim³

et al. 2015

The Journal of Pain

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While high levels of negative affect and cognitions have been associated in chronic pain conditions with greater pain sensitivity, the neural mechanisms mediating the hyperalgesic effect of psychological factors in patients with pain disorders are largely unknown. In this cross-sectional study, we hypothesized that 1) catastrophizing modulates brain responses to pain anticipation, and that 2) anticipatory brain activity mediates the hyperalgesic effect of different levels of catastrophizing, in fibromyalgia (FM) patients. Using functional Magnetic Resonance Imaging, we scanned the brains of 31 FM patients exposed to visual cues anticipating the onset of moderately intense deep-tissue pain stimuli. Our results indicated the existence of a negative association between catastrophizing and pain-anticipatory brain activity, including in the right lateral prefrontal cortex (IPFC). A bootstrapped mediation analysis revealed that pain-anticipatory activity in lateral prefrontal cortex (IPFC) mediates the association between catastrophizing and pain sensitivity. These findings highlight the role of IPFC in the pathophysiology of FM related hyperalgesia, and suggest that deficits in the recruitment of pain-inhibitory brain circuitry during pain-anticipatory periods may play an important contributory role in the association between various degrees of widespread hyperalgesia in FM and levels of catastrophizing, a well validated measure of negative cognitions and psychological distress. Perspective This article highlights the presence of alterations in pain-anticipatory brain activity in FM. These findings provide the rationale for the development of psychological or neurofeedback-based techniques aimed at modifying patients' negative affect and cognitions towards pain.

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Section: Discussionmentioning

confidence: 65%

The Lateral Prefrontal Cortex Mediates the Hyperalgesic Effects of Negative Cognitions in Chronic Pain Patients

Loggia¹,

Berna²,

Kim³

et al. 2015

The Journal of Pain

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“…Since MRS may not accurately measure glutamate (Glu), it is customary to report combined Glu + glutamate (Glx) levels. Greater concentrations of Glx, higher Glx/Cr ratios or both have been detected in a variety of brain regions of FMS compared to healthy subjects [296,297,[304][305][306]. Unfortunately, not only the regions investigated with MRS, but also the regions identified as showing elevated Glx levels vary from one study to the next even when performed by the same group of researchers [296,297,[304][305][306].…”

Section: Neuroendocrine and Cytokine Disturbances Brain Neurochemistrymentioning

confidence: 89%

“…Unfortunately, not only the regions investigated with MRS, but also the regions identified as showing elevated Glx levels vary from one study to the next even when performed by the same group of researchers [296,297,[304][305][306]. This is regrettable because more detailed knowledge of the localization of increased Glx activity could provide insights into the role of Glu in the pathophysiology of FMS, particularly since elevated Glx concentrations in certain brain areas are associated with clinical pain severity, pain sensitivity, and various other symptoms of FMS [296,297,[304][305][306]. After long-term non-pharmacological treatment, the magnitude of the decline in the Glu/Cr ratio of the posterior insula correlated with the magnitude of the decrease in clinical pain and increase of the experimental pressure pain threshold [307].…”

Section: Neuroendocrine and Cytokine Disturbances Brain Neurochemistrymentioning

confidence: 96%

“…Greater concentrations of Glx, higher Glx/Cr ratios or both have been detected in a variety of brain regions of FMS compared to healthy subjects [296,297,[304][305][306]. Unfortunately, not only the regions investigated with MRS, but also the regions identified as showing elevated Glx levels vary from one study to the next even when performed by the same group of researchers [296,297,[304][305][306]. This is regrettable because more detailed knowledge of the localization of increased Glx activity could provide insights into the role of Glu in the pathophysiology of FMS, particularly since elevated Glx concentrations in certain brain areas are associated with clinical pain severity, pain sensitivity, and various other symptoms of FMS [296,297,[304][305][306].…”

Section: Neuroendocrine and Cytokine Disturbances Brain Neurochemistrymentioning

confidence: 98%

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Fibromyalgia: A Critical and Comprehensive Review

Borchers

Gershwin

2015

Clinic Rev Allerg Immunol

215

217

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Fibromyalgia is a disorder that is part of a spectrum of syndromes that lack precise classification. It is often considered as part of the global overview of functional somatic syndromes that are otherwise medically unexplained or part of a somatization disorder. Patients with fibromyalgia share symptoms with other functional somatic problems, including issues of myalgias, arthralgias, fatigue and sleep disturbances. Indeed, there is often diagnostic and classification overlap for the case definitions of a variety of somatization disorders. Fibromyalgia, however, is a critically important syndrome for physicians and scientists to be aware of. Patients should be taken very seriously and provided optimal care. Although inflammatory, infectious, and autoimmune disorders have all been ascribed to be etiological events in the development of fibromyalgia, there is very little data to support such a thesis. Many of these disorders are associated with depression and anxiety and may even be part of what has been sometimes called affected spectrum disorders. There is no evidence that physical trauma, i.e., automobile accidents, is associated with the development or exacerbation of fibromyalgia. Treatment should be placed on education, patient support, physical therapy, nutrition, and exercise, including the use of drugs that are approved for the treatment of fibromyalgia. Treatment should not include opiates and patients should not become poly pharmacies in which the treatment itself can lead to significant morbidities. Patients with fibromyalgia are living and not dying of this disorder and positive outlooks and family support are key elements in the management of patients.

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“…También se han encontrado elevados niveles de Cho en la CPF dorsolateral con una relación positiva del dolor espontáneo referido (82), con resultados más contradictorios de los niveles de dicho metabolito en el hipocampo (47). Estudios más recientes han focalizado su atención en el papel del Glu/Glx en la FM (47), objetivándose un incremento del nivel de Glx en la INS posterior (83) que puede reducirse tras tratamiento con acupuntura (84), en la amígdala derecha (85), en la CPP (86) y en la CPF ventro-lateral (87). Esta heterogénea distribución neuroanatómica de elevados niveles de Glx puede sugerir que dicho metabolito juegue un papel en la variada sintomatología de la FM (47).…”

Section: Alteraciones Molecularesunclassified

Neuroimagen de la fibromialgia: una enfermedad del cerebro

Deus¹

2017

Rev. Soc. Esp. Dolor.

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Este es un archivo PDF de un manuscrito inédito que ha sido aceptado para su publicación en la Revista de la Sociedad Española del Dolor. Como un servicio a nuestros clientes estamos proporcionando esta primera versión del manuscrito en estado de prepublicación. El manuscrito será sometido a la corrección de estilo final, composición y revisión de la prueba resultante antes de que se publique en su forma final. Tenga en cuenta que durante el proceso de producción se pueden dar errores lo que podría afectar el contenido final. El copyright y todos los derechos legales que se aplican al artículo pertenecen a la Revista de la Sociedad Española de Dolor. NEUROIMAGEN DE

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Metabolic Abnormalities in Pain-Processing Regions of Patients with Fibromyalgia: A 3T MR Spectroscopy Study

Cited by 51 publications

References 37 publications

The Lateral Prefrontal Cortex Mediates the Hyperalgesic Effects of Negative Cognitions in Chronic Pain Patients

The Lateral Prefrontal Cortex Mediates the Hyperalgesic Effects of Negative Cognitions in Chronic Pain Patients

Fibromyalgia: A Critical and Comprehensive Review

Neuroimagen de la fibromialgia: una enfermedad del cerebro

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