Towards a neurophysiological signature for fibromyalgia
Autor: | Tor D. Wager, Marina López-Solà, Joan Deus, Jesús Pujol, Ben J. Harrison, Choong-Wan Woo, Jordi Monfort |
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Rok vydání: | 2016 |
Předmět: |
Adult
Male Pain Threshold Fibromyalgia Sensory system Brain mapping Article Machine Learning 03 medical and health sciences 0302 clinical medicine Physical Stimulation Surveys and Questionnaires Threshold of pain Image Processing Computer-Assisted medicine Humans Pain Measurement 030203 arthritis & rheumatology Analgesics Brain Mapping Sensory stimulation therapy medicine.diagnostic_test Chronic pain Brain Middle Aged medicine.disease Magnetic Resonance Imaging Oxygen Logistic Models Anesthesiology and Pain Medicine Neurology Case-Control Studies Posterior cingulate Female Neurology (clinical) Psychology Functional magnetic resonance imaging Neuroscience Insula 030217 neurology & neurosurgery |
Zdroj: | Pain. 158:34-47 |
ISSN: | 1872-6623 0304-3959 |
Popis: | Patients with fibromyalgia (FM) show characteristically enhanced unpleasantness to painful and nonpainful sensations accompanied by altered neural responses. The diagnostic potential of such neural alterations, including their sensitivity and specificity to FM (vs healthy controls) is unknown. We identify a brain signature that characterizes FM central pathophysiology at the neural systems level. We included 37 patients with FM and 35 matched healthy controls, and analyzed functional magnetic resonance imaging responses to (1) painful pressure and (2) nonpainful multisensory (visual-auditory-tactile) stimulation. We used machine-learning techniques to identify a brain-based FM signature. When exposed to the same painful stimuli, patients with FM showed greater neurologic pain signature (NPS; Wager et al., 2013. An fMRI-based neurologic signature of physical pain. N Engl J Med 2013;368:1388-97) responses. In addition, a new pain-related classifier ("FM-pain") revealed augmented responses in sensory integration (insula/operculum) and self-referential (eg, medial prefrontal) regions in FM and reduced responses in the lateral frontal cortex. A "multisensory" classifier trained on nonpainful sensory stimulation revealed augmented responses in the insula/operculum, posterior cingulate, and medial prefrontal regions and reduced responses in the primary/secondary sensory cortices, basal ganglia, and cerebellum. Combined activity in the NPS, FM pain, and multisensory patterns classified patients vs controls with 92% sensitivity and 94% specificity in out-of-sample individuals. Enhanced NPS responses partly mediated mechanical hypersensitivity and correlated with depression and disability (Puncorrected < 0.05); FM-pain and multisensory responses correlated with clinical pain (Puncorrected < 0.05). The study provides initial characterization of individual patients with FM based on pathophysiological, symptom-related brain features. If replicated, these brain features may constitute objective neural targets for therapeutic interventions. The results establish a framework for assessing therapeutic mechanisms and predicting treatment response at the individual level. |
Databáze: | OpenAIRE |
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