Fibromyalgia and Brain Imaging
The changes and long term effects
In the Face of chronic pain
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I have touched on this matter lightly in other pages, but I would like to explore this idea in a bit more detail. Many interesting studies have been done, via brain imaging. We are nearly to the point of being able to map the brain and its patterns to a very sophisticated degree. Several things of interest to note, when it comes to chronic pain conditions.

Brain re-organization:

According to many studies, the brain adapts to painful conditions. How it does this, is it literally changes some of its functions. Now, given the case of day in and day out pain, this would seem perfectly reasonable that it do so. It really doesn't have much of a choice, if the body is to remain even remotely functional. According to the studies, brain mapping shows a one of a kind fingerprint if you will, for almost every condition. FM is no exception.

What they found in our case is:

"Richard Gracely, Ph.D., and Daniel Clauw, M.D., of the University of Michigan in Ann Arbor, used fMRI to study fibromyalgia patients with and without depression. They found that different areas of the brain were activated when patients processed the sensory dimension of pain as opposed to those that were activated for depression ... They concluded, "Evaluation of these sensory and affective dimensions in patients with chronic pain is likely to improve diagnosis, choice of treatment, and treatment efficacy." 

The above findings are highly relevant in light of the common prescription of antidepressants for treating fibromyalgia. A 12-week treatment trial of the antidepressant, Effexor, revealed that fibromyalgia patients with depression benefited with improved mood. However, the pain of fibromyalgia was unfazed by the drug.

A separate report by Gracely and Clauw's team measured the response to experimental pain stimuli in fibromyalgia patients and healthy controls. Interestingly, the healthy controls rated the stimuli to be significantly more unpleasant than the patients. Distress, anxiety or depression did not influence the patient's unpleasantness ratings. The study's authors suggest that the presence of chronic pain can alter one's perception of experimental pain (perhaps as part of the brain's re-organization process), which may pale in comparison to the day-to-day pain of fibromyalgia.

Ali Gur, M.D., of Turkey found an important cytokine chemical, to be elevated in patients with fibromyalgia Correlating this chemical with brain function, he found that fibromyalgia patients with little to no depression, had higher levels and more impaired brain blood flow than those with severe depression. In keeping with the concept that fibromyalgia and depression cause different alterations in brain function, Gur was able to tease out the chemical change caused by fibromyalgia and the compounding issue of feeling depressed. " A. Vania Apkarian, Ph.D

Studies like this, prove what we with FM, have been saying for a long time now. That antidepressants, do little, to nothing for our FM symptoms. ( see antidepressants on site link for more details )

That healthy normals found the experimental pain, more unpleasant than the FM controls, should come as no surprise. We are rather used to pain, we have to be, our bodies don't give us much of a choice in the matter. It does not mean that we feel it any less, but it does suggest that our tolerance level, is higher than our "normal" counterparts. The pain levels handed out by the researchers for testing purposes, does not even compare to what we live with, day in and day out. ( See pain tolerance VS pain threshold on site link )

Neuron damage, due to pain:

"Researchers at Northwestern University's Feinberg School of Medicine in Chicago used functional MRI to scan brain activity in people with chronic low back pain while they tracked a moving bar on a computer screen. They did the same thing with a control group of people with no pain.

In those with no pain, the brain regions displayed a state of equilibrium. When one region was active, the other regions calmed down. But in people with chronic pain, the front region of the cortex mostly associated with emotion "never shuts up." The study author, Dante Chialvo, an associate research professor of physiology, said this in a prepared statement. This region remains highly active, which wears out neurons and alters their connections to each other. This constant firing of neurons could cause permanent damage.

We know when neurons fire too much they may change their connections with other neurons or even die, because they can't sustain high activity for so long, Chialvo said, " if you are a chronic pain patient, you have pain 24 hours a day, seven days a week, every minute of your life. That permanent perception of pain in your brain, makes these areas in your brain continuously active. This continuous dysfunction in the equilibrium of the brain can change the wiring forever and could hurt the brain," Chialvo explained." Med line, The Journal of Neuroscience

Many other studies have been done that back this idea up, of literal physical changes to our gray matter itself, up to and including premature aging of the brain. As we age, we tend to lose gray matter. The brain literally shrinks in size and functionality. However, in chronic pain states, this state of affairs is happening a great deal sooner than our elder counterparts. The cognitive problems we all seem to face, start to make a lot more sense when you take this into account.

High demand for brain power:

It can take us nearly 50 times as much brain power, to do the same task as a healthy person. Not kidding, 50 times as much of the brain, to do the same job.

"Disruptions in this default network could explain why pain patients have problems with attention, sleep disturbances and even depression.These findings suggest that the brain of a chronic pain patient is not simply a healthy brain processing pain information but rather it is an altered brain, that has been changed by the persistent pain in a manner reminiscent of other neurological conditions associated with cognitive impairments” Living with FM

Furthermore, it may well explain why we have problems with even major pain killers. We often need more of them and need to take them more often than "normals" who are in acute pain. The reason being, according to the studies is there have been changes in the brain itself. One study of chronic pain clients noted ...

"A 'ceiling effect' of current analgesics for chronic pain, rarely exceeding a 30% efficacy level in controlled trials.

Chronic pain patients are defined as 'difficult patients' in that they often have neuropsychological changes, that include changes in affect and motivation or changes in cognition, all of which rarely predate their pain condition.

In some conditions such as complex regional pain syndrome (CRPS), manifestations of dysautonomia, movement disorders, and spreading pain (ipsilateral and contralateral) are all indicative of complex secondary changes in the CNS that follow a relatively trivial peripheral nerve injury

Chronic opioid therapy results in a hyperalgesic state in both experimental and clinical pain scenarios implying changes in central processing (e.g., alterations in modulatory systems).

Opioids, arguably the closest approximation to an ideal analgesic, often fail to produce pain relief in all individuals, even at high doses. This implies the development of 'analgesic resistance', a consequence of complex changes in neural systems in chronic pain that complicates the utility of opioids for long term therapy " Neuroimaging

What all that means in a laymans terms is that pain killers often don't work very well, because the neural net has been trashed by brain changes, brought about by being in chronic pain and we have cognitive problems that we didn't have before. ( Good old brain fog ) Futher, there is definitive proof that the central nervous system, in the brain in particular, has been impaired and does not regulate pain properly anymore.

Which should be a really good argument for dealing with pain every time it pops its head up. As if you constantly fail to treat the pain, what you can end up with is a brain and a neural system that is so altered that it can no longer properly respond to the pain suppression medications. That is a really nasty catch 22, when you think about it. It's called, either deal with the pain or set up a condition where what you do have to deal with it, might not work anymore ... when you finallly get around to using them that is!

We have all seen it happen. Too many of us know friends with FM who finally got narcotic meds, only to find that they didn't work very well. Or they were short lived in effectiveness, much to their doctors shock. But, given this idea, the drug action or lack thereof, it seems perfectly understandable and explainable if you consider that the brain itself has literaly been changed.

It's like the brain has had to deal with the pain alarm on so much that it has worn away parts of the brain, with neurons firing, day in and day out that are supposed to fire only on occasion. So much so, to where they can no longer react to a lot of the meds they toss our direction, at least not in a manner they can predict. ( See pain and gender  on site link, for more info )

It might also be a good reason to explain why so many medications do almost nothing for us, much to our doctors bafflement, as they seem to work just fine for others. It's a complex issue, but perhaps, studies like these will bring us a bit closer to answers and therefore medications we can really use.