The Bed Nucleus of the Stria Terminalis as a Brain Correlate of Psychological Inflexibility in Fibromyalgia

Abstract

This study explored the brain structural correlates of psychological flexibility (PF) as measured with the Psychological Inflexibility in Pain Scale (PIPS) in patients with fibromyalgia (FM). Structural magnetic resonance imaging data from 47 FM patients were used to identify Gray Matter Volume (GMV) alterations related to PIPS scores. Brain GMV clusters related to PIPS were then correlated with clinical and cognitive variables to further explore how emerged brain clusters were intertwined with FM symptomatology. Longitudinal changes in PIPS-related brain clusters values were assessed by studying pre–post data from 30 patients (15 allocated to a mindfulness-based stress reduction (MBSR) program and 15 to treatment-as-usual). Changes in PIPS-related brain clusters were also explored in participants showing greater/lower longitudinal changes in PIPS scores. PIPS scores were positively associated with GMV in a bilateral cluster in the ventral part of the bed nucleus of the stria terminalis (BNST). Significant associations between BNST cluster with functional impairment, depressive symptomatology, perceived stress and the nonjudging mindfulness facet were observed. Participants reporting greater pre–post increases in PIPS scores showed greater increases in BNST cluster values. These findings contribute to the understanding on the neurobiological bases of PF in FM and encourage further explorations of the role of the BNST in chronic pain.

Neural correlates of co-occurring pain and depression: an activation-likelihood estimation (ALE) meta-analysis and systematic review

“…The ALE analysis identified the right parahippocampal gyrus/amygdala ( p = 4.21E-07, Z = 4.92) as a neural correlate of pain associated with depression (Fig. 2 ), data contributed by five studies [ 35 – 38 , 48 ] – all were studies of pain correlated with depression. Both the left superior frontal gyrus (cluster 1, p = 3.59E-07, Z = 4.96) and the left thalamus (cluster 2, p = 8.51E-07, Z = 4.78) were also identified as neural correlates of depression associated with pain (Fig.…”

Effects of the Mindfulness-Based Blood Pressure Reduction (MB-BP) Program on Depression and Neural Structural Connectivity

“…Studies of hypertension have also explored correlations between hypertension and the diffusivity in the splenium of the corpus callosum, where hypertension was associated with lower fractional anisotropic values and significantly higher mean diffusivity in the splenium (Gons et al 2012). Hypertension is associated with decreases in white matter fractional anisotropy in the fornix as well as the stria terminalis (Williams et al 2019; Hannawi et al 2018; Sabisz, Naumczyk, Marcinkowska, Graff, Gąsecki, et al 2019), and mindfulness-based programs exert beneficial effects on structural properties of the stria terminalis (Feliu-Soler et al 2020). Individuals with fibromyalgia (who often suffer from depression) randomized to mindfulness-based stress reduction exhibit greater increases in pain-flexibility, which is associated with changes in stria terminalis grey matter (Feliu-Soler et al 2020).…”

“…Hypertension is associated with decreases in white matter fractional anisotropy in the fornix as well as the stria terminalis (Williams et al 2019; Hannawi et al 2018; Sabisz, Naumczyk, Marcinkowska, Graff, Gąsecki, et al 2019), and mindfulness-based programs exert beneficial effects on structural properties of the stria terminalis (Feliu-Soler et al 2020). Individuals with fibromyalgia (who often suffer from depression) randomized to mindfulness-based stress reduction exhibit greater increases in pain-flexibility, which is associated with changes in stria terminalis grey matter (Feliu-Soler et al 2020). It is postulated that fornix and stria terminalis related neural tracts may be primary targets for the beneficial effects of mindfulness on hypertension and related comorbidities.…”