Although not presently possible, Dr. Harris says that in the future, “Imaging may be able to confirm these cases, and it could also discover new pathologies that are not currently captured with self report.”
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“This is definitely worth investigating,” says Dr. Lee.
Ultimately, says Dr. Wager, the hope is that research, such as this, will lead to a thorough understanding of fibromyalgia. Presently, fibromyalgia is a syndrome with many subgroups, he says. Patients with ample discomfort related to touch, hearing or vision, but without specific pains in specific places, “may have some underlying problem, which may be related to inflammation or systemic autoimmune disease or broader kinds of brain psychopathology, more like generalized anxiety disorder or depression.” The goal, he says, is to identify brain features that can provide clues for defining subgroups that have more homogeneous neuropathology.”
“Currently, fibromyalgia diagnosis consists of individuals with similar symptoms but who have different pathways leading to those symptoms,” says Dr. Lee. “Thus, some of these methods may be helpful in identifying specific subtypes of patients with fibromyalgia, which in turn may enable better treatments targeted to specific subtypes.”
Potential treatment technologies—still well in the future for these applications—may include transcranial magnetic stimulation or transcranial direct current stimulation in the insula or other parts of the brain that may be found to be involved in fibromyalgia. “You may be able to inhibit specific brain areas without requiring surgery,” says Dr. Harris.
Says Dr. Wager, “We need to identify patients based on underlying pathology rather than just symptoms.”
David C. Holzman writes on medicine, science, environment and energy from Lexington, Mass.
- López-Solà M, Woo CW, Pujol J, et al. Towards a neurophysiological signature for fibromyalgia. Pain. [2016 Aug 31, Epub ahead of print] 2017 Jan;158(1):34–47.
- Harte SE, Ichesco E, Hampson JP, et al. Pharmacologic attenuation of cross-modal sensory augmentation within the chronic pain insula. Pain. 2016 Sep;157(9):1933–1945.
Another Anatomical Marker for Fibromyalgia
In earlier research, Richard Harris, PhD, of the University of Michigan Medical School, and his group previously posited that the activation of the insula is closely tied to a network called the Default Mode Network in fibromyalgia.1 This is a network of brain areas that are activated when a person is thinking introspectively, or “essentially assessing the status of their homeostasis,” says Dr. Harris.
Although the Default Mode Network is not directly activated by pain per se, it is more connected to areas of the brain that are involved in pain, notably the insula, in some pain conditions, such as fibromyalgia. “The insula is definitely an area that lights up in response to pain,” says Dr. Harris.