Andrea Truini1, Emanuele Tinelli1, Maria Chiara Gerardi2, Valentina Calistri3, Cristina Iannuccelli4, Silvia La Cesa1, Lorenzo Tarsitani1, Caterina Mainero5, Piercarlo Sarzi-Puttini6, Giorgio Cruccu1, Francesca Caramia1, Manuela Di Franco4. 1. Department of Neurology and Psychiatry, Sapienza University of Rome, Italy. 2. Rheumatology Unit, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Italy. mariachiara.gerardi@gmail.com. 3. Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy. 4. Rheumatology Unit, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Italy. 5. Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston; and Harvard Medical School, Boston, MA, USA. 6. Rheumatology Unit, Luigi Sacco University Hospital, Milan, Italy.
Abstract
OBJECTIVES: Emerging evidence associates chronic pain syndrome, such as fibromyalgia, with endogenous pain modulatory system dysfunction, leading to an impaired descending pain inhibition. In this study, using resting-state functional magnetic resonance imaging (fMRI), we aimed at seeking possible functional connectivity changes of the periaqueductal gray (PAG), a brainstem area that belongs to the endogenous pain modulatory system, in patients with fibromyalgia. METHODS: In 20 patients with fibromyalgia and 15 healthy subjects, we investigated PAG functional connectivity using resting-state fMRI. We also analysed the correlation between clinical variables, such as pain severity, disease duration, and depressive personality traits with PAG functional connectivity. RESULTS: Compared with control subjects, we identified that patients with fibromyalgia had an increased PAG connectivity with insula, anterior cingulate cortex, and anterior prefrontal cortex. The functional connectivity between PAG and the rostral ventral medulla, however, was not concordantly increased. PAG functional connectivity correlated with pain severity, disease duration, and the depressive personality trait rating. CONCLUSIONS: Our fMRI study showing abnormal resting state functional connectivity of the PAG suggests that patients with fibromyalgia have an endogenous pain modulatory system dysfunction, possibly causing an impaired descending pain inhibition. This abnormal PAG functioning might underlay the chronic pain these patients suffer from.
OBJECTIVES: Emerging evidence associates chronic pain syndrome, such as fibromyalgia, with endogenous pain modulatory system dysfunction, leading to an impaired descending pain inhibition. In this study, using resting-state functional magnetic resonance imaging (fMRI), we aimed at seeking possible functional connectivity changes of the periaqueductal gray (PAG), a brainstem area that belongs to the endogenous pain modulatory system, in patients with fibromyalgia. METHODS: In 20 patients with fibromyalgia and 15 healthy subjects, we investigated PAG functional connectivity using resting-state fMRI. We also analysed the correlation between clinical variables, such as pain severity, disease duration, and depressive personality traits with PAG functional connectivity. RESULTS: Compared with control subjects, we identified that patients with fibromyalgia had an increased PAG connectivity with insula, anterior cingulate cortex, and anterior prefrontal cortex. The functional connectivity between PAG and the rostral ventral medulla, however, was not concordantly increased. PAG functional connectivity correlated with pain severity, disease duration, and the depressive personality trait rating. CONCLUSIONS: Our fMRI study showing abnormal resting state functional connectivity of the PAG suggests that patients with fibromyalgia have an endogenous pain modulatory system dysfunction, possibly causing an impaired descending pain inhibition. This abnormal PAG functioning might underlay the chronic pain these patients suffer from.
Authors: Marina López-Solà; Choong-Wan Woo; Jesus Pujol; Joan Deus; Ben J Harrison; Jordi Monfort; Tor D Wager Journal: Pain Date: 2017-01 Impact factor: 7.926
Authors: Manyoel Lim; Dajung J Kim; Thiago D Nascimento; Eric Ichesco; Chelsea Kaplan; Richard E Harris; Alexandre F DaSilva Journal: Neuromodulation Date: 2021-07-26