In the first part of fibromyalgia , we discuss the evolution of the understanding of the disease , which was originally intended to be an emotional disorder or psychiatric various forms of muscle disease peripheral nerve disorder and brain dysfunction a full tower . Although the diagnostic criteria for fibromyalgia are available for 2 decades , there is no definitive diagnostic test and there is no consensus as to its etiology.
In the second part , we will examine some evidence to suggest fibromyalgia is a disorder of brain dysfunction . Ultimately, the aim of the second part is to identify and characterize the abnormal functioning of the various regions of the brain that have been reported in the recent literature in neuroscience and propose possible natural methods to correct these problems. This represents a major step forward in the treatment of fibromyalgia, as it is an attempt to identify the specific dysfunction and restore normal function of the brain first. Current treatment of fibromyalgia focuses on the management does not restore the function of the symptoms .
Characteristic of fibromyalgia is chronic widespread pain perception in the absence of an identifiable cause . Depression and anxiety, sleep disorders and emotional problems are also often found in patients with fibromyalgia. Therefore , it seems that there are a number of additional anomalies beyond abnormal pain perception in patients with fibromyalgia. This suggests a broad participation in a number of brain regions.
Among the secondary outcomes associated frequently observed in patients with chronic pain in general , and fibromyalgia patients , in particular, are signs of cognitive dysfunction , memory problems , and a process of greater brain called executive function ( the ability to understand the sequence and perform complex tasks ) .
Fibromyalgia patients often have symptoms of cognitive impairment , which can sometimes be demonstrated by clinical studies. A simple bedside test , known as the test clock is often considered abnormal in patients with fibromyalgia. In this test, the patient is invited to the first , a picture of a clock, then you are invited to set the clock hands to illustrate a particular time. This task evaluates a number of functions of the cortical region of the forebrain . Varying degrees of disability to draw exactly the face of a clock and then adjust clockwise at a particular time are used to evaluate the different lobes of the brain, particularly the frontal lobes. This simple test when patients diagnosed with fibromyalgia suggests administered altered frontal brain function and other parts of the brain normally associated with pain. So patients with fibromyalgia seem to have alterations in brain function that goes beyond the treatment of pain. Much more sophisticated brain function in fibromyalgia research supports this theory. Let's review some recent studies on brain function and fibromyalgia.
There are a number of brain imaging that allows researchers to literally see how the brain responds metabolically to various types of stimulation techniques . For the most part , rely on MRIs , but go beyond standard MRI in an increase or decrease in brain metabolism ( and therefore implicit hyper or hypo function) is. Because they are a test of brain function are called functional imaging , MRI, or fMRI for short. For simplicity, said the increased activity observed in these trials ( known brain activation region ) is when a region of the brain "lights " in the analysis. Conversely brain known as deactivation name can also be documented by the use of this technology . These tests are useful in unraveling complex disease processes such as fibromyalgia, as they can show that "light " areas of the brain that are disabled and how these brain responses to compare patients with fibromyalgia and healthy patients as controls . Since fibromyalgia is a chronic pain condition , it is logical that a number of researchers scanned patents with fibromyalgia and pain stimulus used to observe how the brain responds to pain of fibromyalgia. They did the exact same thing in a group of patients without fibromyalgia so that they can compare the brain responses between patients diagnosed with fibromyalgia and those without evidence of fibromyalgia. The results are interesting .
FMRI revealed that fibromyalgia patients had less activation in the right prefrontal cortex - motor, supplementary motor area , the cingulate mid, putamen , and after controlling anxiety in the lower right and turn right frontal insular cortex .
Wow , what does that mean ? Without going into a lesson in neuroanatomy and neurophysiology , the study revealed deficiencies in certain areas of pain in the brain in patients with fibromyalgia, but also found anomalies in addition domains associated with muscle movement and emotional processing may also be . These results represent an abnormal metabolism in the brain of patients with fibromyalgia have not been found in patients who were free of fibromyalgia. The authors of this study concluded that fibromyalgia in parts of the brain that are designed to suppress the pain was defective.
Researchers at the University of Michigan looked infusion (mainly blood ) from different regions of the brain in patients with fibromyalgia compared with control patients without fibromyalgia .
