The study is led by the researchers Maria Suñol and Marina López Solà, members of the Pain and Emotion Neuroscience Laboratory at the Faculty of Medicine and Health Sciences and the Institute of Neurosciences of the University of Barcelona. CREDIT UNIVERSITY OF BARCELONA

Juvenile fibromyalgia is a syndrome characterized by a chronic pain affecting the whole body. It also causes fatigue as well as sleep and mood disorders. It affects children and adolescents —mainly girls— worldwide and it appears during a critical period of the brain development. Analysing the brain changes that occur in the first stages of juvenile fibromyalgia could help to better understand the pathophysiology of this syndrome, which had not been approached from this perspective to date.

A study published in the journal Arthritis and Rheumatology characterizes for the first time the alterations in the grey matter volume in adolescents affected by juvenile fibromyalgia, and it analyses its functional and clinical relevance. The study contributes to identifying potential risk factors that will help testing the efficiency of different treatments to reverse these brain alterations. The new research is led by the postdoctoral researcher Maria Suñol and the lecturer Marina López Solà, from the research group Pain and Emotion Neuroscience Laboratory of the Faculty of Medicine and Health Sciences and the Institute of Neurosciences (UBNeuro) of the University of Barcelona.

The study, which applies several neurophysiology study techniques, counted on the participation of 34 adolescent girls affected by the pathology and a control group of 38 healthy adolescents. The new research has been carried out in collaboration with the professors Susmita Kashikar-Zuck and Robert Coghill, members of the Cincinnati Children’s Hospital (United States).

Juvenile fibromyalgia: brain, self-perception and emotions

The study reveals that the adolescents with juvenile fibromyalgia have less grey matter in the anterior-midcingulate cortex (MCC) region, a brain region which is decisive for pain processing. This feature could be related to the excessive engagement of brain circuits that process pain and it points out to the existence of a reorganization with these neuronal circuits.

The most affected patients by the pathology —and with more symptoms— also show an increase of volume in the frontal regions of the brain that is related to the creation of narratives about oneself and the emotional processing and regulation.

This increase in volume could reflect a certain immaturity in the process of the development of frontal circuits involved with emotion and language. “These findings strengthen the need to consider therapeutic strategies aimed at modulating the activity in these circuits in order to reverse the harmful narratives patients might feel about themselves,” notes Maria Suñol, first author of the study.

It also states that some brain alterations associated with related to juvenile fibromyalgia coincide with those identified in adult women with fibromyalgia. “This suggests that both syndromes share part of the pathophysiology,” notes the lecturer López Solà. “Therefore, it is important to promote the early and guided study of the pathology in adolescents in order to prevent the transition from juvenile to adult fibromyalgia.”

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An MRI image showing the multivariate brain pattern that predicts fibromyalgia status on the basis of brain activation during multisensory stimulation Image: Cognitive and Affective Control Laboratory / University of Colorado Boulder.

University of Colorado Boulder researchers have discovered a brain signature that identifies fibromyalgia sufferers with 93 percent accuracy, a potential breakthrough for future clinical diagnosis and treatment of the highly prevalent condition.

Fibromyalgia is commonly defined as chronic widespread musculoskeletal pain accompanied by symptoms such as fatigue, anxiety and mood disorders. The Centers for Disease Control and Prevention (CDC) estimates that fibromyalgia affects more than five million adults annually in the U.S., with significantly higher occurrence rates in women than in men.

Historically, fibromyalgia has been difficult to diagnose and treat due to a lack of a well-categorized tissue pathology and symptoms that overlap with other common chronic illnesses.

CU Boulder researchers used functional MRI scans (fMRI) to study brain activity in a group of 37 fibromyalgia patients and 35 control patients as they were exposed to a variety of non-painful visual, auditory and tactile cues as well as painful pressure.

The multisensory testing allowed the researchers to identify a series of three sub-markers, or neurological patterns, that correlated with the hypersensitivity to pain that characterizes fibromyalgia.

“The novelty of this study is that it provides potential neuroimaging-based tools that can be used with new patients to inform about the degree of certain neural pathology underlying their pain symptoms,” said Marina López-Solà, a post-doctoral researcher in CU Boulder’s Cognitive and Affective Control Laboratory and lead author of the new study. “The set of tools may be helpful to identify patient subtypes, which may be important for adjusting treatment selection on an individualized basis.”

The findings were recently published in the journal PAIN, published by the International Association for the Study of Pain.

“Though many pain specialists have established clinical procedures for diagnosing fibromyalgia, the clinical label does not explain what is happening neurologically and it does not reflect the full individuality of patients’ suffering,” said Tor Wager, director of the Cognitive and Affective Control Laboratory. “The potential for brain measures like the ones we developed here is that they can tell us something about the particular brain abnormalities that drive an individual’s suffering. That can help us both recognize fibromyalgia for what it is – a disorder of the central nervous system – and treat it more effectively.”

If replicated and expanded upon in future studies, the results could eventually provide a neurological road map to brain activity that would inform diagnosis and therapeutic interventions for fibromyalgia.

“This is a helpful first step that builds off of other important previous work and is a natural step in the evolution of our understanding of fibromyalgia as a brain disorder” said López-Solà.

Dr. Furlan answers a question about what are the predisposing and precipitating factors for nociplastic pain (fibromyalgia). In this video she explains that adverse childhood adversities (ACEs) are important risk factors to develop health issues, including chronic pain and fibromyalgia. She also discusses some strategies to mitigate the negative effects of ACEs in children, so they do not become adults with chronic pain.