WASHINGTON, November 13, 2013 — The November 5 issue of Arthritis and Rheumatism reports results of a new study on fibromyalgia (FM) pain. The study uses a blood pressure cuff to simulate fibromyalgia pain combined with brain scans that reveal pain areas of the brain when they are actually activated. More importantly, the scans reveal what happen in parts of the brain when pain is anticipated, endured and when pain is supposed to be alleviated.
The test revealed that fibromyalgia sufferers go through a different sequence of events than non-sufferers. It also provides information on the reason narcotics are relatively ineffective in the battle on fibromyalgia.
Dr. John Kassel, professor of neurology and director of the division of neuromuscular medicine at Ohio State University’s Werner medical Center states “The healthy volunteers go from a state of no pain to a state of pain but fibromyalgia patients go from a lower state of pain to a higher level of pain which could affect the way they process thee pain and relief cues.”
Those who do not suffer FM can mentally discard some types of experiential pain but FM victims cannot. Dr. Lynn Webster, president of the American Academy of Pain Medicine claims in “People with fibromyalgia that capability seems to be dampened if not eliminated.”
Study author Dr. Marco Loggia at Massachusetts General hospital and Harvard Medical School in Boston explained that doctors used the blood pressure cuff on participant’s calf’s. Participants rated their pain on a scale of 100. This amount of pressure “Gives a very deep, muscular type of pain” close to the clinical pain that a FM victim experiences.
Participants also received a visual clue that indicated when the cuff would begin squeezing and when it would be released. The cues allowed researchers to see how the brain responds to anticipation of pain. Those with FM needed much less pressure to induce equal pain levels of those without FM.
Most important was the ability for researchers using brain scan technology to see the key differences in the manner in which the brain dealt with in the experiments before introduction of actual pain, while experiencing pain, and after the source of pain was removed.
There is a group of neurons in the center of the brain that responds to reward and punishment called the ventral tegmental area (VTA) which helps regulate the release of dopamine. This plays a significant role in a person’s response to pain medications and is implicated in many disorders and drug addiction.
Dopamine is considered a neurotransmitter or nerve signal sender produced by several areas of the brain including the VTA. It interacts with the pituitary gland and the hypothalamus. The VTA is the largest area of dopaminergic cells.
There is ongoing research at the Fibromyalgia Research Foundation in the UK of hormone as related to the pituitary gland and hypothalamus as the brain parts relate to the thyroid gland.
In this study, Loggia said “The VTA in healthy volunteers activated before and during pain and the region deactivated when it received the pain deactivation signal.” He went on to say “In people with FM, we don’t see this”. The activation of the pain cessation signal “is completely blunted.”
It is this altered response of the VTA that may explain the reduced or insufficient effect of narcotics in those with FM.
Loggia and his team detected a different response in the periaqueductal gray (PAG), which is a small area in the brain’s center that plays a role in the transmission of pain. Loggia said “In animals, it has been shown that if you electrically stimulate this area (PAG), pain responses go down.”
In the healthy participants that received a cue that pain is forthcoming, they can prepare themselves for the discomfort. But with participants that have FM, when warned of similar forthcoming pain, the region does not activate leaving them incapable of guarding against and preparing for anticipated pain.
Dr. Kassel claims this study provides another piece of evidence proving FM is “Fundamentally, something amiss and that it is a peripheral disorder is mistaken.
Research of FM and chronic pain by Dr.’s Frank Rice and Phillip Albrecht at Integrated Tissue Dynamics in Albany New York, seems headed in similar direction.
Kassel declares the results of this study may not be singularly sourced by FM and could be a response by those with chronic pain disorders.
Most with FM conclude FM is a chronic pain disorder and this study used FM sufferers against healthy participants so the results would be similar. This is why healthy participant’s base level was zero pain and FM victims base level was a low level of chronic pain.
Paul Mountjoy is a Virginia based writer and psychotherapist
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