From the April issue of The Fibromyalgia Network Newsletter:
"People with fibromyalgia are not only sensitive to pain, but also other nonpainful stimuli. Most patients, for example, state that minimal activity leads to exhaustion, and that they are extremely sensitive to odors and lous noises. Daniel Clauw, M.D., and his research team at the University of Michigan in Ann Arbor, suspect that FM patients have a more global malfunction in the way their brains respond to a variety of stimuli... not just those that are painful. And the insula, a tiney structure in the brain that processes pain, sound, taste, odors, itch, and other sensations may be key.
Experimental sensitivity to the loudness of auditory tones and pressure pain sensitvity were measure for 30 FM patients and age-matched healthy controls. In addition, all subjects completed a questionnaire that assessed their perceived real-life sensitivity to auditory experiences. Compared to healthy controls, people with FM were more sensitive. Patients also rated their real life auditory sensitivity as significantly greater than the healthy subjects. Consistent with previous reports, the pressure pain thresholds for FM patients were roughly one half that of the controls.
Looking at the link between auditory and pressure pain sensitivity to both forms of stimuli.
'Areas in the brain like the inusla that code for all sensory stimuli would be responsible for the shared variance in both the FM patients and the healthy controls,' Clauw says. 'However, if people with FM have a hyper-responsive insula, this could account for their increased sensitivity fo sensory stimuli.'
Based on this study the Michigan team is using functional magnetic resonance imaging (fMRI) of the brain before and after auditory stimuli to determine if the insula shows an exaggerated response in FM patients.
The insula is one brain structure that has been concistently shown in imaging studies to be hyper-responsive to painful and even non-painful stimuli in people with FM. It is uniquely situated just beneath the primary sensory cortex, which is the area in the brain that determines the intensity of a stimulus, and it is located nearby other brain processing structures that may also be involved inFM.
Glutamate is a transmitter that is elevated in the spinal fluid of people with FM, and it is speculated to be the cause of increased pain transmission. In fact, with the aid of magnetic resonance spectroscopy (MRS) imaging, the levels of glutamate in various areas of the brain can be measured non-invasively.
The Michigan team led by Richard Harris, Ph.D., hypothesized that higher glutamate levels in the insula would be associated with increase pain in FM patients. They also anticipated that after FM patients went through nine acupuncture sessions to ease pain, that the drop in glutamate levels would correspond to an increase in pain threshold and a reduction in the insula's pain-related activity.
The study was quite complex and involved brain imaging of ten FM patients multiple times. However, the results were impressive and in check with Clauw's initial hypotheses.
Prior to the nondrug treatment, the higher a patient's pain score, the greater their concentration of glutamate in the inusla. Then half of the subjects were given traditional acupuncture while the others were given sham acupuncture (needles only pricked the skin but were non inserted). The purpose of the acupuncture sessions was not to evaluate the effectiveness of this therapy for FM. Rather, Harris was just looking to vary the degrees in pain levels so he could determine how changes in pain correlated with glutamate levelsa dn activity in the insula.
Following the series of treatments (active or sham), the dgress of pain reduction corresponded to a decrease in the glutamate concentration in the insula. Harris found that lower glutamate levels did correspond with less activation of the insula when patients underwent a pressure pain stimulus.
Naturally, you may be asking: What can I do to reduce the glutamated in my insular cortex? 'Many drugs can modulate glutamate levels,' says Clauw. 'IN fact, this is likely in part how Lyrica and Neurontin work.'
What's next? The team is currently testing commonly prescribed medications for FM using his current protocol to determine their ability to lower glutamate." Medically reviewed and edited by Daniel Clauw, M.D.
sue in ohio
"People with fibromyalgia are not only sensitive to pain, but also other nonpainful stimuli. Most patients, for example, state that minimal activity leads to exhaustion, and that they are extremely sensitive to odors and lous noises. Daniel Clauw, M.D., and his research team at the University of Michigan in Ann Arbor, suspect that FM patients have a more global malfunction in the way their brains respond to a variety of stimuli... not just those that are painful. And the insula, a tiney structure in the brain that processes pain, sound, taste, odors, itch, and other sensations may be key.
Experimental sensitivity to the loudness of auditory tones and pressure pain sensitvity were measure for 30 FM patients and age-matched healthy controls. In addition, all subjects completed a questionnaire that assessed their perceived real-life sensitivity to auditory experiences. Compared to healthy controls, people with FM were more sensitive. Patients also rated their real life auditory sensitivity as significantly greater than the healthy subjects. Consistent with previous reports, the pressure pain thresholds for FM patients were roughly one half that of the controls.
Looking at the link between auditory and pressure pain sensitivity to both forms of stimuli.
'Areas in the brain like the inusla that code for all sensory stimuli would be responsible for the shared variance in both the FM patients and the healthy controls,' Clauw says. 'However, if people with FM have a hyper-responsive insula, this could account for their increased sensitivity fo sensory stimuli.'
Based on this study the Michigan team is using functional magnetic resonance imaging (fMRI) of the brain before and after auditory stimuli to determine if the insula shows an exaggerated response in FM patients.
The insula is one brain structure that has been concistently shown in imaging studies to be hyper-responsive to painful and even non-painful stimuli in people with FM. It is uniquely situated just beneath the primary sensory cortex, which is the area in the brain that determines the intensity of a stimulus, and it is located nearby other brain processing structures that may also be involved inFM.
Glutamate is a transmitter that is elevated in the spinal fluid of people with FM, and it is speculated to be the cause of increased pain transmission. In fact, with the aid of magnetic resonance spectroscopy (MRS) imaging, the levels of glutamate in various areas of the brain can be measured non-invasively.
The Michigan team led by Richard Harris, Ph.D., hypothesized that higher glutamate levels in the insula would be associated with increase pain in FM patients. They also anticipated that after FM patients went through nine acupuncture sessions to ease pain, that the drop in glutamate levels would correspond to an increase in pain threshold and a reduction in the insula's pain-related activity.
The study was quite complex and involved brain imaging of ten FM patients multiple times. However, the results were impressive and in check with Clauw's initial hypotheses.
Prior to the nondrug treatment, the higher a patient's pain score, the greater their concentration of glutamate in the inusla. Then half of the subjects were given traditional acupuncture while the others were given sham acupuncture (needles only pricked the skin but were non inserted). The purpose of the acupuncture sessions was not to evaluate the effectiveness of this therapy for FM. Rather, Harris was just looking to vary the degrees in pain levels so he could determine how changes in pain correlated with glutamate levelsa dn activity in the insula.
Following the series of treatments (active or sham), the dgress of pain reduction corresponded to a decrease in the glutamate concentration in the insula. Harris found that lower glutamate levels did correspond with less activation of the insula when patients underwent a pressure pain stimulus.
Naturally, you may be asking: What can I do to reduce the glutamated in my insular cortex? 'Many drugs can modulate glutamate levels,' says Clauw. 'IN fact, this is likely in part how Lyrica and Neurontin work.'
What's next? The team is currently testing commonly prescribed medications for FM using his current protocol to determine their ability to lower glutamate." Medically reviewed and edited by Daniel Clauw, M.D.
sue in ohio
