Neural Signature for Fibromyalgia May Aid Diagnosis, Treatment

University of Colorado Boulder researchers have discovered a brain signature that identifies fibromyalgia sufferers with 93 percent accuracy, a potential breakthrough for future clinical diagnosis and treatment of the highly prevalent condition.

Fibromyalgia is commonly defined as chronic widespread musculoskeletal pain accompanied by symptoms such as fatigue, anxiety and mood disorders. The Centers for Disease Control and Prevention (CDC) estimates that fibromyalgia affects more than five million adults annually in the U.S., with significantly higher occurrence rates in women than in men.  

Historically, fibromyalgia has been difficult to diagnose and treat due to a lack of well-categorized tissue pathology and symptoms that overlap with other common chronic illnesses.

Diagnostic marker for fibromyalgia

To provide an objective diagnostic marker for fibromyalgia, researchers recently used a multisensory approach to identify a brain signature that distinguishes individuals with fibromyalgia from individuals without it. Of the 72 subjects who participated, all of whom were women, 37 had a confirmed diagnosis of fibromyalgia according to the 1990 American College of Rheumatology criteria.

The other 35 were healthy controls matched for age, education status, and handedness (all were right-handed).Participants were exposed to visual and auditory stimulation and were asked to perform a finger opposition task.

A functional magnetic resonance imaging (fMRI) based neurologic pain signature (NPS) (previously validated to predict experimental pain and discriminate it from other unpleasant/arousing emotional experiences) was applied to the subjects during pain processing. In addition, researchers discriminated patients with fibromyalgia from healthy controls using activation patterns during painful pressure (FM-pain) and during no painful multisensory stimulation.

Conclusion

Patients with fibromyalgia experienced greater NPS than healthy participants when exposed to the same painful stimuli. Furthermore, when pattern response values were combined for the NPS, FM pain, and multisensory patterns using logistic regression, this combined classifier was able to discriminate patients from healthy participants with 92% sensitivity.

To Wager, PhD, director of the cognitive and affective neuroscience laboratory and professor in the department of psychology and neuroscience and the Institute for Cognitive Science at the University of Colorado, Boulder, and author of the study, said, “Abnormal responses to multisensory events was the strongest individual predictor of whether a person had fibromyalgia. This suggests it is a systemic, rather than pain specific, neurological disorder.”

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MRI scans (fMRI) to study brain activity

CU Boulder researchers used functional MRI scans (fMRI) to study brain activity in a group of 37 fibromyalgia patients and 35 control patients as they were exposed to a variety of non-painful visual, auditory and tactile cues as well as painful pressure.

The multisensory testing allowed the researchers to identify a series of three sub-markers, or neurological patterns, that correlated with the hypersensitivity to pain that characterizes fibromyalgia. “The novelty of this study is that it provides potential neuroimaging-based tools that can be used with new patients to inform about the degree of certain neural pathology underlying their pain symptoms,” said Marina López-Solà, a post-doctoral researcher in CU Boulder’s Cognitive and Affective Control Laboratory and lead author of the new study.

“The set of tools may be helpful to identify patient subtypes, which may be important for adjusting treatment selection on an individualized basis.” The findings were recently published in the journal PAIN, published by the International Association for the Study of Pain.

Fibromyalgia is a disorder of central nervous system

“Though many pain specialists have established clinical procedures for diagnosing fibromyalgia, the clinical label does not explain what is happening neurologically and it does not reflect the full individuality of patients’ suffering,” said Tor Wager, director of the Cognitive and Affective Control Laboratory.

“The potential for brain measures like the ones we developed here is that they can tell us something about the particular brain abnormalities that drive an individual’s suffering. That can help us both recognize fibromyalgia for what it is a disorder of the central nervous system – and treat it more effectively.

” If replicated and expanded upon in future studies, the results could eventually provide a neurological road map to brain activity that would inform diagnosis and therapeutic interventions for fibromyalgia.

Neuropathophysiologic basis for the unique syndrome of fibromyalgia

The identification of a fibromyalgia-specific brain signature has the potential to launch the medical community far ahead of the past notion that the condition was in patients’ heads. According to Daniel G. Arkfeld, MD, associate professor of clinical medicine at the Keck School of Medicine of the University of Southern California (USC), and director of rheumatological education at the Keck Hospital of USC, “It is an old idea that fibromyalgia is a made-up disorder and doesn’t exist.

Results of studies such as this, as well as others that have shown high levels of substance P [a pain-promoting or algesic neurotransmitter] in the spinal fluid of patients within fibromyalgia show that there is a neuropathophysiologic basis for the unique syndrome of fibromyalgia.”

Finding the best treatment

The use of such a brain signature has implications beyond improving fibromyalgia diagnosis. “There is a need for objective measures in fibromyalgia. This research may help point toward appropriate targets for a more directed approach in treating fibromyalgia,” said Dr. Arkfeld. Dr. Wager concurred, “We need to diagnose patients and group them based on the underlying neuropathology. Then we have a better chance of finding the best treatments based on an individual’s biology.”

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Reference:

• Neural Signature for Fibromyalgia May Aid Diagnosis, Treatment by University of Colorado at Boulder via laboratoryequipment.com
• Featured Image : An MRI image showing the multivariate brain pattern that predicts fibromyalgia status on the basis of brain activation during multisensory stimulation. (Credit: Cognitive and Affective Control Laboratory / University of Colorado Boulder.)