Note: The authors do not state which non-pharmacological interventions
were used to decrease pain in patients. This would raise additional
questions as to whether the measurement of decreased intrinsic brain
connectivity accurately and objectively measures pain reduction. If
so, further studies could then test the effectiveness of
pharmacological interventions and/or combinations of therapies as well
as possibly elucidating subgroups based on responses. The resting fMRI
method examines intrinsic connectivity, which is defined as ongoing
neural and metabolic activity that occurs in the resting basal state.
An earlier study by the authors complete with a glossary of terms used
can be found here:
http://deepblue.lib.umich.edu/bitstream/2027.42/77979/1/27497_ftp.pdf
Decreased intrinsic brain connectivity is associated with reduced
clinical pain in fibromyalgia.
Napadow V, Kim J, Clauw DJ, Harris RE.
Athinoula A. Martinos Center for Biomedical Imaging, Department of
Radiology, Massachusetts General Hospital, Charlestown, MA 02129;
Department of Radiology, Logan College of Chiropractic, Chesterfield
MO, 63006.
Abstract
OBJECTIVE:
A major impediment toward the development of novel treatment
strategies for fibromyalgia (FM) is the lack of an objective marker
which tracks with spontaneous clinical pain report. Resting state
intrinsic brain connectivity in FM has demonstrated increased insular
connectivity to the default mode network (DMN), a network whose
activity is increased during rest. Moreover increased insular
connectivity to the DMN was associated with increased spontaneous pain
levels. However as these analyses were cross-sectional in nature, they
provided no insight to dynamic changes in connectivity and their
relationship with variation in clinical pain report.
METHODS:
17 FM patients underwent resting state fMRI at baseline and following
4 weeks of a non-pharmacological intervention to diminish pain.
Intrinsic DMN connectivity was evaluated using probabilistic
independent component analysis. A paired analysis evaluated
longitudinal changes in intrinsic DMN connectivity and a multiple
linear regression investigated correlations between longitudinal
changes in clinical pain and changes in intrinsic DMN connectivity.
Changes in clinical pain were assessed with the Short Form of the
McGill Pain Questionnaire (SF-MPQ).
RESULTS:
Clinical pain was reduced following therapy (SF-MPQ sensory scale:
p<0.02). Intrinsic DMN connectivity to the insula was reduced, and
this reduction was correlated with reductions in pain (corrected
p<0.05).
CONCLUSIONS:
Our findings suggest that intrinsic brain connectivity can be used as
a candidate objective marker that tracks intra-subject with changes in
spontaneous chronic pain in FM. We propose that intrinsic connectivity
measures could potentially be used either in research or clinical
settings as a complementary, more objective outcome.
=A9 2012 American College of Rheumatology.
Copyright =A9 2012 by the American College of Rheumatology.
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