title: Towards a neurophysiological signature for fibromyalgia.
abstract: Patients with fibromyalgia (FM) show characteristically enhanced unpleasantness to painful and nonpainful sensations accompanied by altered neural responses. The diagnostic potential of such neural alterations, including their sensitivity and specificity to FM (vs healthy controls) is unknown. We identify a brain signature that characterizes FM central pathophysiology at the neural systems level. We included 37 patients with FM and 35 matched healthy controls, and analyzed functional magnetic resonance imaging responses to (1) painful pressure and (2) nonpainful multisensory (visual-auditory-tactile) stimulation. We used machine-learning techniques to identify a brain-based FM signature. When exposed to the same painful stimuli, patients with FM showed greater neurologic pain signature (NPS; Wager et al., 2013. An fMRI-based neurologic signature of physical pain. N Engl J Med 2013;368:1388-97) responses. In addition, a new pain-related classifier ("FM-pain") revealed augmented responses in sensory integration (insula/operculum) and self-referential (eg, medial prefrontal) regions in FM and reduced responses in the lateral frontal cortex. A "multisensory" classifier trained on nonpainful sensory stimulation revealed augmented responses in the insula/operculum, posterior cingulate, and medial prefrontal regions and reduced responses in the primary/secondary sensory cortices, basal ganglia, and cerebellum. Combined activity in the NPS, FM pain, and multisensory patterns classified patients vs controls with 92% sensitivity and 94% specificity in out-of-sample individuals. Enhanced NPS responses partly mediated mechanical hypersensitivity and correlated with depression and disability (Puncorrected < 0.05); FM-pain and multisensory responses correlated with clinical pain (Puncorrected < 0.05). The study provides initial characterization of individual patients with FM based on pathophysiological, symptom-related brain features. If replicated, these brain features may constitute objective neural targets for therapeutic interventions. The results establish a framework for assessing therapeutic mechanisms and predicting treatment response at the individual level.
authors: Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA.|Institute of Cognitive Science, University of Colorado Boulder, Boulder, CO, USA.
authors: Marina
authors: M
authors: López-Solà
authors: Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA.|Institute of Cognitive Science, University of Colorado Boulder, Boulder, CO, USA.
authors: Choong-Wan
authors: CW
authors: Woo
authors: MRI Research Unit, Department of Radiology, Hospital del Mar, CIBERSAM G21, Barcelona, Spain.
authors: Jesus
authors: J
authors: Pujol
authors: MRI Research Unit, Department of Radiology, Hospital del Mar, CIBERSAM G21, Barcelona, Spain.|Department of Clinical and Health Psychology, Autonomous University of Barcelona, Barcelona, Spain.|Guttmann Neurorehabilitation Institute, Autonomous University of Barcelona, Spain.
authors: Joan
authors: J
authors: Deus
authors: Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Victoria, Australia.
authors: Ben J
authors: BJ
authors: Harrison
authors: Department of Rheumatology, Hospital del Mar, Barcelona, Spain.
authors: Jordi
authors: J
authors: Monfort
authors: Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA.|Institute of Cognitive Science, University of Colorado Boulder, Boulder, CO, USA.
authors: Tor D
authors: TD
authors: Wager
mesh_terms: D000328:Adult; D000700:Analgesics / Q000627:therapeutic use; D001921:Brain / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology*; D001931:Brain Mapping; D016022:Case-Control Studies; D005260:Female; D005356:Fibromyalgia / Q000188:drug therapy / Q000473:pathology* / Q000503:physiopathology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D016015:Logistic Models; D000069550:Machine Learning; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010147:Pain Measurement; D017288:Pain Threshold / Q000502:physiology; D010812:Physical Stimulation / Q000009:adverse effects; D011795:Surveys and Questionnaires
chemical_list: D000700:Analgesics; D010100:Oxygen