They found regional blood flow in the brain a part of the brain believed to be associated with pain, the thalamus is abnormal in patients with fibromyalgia compared to blood flow in the brain structure in patients with fibromyalgia do not .
Another researcher from Spain reported differences in brain activation patterns between patients with fibromyalgia and healthy controls. Fibromyalgia patients showed exaggerated resting pressure . This is similar to the pressure test is used to clinically diagnose patients with fibromyalgia.
fMRI maps following (pressure ) stimulation showed a net total pain response ( sensory- motor cortex , operculum - insula, cingulate cortex and basal ganglia ) to the pressure of light is measured in patients with fibromyalgia. By contrast , the response of the subject to health control this low amount of pressure is mainly engaged somatosensory ( touch response of the brain, no pain) cortex. When combined with the perception of pain , control subjects also showed full activation of pain-related areas , but fibromyalgia patients showed significantly greater activation in the anterior part of the complex lymph basic insulation and cingulate cortex. ( Amplification in pain processing pathways ) .
Researchers in Italy used a known type tests such as magnetic resonance spectroscopy or MRS study comparing patients with fibromyalgia fibromyalgia no different controls. This test MRS can noninvasively measure some of the chemical components in the different parts of the brain . With this different technology, like their colleagues in Michigan have found abnormalities in different brain regions when the results of the analyzes conducted in fibromyalgia patients and controls fibromyalgia patients are compared.
What they found was different chemicals in the frontal cortex conclusion that the presence of high levels of Glu / Cr ( portions of brain chemicals ) in specific regions of the frontal region of the brain reinforces the view that the complex neurophysiologic imbalance different regions of the brain involved in pain behind FM .
Other researchers support the findings of altered brain chemistry in the brain of patients with fibromyalgia specific regions .
Studies using magnetic resonance spectroscopy of protons suggest that glutamate (Glu ), an excitatory neurotransmitter key , may be present at higher levels in the brains of patients with fibromyalgia concentrations. This neurotransmitter imbalance is present in several brain regions that were involved in the processing of pain information .
Since glutamate is known to excite the nervous system , these results suggest that the increased levels of this excitatory chemical in associated with the processing of the brain levels of pain areas could be responsible for further reaction to painful stimuli is the hallmark of fibromyalgia.
A team of researchers from the University of Florida, has compared the actual volume of brain substances in different brain in patients with fibromyalgia and healthy controls. Their findings add to the growing evidence that certain brain regions are abnormal in patients with fibromyalgia.
We found that patients with fibromyalgia have significantly lower volumes of gray matter than healthy controls patients in three specific brain regions, including the anterior and mid- cingulate cortex and insular cortex middle . Using a more rigorous analysis than in other studies provide evidence for reduced gray matter (nerve cells in the real brain) in a number of brain areas related to pain in patients with fibromyalgia volumes.
Although the mechanisms of these changes in the gray matter are presently unclear , may contribute to some of the basic features of this chronic disease, such as affective disorders and chronic widespread pain.
Researchers in London have found a similar loss of gray matter in the brain of patients with fibromyalgia and chronic fatigue.
This study aims to test the hypothesis that changes in gray matter structural brain can occur in chronic intractable pain disorder fibromyalgia. The study results showed that the gray matter density less significantly in patients with fibromyalgia and fatigue marked ( CFS ) in the left supplementary motor area . This brain region plays an important role in cognitive control or direction and translating the painful knowledge; these functions are altered in fibromyalgia associated with marked fatigue
German scholar even report the loss of neurons in the brain (loss of gray matter volume ) in patients with fibromyalgia :
Studies in FMS with functional neuroimaging support the hypothesis of increased central pain ( amplification) . Fibromyalgia patients showed a decrease in the volume of gray matter in the prefrontal cortex, the amygdala and the anterior cingulate
Research in Denmark has adopted a slightly different approach investigated function of the central nervous system . Brain function called " descending pain inhibition " , which is a function responsible for the extinction of the perception of pain caused by the body including brain saw . In normal subjects without fibromyalgia , sustained muscle contraction that activates downstream circuit pain inhibition . Therefore in most patients and exercise therapy can be used to treat pain . However, in patients with fibromyalgia pain rather than inhibit , the downlink channel brain amplified pain actually . Researchers concluded that
Descending pain modulation (control) descending inhibition (reduction of pain) to descending facilitation ( increased pain ) moves after muscle contraction in fibromyalgia.
