Fibromyalgia: altered brain areas interfere with pain treatment

Fibromyalgia is a chronic pain disorder that is still mysterious and therefore difficult to treat. Affecting 1.6% of the French population, its causes are still largely unknown. But a study conducted by the team at the Clinic for Psychosomatic Medicine and Psychotherapy at Ruhr University, Germany, recently provided new data: certain areas of the brain involved in pain processing do not function normally. , which would make it much less controllable.

Poor control of the end of the painful stimulus

In the current study, the team compared two female cohorts: 21 healthy participants and 23 patients with fibromyalgia. Both groups were exposed to heat pain, while their brain activities were monitored by functional magnetic resonance imaging (MRI).

• In a first experiment, the participants were able to stop the pain stimulus themselves;
• In another, a computer controlled the start and end of the stimulus.

The duration of the painful stimuli managed by the computer was identical on average to that of the stimuli controlled by the patients.

This study revealed a certain inequality in the treatment of pain. When the women in the healthy control group were able to terminate the pain stimulus on their own, a number of primarily frontal brain areas were activated, which appear to play an important role in modulating pain. This observation is consistent with previous studies involving healthy subjects. “However, it is interesting to note that we did not detect such activations in our patient group.”, emphasizes Martin Diers. Thus, unlike healthy subjects, participants with fibromyalgia failed to activate brain areas usually involved in pain modulation, as well as reappraisal processes in dorsolateral prefrontal cortex and dorsal anterior cingulate cortex. .

Evidence of impaired pain processing

For the authors, the functional and structural changes described provide evidence of profound deficiencies in pain modulation processes in fibromyalgia:

Thus, the degree to which we experience pain and the resulting restriction largely depends on how we perceive it. If we feel like we can control the pain and turn it off ourselves, for example, we will tolerate it better than if we feel at its mercy. “For people with chronic pain, the inability to control repeated attacks of pain is one of the most important causes of impaired quality of life.”, explains Benjamin Mosch, lead author of the study. Failing to be able to control the pain or to be able to provide a solution, this study reveals why management is not biologically possible for affected patients.

Recognized by the World Health Organization in 1994, fibromyalgia is characterized by recurrent pain along with various other symptoms, including sleep disturbances, depressed moods, chronic fatigue, and digestive problems. On average, it takes 16 years before a diagnosis is made.

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