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Brain
Scans Show Pain
Sensitivity in Fibromyalgia
Excerpt
By
Melissa Schorr, Reuters
Health
SAN FRANCISCO (Reuters Health)
- Brain scans have revealed that women with the chronic condition
fibromyalgia differ from women with depression in their sensitivity
to pain, researchers reported here Wednesday at the American College
of Rheumatology's annual meeting.
Fibromyalgia, a condition that affects 2% of Americans, usually
women, causes muscle pain, stiffness and fatigue. The cause is
unknown.
Because nearly half of fibromyalgia patients have suffered clinical
depression at some point in their lives, some doctors consider
the condition to be a physical manifestation of an underlying
mood disorder like depression, said Dr. Leanne R. Cianfrini, a
psychology researcher at the University of Alabama at Birmingham.
``Because fibromyalgia doesn't have a clear-cut etiology (or
cause), it leads many rheumatologists to interpret their pain
as a simple physical manifestation of an underlying depression,''
she said. ``This can be frustrating and counterproductive to patients.''
To clarify whether there were physiological differences between
patients with fibromyalgia and patients with depression, the investigators
compared pain thresholds and brain activity among 21 women with
fibromyalgia, 8 women with depression and 22 healthy women.
Cianfrini and colleagues administered pressure calculated to
be a level above each woman's pain threshold to three points on
the women's bodies. The women were asked to evaluate their pain
levels. The researchers also used a brain-imaging scan to measure
each woman's brain blood flow while she experienced pain.
The investigators found that the women with fibromyalgia had
lower pain thresholds and reported more pain after pressure stimulation
than the healthy women. The fibromyalgia patients also showed
greater activation of brain structures that process pain after
relatively low levels of pressure.
The pain threshold and experience of pain among the depressed
women was similar to that of the healthy women, the study found.
``We can't deny depression is associated with fibromyalgia, and
it may exacerbate it,'' Cianfrini said. ``But depression does
not seem to be a necessary factor.''
She advised fibromyalgia patients whose doctors seem resistant
to treat them to tell them about her findings. ``The pain is not
due to depression and if they treat depression, your pain may
not necessarily go away,'' she said. ``Patients should say, 'Let's
treat my pain, because it's real.'''
In a similar study, Dr. Richard H. Gracely, a research psychologist
at the National Institutes of Health, presented findings on how
the brains of fibromyalgia patients react to pain.
Gracely and colleagues used a brain scan technique called fMRI
to compare fibromyalgia patients with healthy patients experiencing
pain. The research team found that patients with fibromyalgia
who were given relatively low levels of pressure seemed to experience
the same amount of pain and subsequent brain activity as healthy
people experiencing high levels of induced pain.
``One of the big issues of pain patients is credibility--they
don't have the luxury of physical signs, nobody believes they
have what they say,'' Gracely said. ''Fibromyalgia patients particularly
had it that way because even rheumatologists didn't believe it
was necessarily pain.''
However, these findings provide physical evidence to confirm
what patients report, he added. ``Brain imaging is a way to show
there is something physical that matches with what they're saying,''
Gracely said. ``It's welcome news to people who have this.''
Reference
Source 89
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