MI - A new brain-scan study confirms scientifically what fibromyalgia
patients have been telling a skeptical medical community for years:
They're really in pain.
fact, the study finds, people with fibromyalgia say they feel severe
pain, and have measurable pain signals in their brains, from a gentle
finger squeeze that barely feels unpleasant to people without the
disease. The squeeze's force must be doubled to cause healthy people
to feel the same level of pain - and their pain signals show up
in different brain areas.
published in the May issue of Arthritis
& Rheumatism, the journal of the American College of
Rheumatology, may offer the proof of fibromyalgia's physical roots
that many doubtful physicians have sought. It may also open doors
for further research on the still-unknown causes of the disease,
which affects more than 2 percent of Americans, mainly women.
Richard Gracely, Ph.D., and Daniel Clauw, M.D., did the study at
Georgetown University Medical Center and the National Institutes
of Health, but are now continuing the work at the University
of Michigan Health System. In an editorial in the same issue,
Clauw and U-M rheumatologist Leslie Crofford, M.D., stress the importance
of fibromyalgia research and care.
subjective pain sensation with objective views of brain signals,
the researchers used a super-fast form of MRI brain imaging, called
functional MRI or fMRI, on 16 fibromyalgia patients and 16 people
without the disease. As a result, they say, the study offers the
first objective method for corroborating what fibromyalgia patients
report they feel, and what's going on in their brains at the precise
moment they feel it. And, it gives researchers a road map of the
areas of the brain that are most - and least - active when patients
technology gave us a unique opportunity to look at the neurobiology
underlying tenderness, which is a hallmark of fibromyalgia,"
says Clauw. "These results, combined with other work done by
our group and others, have convinced us that some pathologic process
is making these patients more sensitive. For some reason, still
unknown, there's a neurobiological amplification of their pain signals."
from the study were presented last year at the ACR annual meeting.
The project will continue later this year at UMHS, joining other
fMRI fibromyalgia research now under way.
For decades, patients and physicians have built a case that fibromyalgia
is a specific, diagnosable chronic disease, characterized by tenderness
and stiffness all over the body as well as fatigue, headaches, gastrointestinal
problems and depression. Many patients with the disease find it
interferes with their work, family and personal life. Statistics
show that far more women than men are affected, and that it occurs
mostly during the childbearing years.
The ACR released
classification criteria for fibromyalgia in 1990, to help doctors
diagnose it and rule out other chronic pain conditions. Clauw and
Crofford's editorial looks at the current state of research, and
calls for rheumatologists to take the lead in fibromyalgia care
But many skeptics
have debated the very existence of fibromyalgia as a clearly distinct
disorder, saying it seemed to be rooted more in psychological and
social factors than in physical, biological causes. Their argument
has been bolstered by the failure of research to find a clear cause,
an effective treatment, or a non-subjective way of assessing patients.
While the debate
has raged, neuroscientists have begun to use brain scan technology
to identify the areas of the normal human brain that become most
active during pain. A few studies have even assessed the blood flow
in those areas in fibromyalgia patients during baseline brain scans.
The new study is the first to use both high-speed scanning and a
In the study,
fibromyalgia patients and healthy control subjects had their brains
scanned for more than 10 minutes while a small, piston-controlled
device applied precisely calibrated, rapidly pulsing pressure to
the base of their left thumbnail. The pressures were varied over
time, using painful and non-painful levels that had been set for
each patient prior to the scan.
design gave two opportunities to compare patients and controls:
the pressure levels at which the pain rating given by patients and
control subjects was the same, and the rating that the two different
types of participants gave when the same level of pressure was applied.
found that it only took a mild pressure to produce self-reported
feelings of pain in the fibromyalgia patients, while the control
subjects tolerated the same pressure with little pain.
patients, that same mild pressure also produced measurable brain
responses in areas that process the sensation of pain," says
Clauw. "But the same kind of brain responses weren't seen in
control subjects until the pressure on their thumb was more than
activity increased in many of the same areas in both patients and
control subjects, there were striking differences too. Patients
feeling pain from mild pressure had increased activity in 12 areas
of their brains, while the control subjects feeling the same pressure
had activation in only two areas. When the pressure on the control
subjects' thumbs was increased, so did their pain rating and the
number of brain areas activated. But only eight of the areas were
the same as those in patients' brains.
In all, the
fibromyalgia patients' brains had both some areas that were activated
in them but not in controls, and some areas that stayed "quiet"
in them but became active in the brains of controls feeling the
same level of pain. This response suggests that patients have enhanced
response to pain in some brain regions, and a diminished response
in others, Clauw says.
The study was
supported in part by the National Fibromyalgia Research Association,
the U.S. Army and the NIH. In addition to Clauw and Gracely, the
research team included Frank Petzke, M.D.; and Julie M. Wolf, BA.
on this release
study on fibromyalgia pain explores basic brain science and its
connection with pain perception. It does not suggest specific new
treatment options, and the participants did not receive any pain
relief from taking part in the study. We do hope to continue this
line of research in the future, and we will need more research volunteers
at that time. Many of our future studies will attempt to learn more
about the basic root causes of fibromyalgia - - they will not seek
to ease the symptoms of participants.
If you have
been diagnosed with fibromyalgia and would like to be contacted
with further information about participating in fibromyalgia research
at the University of Michigan, please call 800-742-2300, and enter
category 6501. After listening to the recording, press 1 to leave
your name, phone number, location and age after the tone.
If you are
seeking treatment for fibromyalgia, please call the Arthritis Foundation
at 1-800-283-7800 to learn how to find a specialist near you. You
can also visit their web site, www.arthritis.org,
and enter your ZIP code to find the chapter nearest you.
for your interest in fibromyalgia research at the University of
Michigan Health System. We are glad to help improve the scientific
understanding of fibromyalgia, and we hope our work may some day
lead to better treatment strategies for everyone with this condition.
NOTE FOR REPORTERS:
Click here to read the entire research
paper. If you'd like to arrange an interview with Dr. Clauw, Dr.
Gracely, or Dr. Crofford, please call UMHS Public Relations at 734-764-2220
or send e-mail to firstname.lastname@example.org.
Several fibromyalgia patients, not involved in this study, have
agreed to make themselves available for interviews on their experience
with the disease.
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