Other researchers support the hypothesis that the suppression circuit descendants pain are abnormal in patients with fibromyalgia.
We focus our analysis on two areas in which there is strong evidence of sensory abnormalities
Signaling reducing down control , including the removal from below and / or improvement of roads facilitating descending inhibitory pathways , and changes in key neurotransmitters associated with central sensitization .
A team of Sweden , further characterized faulty circuits modulate pain in patients with fibromyalgia :
Fibromyalgia patients showed an increased sensitivity to pain induction than controls because they require less pressure to evoke the grandeur of equal pain. Despite lower pressures are applied in fibromyalgia patients - fMRI analysis revealed no differences in activity in brain regions associated with attention and sensory regions assign or projections of the body area stimulated. However, the primary link in the system of regulation of pain down ( the rostral anterior cingulate cortex ) patients did not respond to the provocation of pain. The author concluded that
attenuated pain response observed in this brain region is the first demonstration of a specific region of the brain where the deterioration of pain inhibition in FM patients is expressed.
This may be one explanation why many fibromyalgia patients have difficulty tolerating the year. Normal muscle activity based brain lights descending pain pathways that reduce pain . These appear to be at least fibromyalgia ineffective and at worst could enhance the perception of pain. Researchers in Germany have reported similar results. They created experimental pain stimuli in control patients with fibromyalgia and healthy controls. When they built muscle aches they found:
Repetitive ( painfully ) induced excitation of muscle tissue leads to a perception of pain longer and more widespread activation in brain areas related to pain in patients with fibromyalgia. This altered brain activity was observed mainly in the left ( ipsilateral side of it ~ ) insula region of the brain , the contrast between the groups (patients with fibromyalgia compared with healthy controls) showed significantly greater activation for fibromyalgia patients in the insula above left. Kitchenware researcher found that peak pain scores were comparable between controls and patients with fibromyalgia, but the duration of pain ( prolonged pain ) spread in fibromyalgia
Researchers from Massachusetts General Hospital have found abnormalities in the interaction between different brain structures in patients with fibromyalgia. Using a technique to evaluate how different parts of the brain communicate with each other (called functional network connectivity ) , these researchers found abnormalities appear to be specific for patients diagnosed with fibromyalgia. report :
These results indicate that the brain activity at rest in multiple networks is associated with clinical spontaneous pain in patients with fibromyalgia . These findings may have broader implications for how subjective experiences such as pain caused by a complex interaction between multiple brain networks.
A team of researchers from France Similar findings have changed the brain that is related to abnormalities in several specific chemical neurotransmitters in specific parts of the brain in patients with network connectivity of fibromyalgia :
Cortical excitability and cortical modulation ( brain network connectivity ) systematically by transcranial magnetic stimulation ( TMS) of the motor cortex in fibromyalgia patients was evaluated. Fibromyalgia is associated with deficits in cortical modulation involving both GABAergic and glutamatergic mechanisms that could be related to some aspects of the pathophysiology of this chronic pain syndrome . Our data adds to the growing evidence of objective and quantifiable in brain function changes in fibromyalgia.
So what does all this mean and how can we use it to help patients with fibromyalgia ? The welcome message most important decision is that there are specific brain regions that do not work correctly in patients suffering from fibromyalgia. We now have a fairly clear idea of the structure of the brain that are abnormal. In addition , we now have a good understanding of most chemical abnormalities in these brain regions .
So the next logical step is to discuss targeted therapies that could influence specific areas of abnormal brain function in patients with fibromyalgia. Restore the treatment of pain in the brain through a normal function . There are a number of methods and techniques that we can apply .
Then we can consider how to balance and modulate abnormal chemical in specific brain regions discussed in the previous article.
Based on some of the same types of studies discussed in this article, seems to have the tools to re- integrate both brain function and brain chemistry balance in patients with fibromyalgia. How do we do ? You'll have to read the third part of our series on fibromyalgia . Stay tuned .
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