Fibromyalgia: Scan Reveals Increased Brain Activation in Pain, Emotion and Affect Areas

MedicalResearch.com Interview with:
Daniel S. Albrecht, Ph.D.

Research Fellow, Department of Radiology
Harvard Medical School

MedicalResearch.com: What is the background for this study? Can you briefly describe what is meant by fibromyalgia?

Response: Fibromyalgia (FM) is a poorly understood chronic condition characterized by widespread musculoskeletal pain, fatigue, unrefreshing sleep, memory deficits and attention difficulties, among other symptoms. FM affects an estimated 4 million adults in the U.S., but despite this prevalence, effective therapies for treating FM are lacking.

This combined MR/PET image highlights areas of the brain in which patients with fibromyalgia were found to have increased glial activation, compared with unaffected control volunteers. Credit: Marco Loggia, PhD, Martinos Center for Biomedical Imaging, Massachusetts General Hospital

This combined MR/PET image highlights areas of the brain in which patients with fibromyalgia were found to have increased glial activation, compared with unaffected control volunteers.
Credit: Marco Loggia, PhD, Martinos Center for Biomedical Imaging, Massachusetts General Hospital

Part of the reason for the paucity of effective therapeutics is insufficient knowledge of the underlying mechanisms contributing to FM. Previous work from co-senior author of the current manuscript, Eva Kosek, MD, PhD, and collaborators at the Karolinska Institute in Sweden found elevated inflammatory molecules in the cerebrospinal fluid of FM patients, which could be reflective of brain neuroinflammation in these patients. However, no study had directly assessed the presence of neuroinflammation in the brain of FM patients.

Co-senior author of the study, Marco Loggia, PhD, and collaborators showed in a 2015 Brain publication that individuals with chronic low back pain (cLBP) exhibit evidence of brain neuroinflammation, specifically activation of glial cells. Our team utilized simultaneous MR/PET imaging to image brain levels of the 18 kDa translocator protein (TSPO), which is widely used as a marker of glial activation due to vast upregulation of TSPO in glial cells, e.g. microglia and astrocytes, in preclinical models of inflammation and neurological disease. Dr. Loggia sought to extend these finding in cLBP to FM, hypothesizing that activation of glial cells may also be associated with FM pathology. To this end, we used the same TSPO PET tracer to image 20 FM patients and 16 healthy controls.

During a conference where I was presenting preliminary results of the fibromyalgia study, Dr. Loggia met with Dr. Kosek and discovered that, across the Atlantic, her group was performing a very similar study, imaging 11 FM patients and 11 controls with the same TSPO PET compound. They decided to form a collaboration, and logistic talks began to determine the best strategy to combine and analyze the separate datasets. In addition to PET imaging with the TSPO tracer, which is suggested to reflect activated microglia and astrocytes, Dr. Kosek’s group also collected PET scans using a tracer thought to bind specifically to astrocytes rather than microglia. This tracer was used in order to discern the relative contributions of microglia and astrocytes to any observed differences in TSPO PET signal.

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Tai Chi At Least As Beneficial As Standard Therapy For Fibromyalgia

MedicalResearch.com Interview with:
“tai chi 11.4.09” by Luigi Scorcia is licensed under CC BY 2.0Chenchen Wang MD, MSc
Professor of Medicine
Tufts University School of Medicine
Director, Center For Complementary And Integrative Medicine
Division of Rheumatology
Tufts Medical Center Boston, MA 02111 

MedicalResearch.com: What is the background for this study?

Response: Patients with chronic widespread pain often try many different types of pain medications, anti-depressants, physical therapy, and other approaches, and commonly find that none of these therapies work for them. Finding safe, effective approaches for pain management is an urgent priority. Previous evidence suggested that Tai Chi, a multi-dimensional mind-body practice that integrates physical, psychosocial, and behavioral elements, may be especially suited to address both chronic pain and associated psychological and somatic symptoms. In our most recent study published in the BMJ, we directly compared the effectiveness of Tai Chi versus aerobic exercise, which is a standard care non-drug treatment for fibromyalgia. Continue reading

RNA-based Blood Test Can Detect Fibromyalgia

MedicalResearch.com interview with:

Dr. Chase Spurlock, PhD CEO, IQuity, Specialty Diagnostic Technologies Faculty, Vanderbilt University Medical Center

Dr. Chase Spurlock

Dr. Chase Spurlock, PhD
CEO, 
IQuitySpecialty Diagnostic Technologies
Faculty, Vanderbilt University Medical Center

Dr. Spurlock discusses IQuity’s release of IsolateFibromyalgia, the first RNA-based blood test to detect fibromyalgia.

MedicalResearch.com: What is the background for this test? Would you briefly explain what fibromyalgia is, whom it affects and why it has been difficult to definitely diagnosis? 

