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Functional Imaging of Pain in Patients with
Primary Fibromyalgia
DANE B. COOK, GUDRUN LANGE, DONALD S. CICCONE, WEN-CHING LIU, JASON STEFFENER, and BENJAMIN H. NATELSON
ABSTRACT.
Methods. Two groups of women, 9 with FM and 9 pain-free, volunteered to participate. In Experiment 1, we assessed psychophysical responses to painful stimuli and prepared participants for fMRI testing. For Experiment 2, subjects underwent fMRI scanning while receiving painful and nonpainful heat stimuli. Conventional and functional MR images were acquired using a 1.5 T MR scanner. Scanning occurred over 5 conditions. Condition 1 served as a practice session (no stimuli). Conditions 2 and 5 consisted of nonpainful warm stimuli. Conditions 3 and 4 consisted of an absolute thermal pain stimulus (47°C) and a perceptually equivalent pain stimulus delivered in counterbalanced order. Results. Experiment 1 indicated that subjects with FM were significantly more sensitive to experimental heat pain than controls (p < 0.001). In Experiment 2, fMRI data indicated that the FM group exhibited greater activity than controls over multiple brain regions in response to both nonpainful and painful stimuli (p < 0.01). Specifically, in response to nonpainful warm stimuli, FM subjects had significantly greater activity than controls in prefrontal, supplemental motor, insular, and anterior cingulate cortices (p < 0.01). In response to painful stimuli, FM subjects had greater activity in the contralateral insular cortex (p < 0.01). Data from the practice session indicated brain activity in pain-relevant areas for the FM group but not for controls. Conclusion. Our results provide further evidence for a physiological explanation for FM pain. (J Rheumatol 2004;31:364-78) Key Indexing Terms:
FIBROMYALGIA
From the Chronic Fatigue Syndrome Cooperative Research Center and Departments of Radiology, Psychiatry, and Neurosciences, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark; and the War-Related Illnesses and Injury Study Center, Veterans Affairs New Jersey Health Care, East Orange, New Jersey, USA. Supported by the pilot grants module of the National Institutes of Health, grant AI-32247. D.B. Cook, PhD, Assistant Professor, Department of Radiology, CFS Cooperative Research Center, War-Related Illness and Injury Study Center; G. Lange, PhD, Associate Professor, Department of Radiology, War-Related Illness and Injury Study Center; D.S. Ciccone, PhD, Assistant Professor, Department of Psychiatry; W-C. Liu, PhD, Assistant Professor, Department of Radiology; J. Steffener, MA, Department of Psychiatry; B.H. Natelson, MD, Professor, Department of Neurosciences, Director, CFS Cooperative Research Center, Director, War-Related Illness and Injury Study Center. Address reprint requests to Dr. D.B. Cook, Fatigue Research Center, New Jersey Medical School, 88 Ross Street, East Orange, NJ 07018. E-mail: cookdb@njneuromed.org Submitted August 30, 2002; revision accepted June 26, 2003. |