Variations in brain gray matter associated with chronic pain.

Variations in brain gray matter volume and density have been reported in association with a variety of disorders characterized by chronic pain, including chronic low back pain, fibromyalgia, and irritable bowel syndrome. Correlation analyses have demonstrated relationships between morphometric and clinical variables. However, conclusions regarding the nature of these relationships are problematic given that currently available data are derived exclusively from cross-sectional studies.

Enhanced pain perception in rheumatoid arthritis: novel considerations.

Enhanced pain perception is common among patients with rheumatoid arthritis (RA). Given the putative role of proinflammatory cytokines in the development of hyperalgesia, a greater understanding of factors that facilitate increased cytokine expression in RA stands to increase understanding of the sources of enhanced pain perception. Patients with RA have significantly greater stress-induced proinflammatory cytokine release.

Changes in hippocampal metabolites after effective treatment for fibromyalgia: a case study.

Background: Fibromyalgia has been associated with disrupted hippocampal brain metabolite ratios by studies using single voxel magnetic resonance spectroscopy (1H-MRS). Exposure to stress is considered a risk factor for the development and exacerbation of fibromyalgia symptoms. Basic science has demonstrated the hippocampus to be exquisitely sensitive to the effects of stressful experience, which results in changes including alterations in metabolite content and frank atrophy.

Symptom clusters in fibromyalgia: potential utility in patient assessment and treatment evaluation.

Background: Recent evidence points to the likelihood of heterogeneity in the presentation and, perhaps, etiology of fibromyalgia (FM). A clearer understanding of the symptomatology and consideration of potential FM subtypes could add insights regarding this condition.

Objective: The aim of this study was to determine whether clusters could be identified among 20 symptoms that participants in a prior online study identified and to elucidate the underlying structure of resultant clusters.

Changes in gray matter density in fibromyalgia: correlation with dopamine metabolism.

Unlabelled: Fibromyalgia (FM) has been associated with alterations in brain morphometry and abnormal dopaminergic neurotransmission. Evidence from preclinical models has demonstrated that dopamine plays a role in promoting neuronal integrity. We therefore sought to confirm previous findings of reduced gray matter density in subjects with FM and to determine whether variations in dopamine metabolism might affect gray matter density.

Hippocampal metabolite abnormalities in fibromyalgia: correlation with clinical features.

Unlabelled: Although the pathology of fibromyalgia is poorly understood, a growing body of evidence suggests involvement of the central nervous system. The hippocampus is a brain center that is sensitive to the effects of stress exposure and has been demonstrated to be affected in a variety of disorders whose onset, like fibromyalgia, are associated with stressful experience. We therefore interrogated the bilateral hippocampus of 16 female fibromyalgia patients in comparison to 8 age- and gender-matched healthy control subjects using single voxel proton magnetic resonance spectroscopy.

Role of central dopamine in pain and analgesia.

Recent insights have demonstrated a central role for dopaminergic neurotransmission in modulating pain perception and natural analgesia within supraspinal regions, including the basal ganglia, insula, anterior cingulate cortex, thalamus and periaqueductal gray. In addition, while the participation of serotonin and norepinephrine in spinal descending inhibition of pain is well known, a critical role for dopamine in descending inhibition has also been demonstrated. Decreased levels of dopamine likely contribute to the painful symptoms that frequently occur in Parkinson's disease.

Insular hypometabolism in a patient with fibromyalgia: a case study.

Background: Neuroimaging studies have demonstrated differential involvement of a variety of brain centers in fibromyalgia both at baseline and in response to stimulation. The insular cortex is one such structure.

Findings: A 46-year-old woman with chronic widespread pain underwent positron emission tomography utilizing 18F-fluorodeoxyglucose while participating as a healthy control subject in a brain imaging study.

Fibromyalgia patients show an abnormal dopamine response to pain.

Fibromyalgia is characterized by chronic widespread pain and bodily tenderness and is often accompanied by affective disturbances. Accumulating evidence indicates that fibromyalgia may involve a dysfunction of modulatory systems in the brain. While brain dopamine is best known for its role in pleasure, motivation and motor control, recent evidence suggests that it is also involved in pain modulation.

Novel pharmacotherapy for fibromyalgia.

Fibromyalgia is a common disorder that is characterized by chronic widespread pain, tenderness to light palpation, fatigue and sleep disturbances. The present lack of a well-accepted model of the disorder has hampered progress towards adequate treatment. A review of potential models to explain the pathophysiology underlying its primary symptom (i.

Accelerated brain gray matter loss in fibromyalgia patients: premature aging of the brain?

Fibromyalgia is an intractable widespread pain disorder that is most frequently diagnosed in women. It has traditionally been classified as either a musculoskeletal disease or a psychological disorder. Accumulating evidence now suggests that fibromyalgia may be associated with CNS dysfunction.

Reduced presynaptic dopamine activity in fibromyalgia syndrome demonstrated with positron emission tomography: a pilot study.

Unlabelled: Although the pathophysiology underlying the pain of fibromyalgia syndrome (FMS) remains unknown, a variety of clinical and investigational findings suggests a dysregulation of dopaminergic neurotransmission. We therefore investigated presynaptic dopaminergic function in 6 female FMS patients in comparison to 8 age- and gender-matched controls as assessed by positron emission tomography with 6-[(18)F]fluoro-L-DOPA as a tracer. Semiquantitative analysis revealed reductions in 6-[(18)F]fluoro-L-DOPA uptake in several brain regions, indicating a disruption of presynaptic dopamine activity wherein dopamine plays a putative role in natural analgesia.

A reconsideration of the relevance of systemic low-dose ketamine to the pathophysiology of fibromyalgia.

Unlabelled: Fibromyalgia is a common disorder characterized by chronic widespread pain that affects an estimated 2% of the general population. Recent advances have shed insight on this mysterious disorder, leading to the growing conclusion that disturbances of pain-related processes within the central nervous system, termed central sensitization, represent its most likely source. The phenomenon of central sensitization depends on plasticity in function of N-methyl-D-aspartate (NMDA) subtype glutamate receptors.

Open trial of pindolol in the treatment of fibromyalgia.

Background: Evidence suggests that fibromyalgia is related to both chronic sympathetic hyperactivity and decreased levels of serotonin.

Objective: To examine the efficacy of pindolol, a mixed serotonin (5-HT)(1A) presynaptic autoreceptor/beta-adrenergic receptor antagonist, in the treatment of fibromyalgia.

Methods: An open trial was conducted using 20 female patients who met the American College of Rheumatology criteria for fibromyalgia.

Stress and dopamine: implications for the pathophysiology of chronic widespread pain.

Fibromyalgia has been called a "stress-related disorder" due to the onset and exacerbation of symptoms in the context of stressful events. Evidence suggests that inhibition of tonic pain is mediated by activation of mesolimbic dopamine neurons, arising from the cell bodies of the ventral tegmental area and projecting to the nucleus accumbens. This pain-suppression system is activated by acute stress, via the release of endogenous opioids and substance P within the ventral tegmental area.