Dr. Spurlock: We developed the IsolateFibromyalgia™ test using our established RNA assay platform, IQIsolate™, to help clinicians receive timely and accurate information. This technology has evolved from over a decade of research at Vanderbilt University and continues at IQuity funded by both the National Institutes of Health (NIH) as well as private investors. We discovered that differences in RNA expression patterns could be detected in patients with a variety of human conditions spanning infection to more complex inflammatory diseases. With our focus on autoimmune disease, we identified and validated RNAs capable of distinguishing multiple sclerosis, IBS, Crohn’s, ulcerative colitis and fibromyalgia syndrome. In the case of fibromyalgia, our research involved almost 600 subjects including healthy individuals, patients with endocrine conditions, dermatologic conditions and rheumatologic diseases — rheumatoid arthritis, Sjogren’s syndrome and systemic lupus erythematosus. Reported sensitivity and specificity of this assay is 92 percent and 96 percent, respectively.

Fibromyalgia syndrome is characterized by widespread musculoskeletal pain often initially localized to the neck and shoulders. Patients typically describe pain throughout the muscles but may also report pain in the joints. Furthermore, fibromyalgia is usually accompanied by fatigue as well as cognitive disturbance. Patients most afflicted are women between ages 20 and 55. Fibromyalgia affects approximately as many as 6-10 million people in the U.S.

The difficulty in reaching a definitive diagnosis lies in two important issues. First, the cause of the syndrome is unknown, and the way the condition presents and progresses can vary among patients. Secondarily, fibromyalgia syndrome mimics many other conditions due to the multiple nonspecific symptoms associated with fibromyalgia. Patients look well, there are no obvious abnormalities on physical examination other than tenderness, and laboratory and radiologic studies are normal. With no discernable abnormalities in routine clinical laboratory testing or imaging, the diagnosis is based on subjective reporting of symptoms.

The difficulties and complex nature of receiving a correct fibromyalgia diagnosis are apparent. Despite improved awareness among primary care clinicians, many continue to be uncomfortable with making this diagnosis. Fibromyalgia patients on average wait almost a year after experiencing symptoms before seeing a physician and end up visiting on average 3.7 different physicians before a diagnosis. The diagnostic journey can take years. IsolateFibromyalgia provides the clinician and patient actionable information with 94 percent accuracy.

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Emotional Awareness and Expression Therapy Reduced Pain of Fibromyalgia

MedicalResearch.com Interview with:
Mark A. Lumley, Ph.D.
Distinguished Professor and Director of Clinical Psychology Training
Department of Psychology
Wayne State University
Detroit, Michigan  48202 and
Howard Schubiner, M.D
Founder and Director Mind-Body Medicine Center
Providence-Providence Park Hospitak
Warren, MI 48092 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Fibromyalgia is a condition that afflicts many people with chronic pain and other symptoms, which are often severe. There is no clear evidence of tissue damage or other peripheral causes of the symptoms, and experts agree that the pain is real, and its primary source is the brain. Medications for fibromyalgia have limited effectiveness, so psychological and behavioral therapies are core to treatment.

Research documents a strong relationship between emotions and pain, and many patients with FM struggle with negative emotions related to difficult life circumstances, such as trauma, abuse, or relationship conflicts. Ironically, most psychological therapies for FM do not address these problems, but rather teach people how to manage their symptoms. Emerging research, however, demonstrates that therapies that help patients engage rather than avoid their difficult emotional experiences improve both psychological and physical symptoms, including pain. Therefore, we developed an emotion-focused therapy, which we call Emotional Awareness and Expression Therapy (EAET), and compared it to both an active education-based control condition and to the leading psychological intervention for fibromyalgia, cognitive-behavior therapy (CBT).

The EAET condition was substantially better on multiple outcomes that the control condition 6 months after treatment. Importantly, although EAET did not differ from CBT on many outcomes, EAET was superior than CBT on reducing widespread and in the percentage of individuals achieving substantial pain reduction (that is, at least 50% pain reduction from baseline).

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Spine Pain Patients: Prevalence of Fibromyalgia in Tertiary Pain Clinic

 Chad M. Brummett, M.D. Assistant Professor, University of Michigan Health System Department of Anesthesiology Division of Pain Medicine 1500 East Medical Center Drive, 1H247 UH, Box 5048 Ann Arbor, MI 48109MedicalResearch.com Interview with:
Chad M. Brummett, M.D.
Assistant Professor, University of Michigan Health System
Department of Anesthesiology
Division of Pain Medicine
1500 East Medical Center Drive, 1H247 UH, Box 5048
Ann Arbor, MI 48109


MedicalResearch.com:  What are the main findings of the study?

Dr. Brummett: The study found that 42% of new patients presenting to a tertiary care pain clinic with a primary spine pain diagnosis met the American College of Rheumatology (ACR) survey criteria for fibromyalgia, which is a measure of widespread body pain and comorbid symptoms (e.g. trouble thinking, fatigue, mood symptoms, etc.).  Patients categorized as fibromyalgia-positive using the survey measure were distinctly different from those not meeting criteria.  In a multivariate regression model, independent predictors of being categorized as fibromyalgia-positive were female sex, higher neuropathic pain scores, anxiety, and lower physical function.
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