Abstract
The primary symptom of fibromyalgia (FM) is chronic, widespread pain; however, patients
report additional symptoms including decreased concentration and memory. Performance-based
deficits are seen mainly in tests of working memory and executive function. Neural
correlates of executive function were investigated in 18 FM patients and 14 age-matched
healthy controls during a simple Go/No-Go task (response inhibition) while they underwent
functional magnetic resonance imaging (fMRI). Performance was not different between
FM and healthy control, in either reaction time or accuracy. However, fMRI revealed
that FM patients had lower activation in the right premotor cortex, supplementary
motor area, midcingulate cortex, putamen and, after controlling for anxiety, in the
right insular cortex and right inferior frontal gyrus. A hyperactivation in FM patients
was seen in the right inferior temporal gyrus/fusiform gyrus. Despite the same reaction
times and accuracy, FM patients show less brain activation in cortical structures
in the inhibition network (specifically in areas involved in response selection/motor
preparation) and the attention network along with increased activation in brain areas
not normally part of the inhibition network. We hypothesize that response inhibition
and pain perception may rely on partially overlapping networks, and that in chronic
pain patients, resources taken up by pain processing may not be available for executive
functioning tasks such as response inhibition. Compensatory cortical plasticity may
be required to achieve performance on a par with control groups.
Perspective
Neural activation (fMRI) during response inhibition was measured in fibromyalgia patients
and controls. FM patients show lower activation in the inhibition and attention networks
and increased activation in other areas. Inhibition and pain perception may use overlapping
networks: resources taken up by pain processing may be unavailable for other processes.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of PainAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Human brain mechanisms of pain perception and regulation in health and disease.Eur J Pain. 2005; 9: 463-484
- Imaging CNS modulation of pain in humans.Physiology (Bethesda). 2008; 23: 371-380
- Use of neuroimaging to understand abnormal pain sensitivity in fibromyalgia.Curr Rheumatol Rep. 2000; 2: 141-148
- Measurement properties of the Medical Outcomes Study Sleep Scale in patients with fibromyalgia.Sleep Med. 2009; 10: 766-770
- Probing the working memory system in chronic fatigue syndrome: A functional magnetic resonance imaging study using the n-back task.Psychosom Med. 2006; 68: 947-955
- Altered resting state attentional networks in diabetic neuropathic pain.J Neurol Neurosurg Psychiatry. 2010; 81: 806-811
- Pain assessment: Global use of the Brief Pain Inventory.Ann Acad Med Singapore. 1994; 23: 129-138
- Engagement of large-scale networks is related to individual differences in inhibitory control.Neuroimage. 2010; 53: 653-663
- Functional imaging of pain in patients with primary fibromyalgia.J Rheumatol. 2004; 31: 364-378
- Functional neuroimaging correlates of mental fatigue induced by cognition among chronic fatigue syndrome patients and controls.Neuroimage. 2007; 36: 108-122
- The reorienting system of the human brain: From environment to theory of mind.Neuron. 2008; 58: 306-324
- Attentional functioning in fibromyalgia, rheumatoid arthritis, and musculoskeletal pain patients.Arthritis Rheum. 2002; 47: 639-644
- Disruption of cognitive function in Fibromyalgia Syndrome.Pain. 2008; 139: 610-616
- A core system for the implementation of task sets.Neuron. 2006; 50: 799-812
- Functional connectivity delineates distinct roles of the inferior frontal cortex and presupplementary motor area in stop signal inhibition.J Neurosci. 2009; 29: 10171-10179
- Assessment of fatigue in patients with fibromyalgia and chronic widespread pain. Reliability and validity of the Swedish version of the MFI-20.Disabil Rehabil. 2007; 29: 1665-1670
- Anxiety and cognitive efficiency: Differential modulation of transient and sustained neural activity during a working memory task.Cogn Affect Behav Neurosci. 2008; 8: 239-253
- Review of cognitive dysfunction in fibromyalgia: A convergence on working memory and attentional control impairments.Rheum Dis Clin North Am. 2009; 35: 299-311
- Memory beliefs and function in fibromyalgia patients.J Psychosom Res. 2005; 58: 263-269
