title: Cerebral blood flow dynamics during pain processing in patients with fibromyalgia syndrome.
abstract: OBJECTIVE
  Increased cerebral blood flow during processing of acute pain has repeatedly been observed in fibromyalgia syndrome. The study investigated the time dynamics of the pain-related hemodynamic response in fibromyalgia using transcranial Doppler sonography.
  
  
  METHODS
  In 25 women with fibromyalgia and 25 healthy participants, blood flow velocities in the anterior and middle cerebral arteries of both hemispheres were recorded, while heat stimuli of 45°C were applied to their forearms. Thermal pain threshold and subjective pain experience during stimulation were assessed, and the participants completed the McGill Pain Inventory, Beck Depression Inventory, and State-Trait Anxiety Inventory.
  
  
  RESULTS
  The early component of the blood flow response in both anterior cerebral arteries, that is, the steep flow increase during the initial stimulation period, was more pronounced in the patients than in the controls (mean [standard deviation] = 1.28% [1.85%] versus 0.24% [1.58%], p = .04). The patients showed lower pain threshold (p = .018), stronger sensory and affective pain experience (p < .001), and increased values on all questionnaire scales (all p values < .001). Although higher scores on each of the scales were associated with a stronger early blood flow response (r values ranging from 0.17 to 0.36), clinical pain severity proved to be the best predictor (β = .33, p = .02).
  
  
  CONCLUSIONS
  The increased blood flow response in the anterior cerebral arteries reflects hyperactivity of medial structures of the neuromatrix of nociception, structures involved in the processing of affective and cognitive aspects of pain. Aberrances in cerebral blood flow related to fibromyalgia and its clinical characteristics become particularly apparent in the enhancement of the initial component of the hemodynamic response.
authors.affiliation: Department of Applied Psychology, UMIT University for Health Sciences, Medical Informatics and Technology, Austria. duschek@lmu.de
authors.forename: Stefan
authors.initials: S
authors.lastname: Duschek
authors.forename: Tanja
authors.initials: T
authors.lastname: Mannhart
authors.forename: Andreas
authors.initials: A
authors.lastname: Winkelmann
authors.forename: Karim
authors.initials: K
authors.lastname: Merzoug
authors.forename: Natalie S
authors.initials: NS
authors.lastname: Werner
authors.forename: Daniel
authors.initials: D
authors.lastname: Schuepbach
authors.forename: Pedro
authors.initials: P
authors.lastname: Montoya
mesh_terms: D000328:Adult; D020771:Anterior Cerebral Artery / Q000503:physiopathology; D001783:Blood Flow Velocity; D001921:Brain / Q000098:blood supply*; D016022:Case-Control Studies; D002536:Cerebral Arteries / Q000503:physiopathology*; D005260:Female; D005356:Fibromyalgia / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006358:Hot Temperature; D006801:Humans; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000503:physiopathology; D010147:Pain Measurement; D058748:Pain Perception; D017288:Pain Threshold; D013997:Time Factors; D017585:Ultrasonography, Doppler, Transcranial