Abstract
Fibromyalgia (FMS) is a complex clinical syndrome that includes many symptoms beyond chronic pain. The studies that have addressed brain morphometry in FMS have had very heterogeneous results. Thus, the question of which specific FMS symptoms and clinical features—pain, but also psychological distress, sleep-related problems, health status, and medication intake—impact on brain morphometry remains open. Here, we wanted to determine if brain changes in FMS are “symptom-related” more than “diagnostic-related”. We performed an observational study of 46 premenopausal women (23 FMS patients and 23 age-matched healthy participants). Magnetic resonance images were analyzed using voxel-based morphometry and subcortical segmentation. We used multiple regression models to assess the associations between total and local brain volumes and FMS clinical characteristics. Furthermore, we calculated associations between subcortical structures’ shapes and volumes and FMS clinical characteristics. Larger psychological distress, anxiety, and sleepiness, and higher analgesic consumption accounted for 38 % of FMS patients’ smaller total gray matter volume (GMV). For both groups, local decrements of GMV in the medial orbitofrontal cortex were associated to larger psychological distress. Local increases of GMV were positively related to pain scores (superior frontal gyrus), psychological distress (cerebellum), anxiety (medial orbitofrontal cortex), and sleepiness (frontal superior medial cortex). FMS clinical characteristics were also associated to deformations in subcortical structures and volumes changes. This study reveals that total and local GMV changes in FMS go beyond the traditional “pain matrix” alterations. We demonstrated that brain morphology is altered by pain, but also by clinical characteristics that define the FMS experience.
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Acknowledgments
CDP was supported by a FPU grant from the Spanish Ministry of Education (AP 2007-02965) and is currently supported by a UGR Postdoctoral Fellowship (2013 University of Granada Research Plan). Research by CDP is funded by a CEI Biotic grant (V7-2015). Research by GBC is funded by a Spanish Ministry of Economy and Competitiveness grant (EDU2010-21215). Research by AC is funded by a Spanish Ministry of Economy and Competitiveness grant (PSI2012-39292).
We would like to thank Dr. L. L. Di Stasi (Mind, Brain, and Behavior Research Center, University of Granada, Spain) for his suggestions to improve the manuscript and his assistance designing the graphical material. We also thank Dr. M. B. McCamy (Division of Neurobiology, Barrow Neurological Institute, Phoenix, AZ, US) and R. Fernandez-Mendez (School of Health Sciences, University of Nottingham, UK) for his valuable advice and assistance in language edition.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the University of Granada’s Ethics Committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards (Williams 2008). All participants gave written informed consent after a complete description of the study.
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3-D models of subcortical structures showing shape changes related to pain intensity, psychological distress, anxiety, sleep quality, sleepiness, and health status. Red surface represents expansions, whereas blue one contractions
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Diaz-Piedra, C., Guzman, M.A., Buela-Casal, G. et al. The impact of fibromyalgia symptoms on brain morphometry. Brain Imaging and Behavior 10, 1184–1197 (2016). https://doi.org/10.1007/s11682-015-9485-2
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DOI: https://doi.org/10.1007/s11682-015-9485-2