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Painful After-Sensations in Fibromyalgia are Linked to Catastrophizing and Differences in Brain Response in the Medial Temporal Lobe

  • Kristin L. Schreiber
    Correspondence
    Address reprint requests to Kristin L. Schreiber, PhD, Department of Anesthesiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.
    Affiliations
    Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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  • Marco L. Loggia
    Affiliations
    Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts

    Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
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  • Jieun Kim
    Affiliations
    Korea Institute of Oriental Medicine, Daejeon, Korea
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  • Christine M. Cahalan
    Affiliations
    Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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  • Vitaly Napadow
    Affiliations
    Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts

    Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
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  • Robert R. Edwards
    Affiliations
    Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts

    Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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      Highlights

      • Painful after-sensations (PAS) after a prolonged mechanical stimulus were more common and severe in individuals with fibromyalgia (FM).
      • PAS and catastrophizing were associated with clinical pain severity in FM.
      • Functional magnetic resonance imaging showed reduced deactivation of the medial temporal lobe in FM patients in the poststimulation period.
      • Greater PAS severity was associated with less medial temporal lobe deactivation.

      Abstract

      Fibromyalgia (FM) is a complex syndrome characterized by chronic widespread pain, hyperalgesia, and other disabling symptoms. Although the brain response to experimental pain in FM patients has been the object of intense investigation, the biological underpinnings of painful after-sensations (PAS), and their relation to negative affect have received little attention. In this cross-sectional cohort study, subjects with FM (n = 53) and healthy controls (n = 17) were assessed for PAS using exposure to a sustained, moderately painful cuff stimulus to the leg, individually calibrated to a target pain intensity of 40 of 100. Despite requiring lower cuff pressures to achieve the target pain level, FM patients reported more pronounced PAS 15 seconds after the end of cuff stimulation, which correlated positively with clinical pain scores. Functional magnetic resonance imaging revealed reduced deactivation of the medial temporal lobe (MTL; amygdala, hippocampus, parahippocampal gyrus) in FM patients, during pain stimulation, as well as in the ensuing poststimulation period, when PAS are experienced. Moreover, the functional magnetic resonance imaging signal measured during the poststimulation period in the MTL, as well as in the insular and anterior middle cingulate and medial prefrontal cortices, correlated with the severity of reported PAS by FM patients. These results suggest that the MTL plays a role in PAS in FM patients.

      Perspective

      PAS are more common and severe in FM, and are associated with clinical pain and catastrophizing. PAS severity is also associated with less MTL deactivation, suggesting that the MTL, a core node of the default mode network, may be important in the prolongation of pain sensation in FM.

      Key words

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