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 The small new study provides clues to what might be going wrong in
the nervous system of people with fibromyalgia, along with possible
new approaches to alleviating their pain.
“If we understand the mechanism, we may come up with new and
potentially better forms of treatment,” said lead author Marina
López-Solà of the department of Psychology and Neuroscience at the
University of Colorado, Boulder.
Fibromyalgia, which patients experience as widespread muscle pain
and fatigue, affects as many as five million Americans, most
commonly middle-aged women, according to the U.S. Department of
Health and Human Services.
Its cause is unknown and there is no cure, but medications can treat
the symptoms.
The new results suggest not only that fibromyalgia is related to
greater processing of pain-related signals, but also potentially to
a misprocessing of other types of non-painful sensory signals that
may be important to address during treatment, Lopez-Sola told
Reuters Health by email.
She and her team used "functional magnetic resonance imaging," which
measures blood flow changes in the brain, to assess brain responses
among 35 women with fibromyalgia and 25 similar women without the
disorder.
The fibromyalgia patients were more sensitive to non-painful
stimulation compared to people without the disorder, they report in
Arthritis and Rheumatism.
Researchers showed the subjects some colors, played some tones and
asked subjects to perform very simple motor tasks at the same time,
like touching the tip of the right thumb with another finger.
Areas of the brain’s cortex primarily responsible for processing
visual, auditory and motor signals were significantly activated in
the healthy comparison group, but not in the fibromyalgia group.
However, other brain regions that are not relevant for primary
processing were activated in fibromyalgia sufferers but not in
healthy controls.
What seems to be happening is that the brains of fibromyalgia
patients are under-processing certain forms of sensory information
at the first stages of processing, but are also amplifying the
signal at a later level of sensory integration of multiple sensory
inputs, Lopez-Sola said.
“When you are in pain, it is probable that you are more concentrated
on your own pain than on the tasks you have to pay attention to,”
said Dr. Pedro Montoya of the Research Institute on Health Sciences
at the Universitat Illes Balears in Palma de Mallorca, Spain, who
was not part of the new study.
“For me, these findings provide further support for the idea that
psychological strategies aimed at changing the focus of attention
from the body to external cues could be useful for these patients,”
Montoya said.
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There were only a small number of people involved in the study, and
the researchers did not account for other mental health conditions
the participants may have had, both factors that limit the results,
said Dr. Winfried Hauser, associate professor of Psychosomatic
Medicine at Technische Universitat Munchen in Germany.
People with fibromyalgia often also have conditions like depression,
so some people believe the disorder has a mental basis, said Michael
E. Geisser, professor in the department of physical medicine and
rehabilitation at the University of Michigan in Ann Arbor.
But evidence for a neuro-anatomical basis for fibromyalgia is
growing, said Geisser, who was not part of the new study.
“There is increasing evidence that fibromyalgia is not just a pain
condition,” he told Reuters Health by email. “More recent research
done on persons with fibromyalgia, such as the research by
Lopez-Sola and colleagues, suggests that persons with fibromyalgia
suffer from a central processing deficit of multiple types of
sensory stimuli, not just pain.”
“It’s as if the volume control for sensation in persons with
fibromyalgia is turned up, or louder, for many types of sensation
compared to persons without the disorder,” he said.
That might help explain why many people with fibromyalgia also often
suffer from fatigue, cognitive problems or mood disturbance, Geisser
said.
Currently, people with the disorder can take anticonvulsant
medications, such as pregabalin (Lyrica), and antidepressants such
as duloxetine (Cymbalta) and milnacipran (Savella), which have been
FDA approved for treating fibromyalgia.
Further research to improve understanding of where there are
problems in the brain for people with the disorder could lead to the
development of new treatments, Geisser said.
For example, it would be interesting to see if a treatment targeted
at dampening response in an area of the brain that “overreacted” in
this study helped to treat fibromyalgia symptoms, he said.
SOURCE: http://bit.ly/1mbOikg Arthritis and Rheumatism, online
September 15, 2014.
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