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Brain Chemical Tied To Fibromyalgia

This report was extracted from list@hdot.tv.

NEW YORK (Reuters) -- Fibromyalgia, a disease featuring fatigue and
muscle pains, affects 1 in every 20 people. Researchers say they may
have discovered the first physical clues to the origins of the disease.

"This finding should provide some relief to millions of people who have
been told that their pain is all in their head," says Laurence Bradley,
PhD, who led a University of Alabama study into the origins of the
disease. There's never been real physical evidence of fibromyalgia from
the usual tests -- up to now, blood samples and tissue biopsies from
patients with the disease have shown no apparent abnormalities.

Because of this, some researchers have theorized that fibromyalgia is a
psychological rather than a physical ailment. But using cerebrospinal
fluid drawn from spinal taps performed on those with fibromyalgia,
Bradley's team discovered higher levels of a brain chemical called
Substance P.

Bradley says Substance P is a neurological chemical which "allows cells
in the nervous system to communicate with one another about potentially
harmful stimuli," and create the sensation of pain.

Substance P levels are doubled or tripled in fibromyalgics, says
Bradley. This, in turn, could produce more episodes of pain transmission
throughout the body, he explained.

Researchers also used high-tech brain imaging on fibromyalgia patients,
and found lower blood flow to segments of the brain specifically
concerned with pain transmission. "If these pain centres are not working
efficiently, they might not be inhibiting pain transmission as well as
they should," said Bradley. In other words, in healthy individuals,
these 'pain centres' keep the gates closed on most pain. In those with
fibromyalgia, the gates are opened wider. "You see consistently -- in
those with fibromyalgia -- very low pain threshold levels. Levels two or
three times lower than that in healthy individuals," said Bradley.

Bradley thinks these two findings rule out a psychological base for
fibromyalgia. He says his findings "are not just artefacts of
psychiatric ailments." "Now that we know there are physical
abnormalities in a wide variety of people with this disorder," said
Bradley, "we can focus our research to determine why [they occur]....
This may be a lead in developing treatments for this painful disorder."

He says the next step is watching brain blood flow in healthy people and
comparing it to the results in fibromyalgic subjects. These tests will
be conducted using magnetic resonance imaging (MRI) and a computerized
brain-scan technique called Single Photon Emission Computed Tomography
(SPECT).

"We have preliminary evidence that in healthy people, there's greater
activation of blood flow as they respond to pain stimuli," said Bradley.
He says his team will also look at a possible common origin between
fibromyalgia and another syndrome with unexplained symptoms of tiredness
and achiness -- Chronic Fatigue Syndrome.

Bradley presented his findings at the American College of Rheumatology
national meeting in Orlando.

http://www.spinalrehab.com.au/Updates/Fibromyalgia.htm

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Fibromyalgia Pain Isn’t All In Patients’ Heads,
New Brain Study Finds

ANN ARBOR, MI – A new brain-scan study confirms scientifically what
fibromyalgia patients have been telling a skeptical medical community
for years: They’re really in pain.

In fact, the study finds, people with fibromyalgia say they feel severe
pain, and have measurable pain signals in their brains, from a gentle
finger squeeze that barely feels unpleasant to people without the
disease. The squeeze’s force must be doubled to cause healthy people to
feel the same level of pain — and their pain signals show up in
different brain areas.

The results, published in the current issue of Arthritis & Rheumatism,
the journal of the American College of Rheumatology, may offer the proof
of fibromyalgia’s physical roots that many doubtful physicians have
sought. It may also open doors for further research on the still-unknown
causes of the disease, which affects more than 2 percent of Americans,
mainly women.

Lead authors Richard Gracely, Ph.D., and Daniel Clauw, M.D., did the
study at Georgetown University Medical Center and the National
Institutes of Health, but are now continuing the work at the University
of Michigan Health System. In an editorial in the same issue, Clauw and
U-M rheumatologist Leslie Crofford, M.D., stress the importance of
fibromyalgia research and care.

