Can Brain Activity Help Diagnose and Treat Fibromyalgia?

Finding a Signature Pattern Is Key

Brain scan images captured via MRI.
fMRI activity patterns may help diagnose, treat fibromyalgia. PASIEKA/Getty Images

Does a finding based on high-tech brain scans provide a new way to diagnose and treat fibromyalgia? Researchers from the University of Colorado Boulder say it just might.

For decades, researchers have looked for something in our bodies that they can point to and say, "See that? That's what makes it fibromyalgia." That particular thing has been elusive, though. Sure, we tend to have dysfunction in a lot of areas, but not in a unique way that's consistent from one patient to another.

If it's not unique and consistent, it might help guide a doctor's diagnostic decisions, but it can't stand on its own as a diagnostic tool. Because the known dysfunctions and irregularities of fibromyalgia are highly variable, and because many of them are also characteristics of other illnesses, we're left with less-then-optimal diagnostic tests.

Searching for Patterns

When your senses (sight, smell, hearing, etc.) send information to your brains, certain areas of the brain become active. A type of brain scan called functional magnetic resonance imaging (fMRI) can see which areas are involved in processing that information. Unlike a standard MRI, which only provides a snapshot of the brain, fMRI shows how the activity changes in response to what's going on.

According to 2016 research published in the journal Pain, by using fMRI, researchers say they can predict fibromyalgia with 93-percent accuracy.

That's due to consistent activity patterns that they observed in the brain.

In order to identify these patterns, they took 37 people with fibromyalgia and 35 healthy people and exposed them to different stimuli during fMRIs. These stimuli included visuals, sound, touch, and painful pressure.

That let the researchers see how the brains responded and compare the hypersensitive fibromyalgia brain patterns to those of the control group.

What they found was a series of three neurological patterns that were linked to the pain hypersensitivity that defines the condition.

That's right—certain patterns of brain activity indicate fibromyalgia. It's an image a doctor can point to and say, "That's what fibromyalgia looks like."

Specifically, researchers noted a greater response in what earlier research dubbed the Neurologic Pain Signature. That's not a fibromyalgia-specific measurement, though.

In what they're calling the FM-pain marker, painful stimuli were linked to abnormal responses in multiple brain regions, including:

  • insula/operculum, which deals with sensory integration (heightened response)
  • medial prefrontal regions, which are involved with self-referential processes (heightened response)
  • lateral frontal cortex, which is involved in voluntary movement, language, and math (lowered response)

Non-painful stimuli were linked to abnormalities in even more regions.

The responses were more significant in people who reported greater symptom severity, as well.

Impact on Diagnostics

That's a boon to doctors, many of whom struggle with diagnosing this condition.

However, it's even more significant to patients, who've too often been doubted by medical professions and friends and family precisely because there's no scan or blood test to confirm the diagnosis.

It's also comforting to those who are newly diagnosed, who may wonder if the doctor was right or if something else is wrong with them.

Having that thing to point to would make a world of difference for everyone involved.

"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 CU Boulder's Cognitive and Affective Control Laboratory, in a press release.  

"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," he said.

Impact on Treatment

Then comes the question of treatment. Right now, we have certain treatments that are effective for certain—but not all—people with fibromyalgia.

Many doctors believe the illness is made up of several subgroups, each of which need a different treatment approach. But those subgroups aren't well defined yet, so each one of us has to experiment with different treatments until we figure out what works for us. It's a long, often frustrating, often expensive process that can be grueling and demoralizing.

But this could be the first step toward changing that.

"The set of tools may be helpful to identify patient subtypes, which may be important for adjusting treatment selection on an individualized basis," said the study's lead author, Marina Lopez-Sola.

Because responses were greater for sicker people, it could give doctors an objective way to tell how well treatments are working, as well.

It's important to remember, though, that those are possible, long-term impacts of this study. Before anything changes in the medical community, we'll need multiple larger studies that confirm these findings. That takes time.

Immediate Significance

With just over 70 participants, we can't expect doctors to start rushing possible fibromyalgia patients to the fMRI to look for these patterns, or to have subgroup-specific treatment recommendations in the next few years.

This study does have some immediate significance, though. First, it gives researchers something to build on. That goes for both diagnostics and treatments.

Beyond that, it helps further legitimize the illness. Every bit of physiological evidence we gain, especially those that are easy to see, helps lessen skepticism in medical professionals.

It's also something we can show to our friends, family, bosses, etc. to help them see that yes, we really are sick.

For those of us living with fibromyalgia, research like this can be vindicating. It also demonstrates the leaps forward researchers are making, which provides hope even if it doesn't change much in the short-term. For many, it helps to know that this condition is being taken seriously and that things will continue to get better for us.

Source:

Lopez-Sola M, Woo CW, Pujol J, et al. Towards a neurophysiological signature for fibromyalgia. Pain. 2016 Aug 31. [Epub ahead of print.]

Press release. University of Colorado Boulder. Oct. 17, 2016. Neural signature for fibromyalgia may aid diagnosis, treatment.

Wager RD, Atlas LY, Lindquist MA, et al. An fMRI-based neurologic signature of physical pain. New England journal of medicine. 2013 Apr 11;368(15):1388-97.

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