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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Article info
Publication history
Published online: March 12, 2017
Accepted:
February 27,
2017
Received in revised form:
February 17,
2017
Received:
October 8,
2016
Footnotes
K.L.S. and M.L.L. contributed equally to this work.
This work was supported by the National Institutes of Health, National Center for Complementary and Integrative Health (R01-AT007550, P01-AT006663), the National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01-AR064367), and the National Center for Research Resources (P41RR14075, S10RR021110, S10RR023043).
The authors have no conflicts of interest to declare.
Supplementary data accompanying this article are available online at www.jpain.org and www.sciencedirect.com.
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© 2017 by the American Pain Society