- Functional magnetic resonance imaging evidence of augmented pain processing in fibromyalgia.Arthritis Rheum. 2002; 46: 1333-1343
- Striatal dysfunction marks preexisting risk and medial prefrontal dysfunction is related to problem drinking in children of alcoholics.Biol Psychiatry. 2010; 68: 287-295
- Components of attentional bias to threat in high trait anxiety: Facilitated engagement, impaired disengagement, and attentional avoidance.Behav Res Ther. 2006; 44: 1757-1771
- Memory functioning in patients with primary fibromyalgia and major depression and healthy controls.J Psychosom Res. 1997; 42: 297-306
- Objective evidence of cognitive complaints in Chronic Fatigue Syndrome: A BOLD fMRI study of verbal working memory.Neuroimage. 2005; 26: 513-524
- Possible deficiencies of pain modulation in fibromyalgia.Clin J Pain. 1997; 13: 189-196
- Distraction as a key determinant of impaired memory in patients with fibromyalgia.J Rheumatol. 2006; 33: 127-132
- Further validation of the Multidimensional Fatigue Inventory in a US adult population sample.Popul Health Metr. 2009; 7: 18
- Working memory performance is correlated with local brain morphology in the medial frontal and anterior cingulate cortex in fibromyalgia patients: Structural correlates of pain-cognition interaction.Brain. 2008; 131: 3222-3231
- Identifying the clinical domains of fibromyalgia: Contributions from clinician and patient delphi exercises.Arthritis Care Res. 2008; 59: 952-960
- Somato-motor inhibitory processing in humans: An event-related functional MRI study.Neuroimage. 2008; 39: 1858-1866
- Intrinsic brain connectivity in fibromyalgia is associated with chronic pain intensity.Arthritis Rheum. 2010; 62: 2545-2555
- Cognitive function in fibromyalgia patients.Arthritis Rheum. 2001; 44: 2125-2133
- Functional imaging of brain responses to pain. A review and meta-analysis (2000).Neurophysiol Clin. 2000; 30: 263-288
- The CES-D Scale: A self-report depression scale for research in the general population.Appl Psychol Meas. 1977; 1: 385-401
- Right inferior prefrontal cortex mediates response inhibition while mesial prefrontal cortex is responsible for error detection.Neuroimage. 2003; 20: 351-358
- [Cognitive impairment in patients suffering from fibromyalgia: An underestimated problem.].Schmerz. 2010; 24: 46-53
- Development and validation of a Multiple Ability Self-Report Questionnaire.J Clin Exp Neuropsychol. 1994; 16: 93-104
- Meta-analysis of Go/No-go tasks demonstrating that fMRI activation associated with response inhibition is task-dependent.Neuropsychologia. 2008; 46: 224-232
- The Multidimensional Fatigue Inventory (MFI) psychometric qualities of an instrument to assess fatigue.J Psychosomtic Res. 1995; 39: 315-325
Spielberger CD: State-trait personality inventory. Available at: http://mindgarden.com/products/stpi.htm. Accessed March 18, 2010
- Manual for the State-Trait Anxiety Inventory.Consulting Psychologists Press, Palo Alto, CA1983
Spritzer KL, Hays RD: MOS sleep scale: A manual for use and scoring. Version 1.0. Los Angeles, CA, 2003
- The MOS short-form general health survey. Reliability and validity in a patient population.Med Care. 1988; 26: 724-735
- Patient compliance with paper and electronic diaries.Control Clin Trials. 2003; 24: 182-199
- Nociceptive processing in the human brain.Curr Opin Neurobiol. 2005; 15: 478-487
- Maintenance versus manipulation in verbal working memory revisited: An fMRI study.Neuroimage. 2003; 18: 247-256
- Advances in the assessment of fibromyalgia.Rheum Dis Clin North Am. 2009; 35: 339-357
- The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity.Arthritis Care Res (Hoboken). 2010; 62: 600-610
- The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee.Arthritis Rheum. 1990; 33: 160-172
- FMRI of working memory in patients with mild cognitive impairment and probable Alzheimer’s disease.Eur Radiol. 2006; 16: 193-206
- Neural substrates associated with the concurrent performance of dual working memory tasks.Int J Neurosci. 2004; 114: 613-631
Article info
Publication history
Published online: September 26, 2011
Accepted:
June 23,
2011
Received in revised form:
June 21,
2011
Received:
February 18,
2011
Footnotes
Supported in part by grant numbers R01-AR050044 (NIAMS/NIH), and DAMD 17-00-2-0018 (Department of Defense) to David Williams and Daniel Clauw and by a grant of the DFG (Deutsche Forschungsgemeinschaft, GZ: SchM 2665/1-1) to Tobias Schmidt-Wilcke.
The authors have no conflicts of interest to report.
Identification
Copyright
© 2011 American Pain Society. Published by Elsevier Inc. All rights reserved.