To correlate subjective pain sensation with objective views of brain
signals, the researchers used a super-fast form of MRI brain imaging,
called functional MRI or fMRI, on 16 fibromyalgia patients and 16 people
without the disease. As a result, they say, the study offers the first
objective method for corroborating what fibromyalgia patients report
they feel, and what’s going on in their brains at the precise moment
they feel it. And, it gives researchers a road map of the areas of the
brain that are most — and least — active when patients feel pain.

"The fMRI technology gave us a unique opportunity to look at the
neurobiology underlying tenderness, which is a hallmark of
fibromyalgia," says Clauw. "These results, combined with other work done
by our group and others, have convinced us that some pathologic process
is making these patients more sensitive. For some reason, still unknown,
there’s a neurobiological amplification of their pain signals."

Further results from the study were presented last year at the ACR
annual meeting. The project will continue later this year at UMHS,
joining other fMRI fibromyalgia research now under way.

For decades, patients and physicians have built a case that fibromyalgia
is a specific, diagnosable chronic disease, characterized by tenderness
and stiffness all over the body as well as fatigue, headaches,
gastrointestinal problems and depression. Many patients with the disease
find it interferes with their work, family and personal life. Statistics
show that far more women than men are affected, and that it occurs
mostly during the childbearing years.

The ACR released classification criteria for fibromyalgia in 1990, to
help doctors diagnose it and rule out other chronic pain conditions.
Clauw and Crofford’s editorial looks at the current state of research,
and calls for rheumatologists to take the lead in fibromyalgia care and
science.

But many skeptics have debated the very existence of fibromyalgia as a
clearly distinct disorder, saying it seemed to be rooted more in
psychological and social factors than in physical, biological causes.
Their argument has been bolstered by the failure of research to find a
clear cause, an effective treatment, or a non-subjective way of
assessing patients.

While the debate has raged, neuroscientists have begun to use brain scan
technology to identify the areas of the normal human brain that become
most active during pain. A few studies have even assessed the blood flow
in those areas in fibromyalgia patients during baseline brain scans. The
new study is the first to use both high-speed scanning and a painful
stimulus.

In the study, fibromyalgia patients and healthy control subjects had
their brains scanned for more than 10 minutes while a small,
piston-controlled device applied precisely calibrated, rapidly pulsing
pressure to the base of their left thumbnail. The pressures were varied
over time, using painful and non-painful levels that had been set for
each patient prior to the scan.

The study’s design gave two opportunities to compare patients and
controls: the pressure levels at which the pain rating given by patients
and control subjects was the same, and the rating that the two different
types of participants gave when the same level of pressure was applied.

The researchers found that it only took a mild pressure to produce
self-reported feelings of pain in the fibromyalgia patients, while the
control subjects tolerated the same pressure with little pain.

"In the patients, that same mild pressure also produced measurable brain
responses in areas that process the sensation of pain," says Clauw. "But
the same kind of brain responses weren’t seen in control subjects until
the pressure on their thumb was more than doubled."

Though brain activity increased in many of the same areas in both
patients and control subjects, there were striking differences too.
Patients feeling pain from mild pressure had increased activity in 12
areas of their brains, while the control subjects feeling the same
pressure had activation in only two areas. When the pressure on the
control subjects’ ****** was increased, so did their pain rating and the
number of brain areas activated. But only eight of the areas were the
same as those in patients’ brains.

In all, the fibromyalgia patients’ brains had both some areas that were
activated in them but not in controls, and some areas that stayed
"quiet" in them but became active in the brains of controls feeling the
same level of pain. This response suggests that patients have enhanced
response to pain in some brain regions, and a diminished response in
others, Clauw says.

The study was supported in part by the National Fibromyalgia Research
Association, the U.S. Army and the NIH. In addition to Clauw and
Gracely, the research team included Frank Petzke, M.D.; and Julie M.
Wolf, BA. For more information on fibromyalgia research and treatment at
UMHS, visit http://www.med.umich.edu/intmed/rheumatology/fmweb.


http://www.sciencedaily.com/releases/2002/06/020607073056.htm