Investigations on the interaction between chronic pain and cognition in fibromyalgia patients under medica treatment applying functional and morphometric brain imaging
Final Report Abstract
In the studies described above we could demonstrate that patients with chronic widespread pain show changes in brain activation associated with executive functioning; this could be shown for a inhibition task (Go/No-Go) as well as for a working memory task (n-back). Patients, as hypothesised, showed less taskrelated activation in regions that are also involved in pain perception, such as the ACC/midCC, as well as the insular cortex. These results are consistent with a “competing demands” problem with neural resources in FM. It appears as though perception and processing of pain activates areas of the brain that are also involved in cognition/executive functioning. For the Go/No-Go task we could also demonstrate (within a longitudinal study) that there was a correlation between change in clinical pain (body regions in pain) and task related activation in the midCC/SMA. For the Go/No-Go task as well as the working memory task (at baseline) we did not find a significant difference in performance (accuracy and reaction time) between patients and healthy controls. This is in agreement with the clinical finding that perceived dyscognition exceeds deficits found when applying standardized neuropsychological testing. However, in the working memory task we found a block by group interaction showing a steadily improvement in healthy controls but not in FM patients. This suggests a lack of adaptation and/or increased rate of fatiguing; we conclude that future studies should extend cognitive testing, to also investigate learning and adaptation. As expected (with respect to the small n) treatment with the selective serotonin and norepinephrine reuptake inhibitor milnacipran did not lead to a significant improvement of clinical pain (across the group). However, milnacipran treatment was associated with a decrease in (experimental) pain related BOLD signal in the left posterior insular cortex and even more pronounced with a change in ACC – PAG connectivity which correlated with improvement in clinical pain. Preliminary results also suggest that milnacipran treatment is associated with changes in task (working memory) related connectivity between the DLPFC and the ACC. Further analyses will be performed to investigate in more detail changes in functional connectivity in the EAN as they relate to both milnacipran treatment and improvement in clinical pain.
Publications
- Pharmacotherapy in fibromyalgia (FM): Implications for the underlying pathophysiology. Pharmacology & Therapeutics. 2010 Sep; 127(3): 283-294
Schmidt-Wilcke T, Clauw DJ
- Schmerz und Aufmerksamkeit - kognitive Defizite bei Fibromyalgiepatienten. Der Schmerz. 2010 Feb; 24(1): 46-53
Schmidt-Wilcke T, Wood P, Lürding R
- Executive function in chronic pain patients and healthy controls: Different cortical activation during response inhibition in fibromyalgia. J Pain. 2011 Dec; 12(12):1219-29
Glass J, Williams DA, Fernandez-Sanchez M, Kairys A, Barjola P, Heitzeg M, Clauw DJ, Schmidt-Wilcke T
- Fibromyalgia: from pathophysiology to therapy. Nature Rheumatology Reviews. 2011 Jul 19;7(9):518-27
Schmidt-Wilcke T, Clauw DJ
- Altered functional connectivity between insula and the cingulate cortex in patients with TMD, Headache. 2012 Mar; 52(3):441-54
Ichesco E, Quintero A, Sundgren P Clauw DJ, Peltier S, Gerstner G, Schmidt- Wilcke T
- Changes in regional gray matter volume in women with chronic pelvic pain - a voxel based morphometry study. Pain, 2012 May; 153(5):1006-14
As-Sani S, Harris R, Napadow V, Kim J, Neshewat G, Kairys A, Williams D, Clauw DJ, Schmidt-Wilcke T
(See online at https://doi.org/10.1016/j.pain.2012.01.032) - Reduced insular gamma-aminobutyric acid in fibromyalgia, Arthritis & Rheumatism. 2012 Feb; 64(2):579-83
Foerster B, Petrou M, Edden R, Clauw DJ, Sundgren P, Schmidt-Wilcke T, Lowe, S. Harris R
