Premium
3D magnetic resonance spectroscopic imaging reveals links between brain metabolites and multidimensional pain features in fibromyalgia
Author(s) -
Lee Jeungchan,
Andronesi Ovidiu C.,
TorradoCarvajal Angel,
Ratai EvaMaria,
Loggia Marco L.,
Weerasekera Akila,
Berry Michael P.,
Ellingsen DanMikael,
Isaro Laura,
Lazaridou Asimina,
Paschali Myrella,
Grahl Arvina,
Wasan Ajay D.,
Edwards Robert R.,
Napadow Vitaly
Publication year - 2021
Publication title -
european journal of pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.305
H-Index - 109
eISSN - 1532-2149
pISSN - 1090-3801
DOI - 10.1002/ejp.1820
Subject(s) - fibromyalgia , anterior cingulate cortex , functional magnetic resonance imaging , chronic pain , thalamus , insula , cingulate cortex , insular cortex , neuroscience , psychology , medicine , magnetic resonance imaging , nociception , cognition , central nervous system , receptor , radiology
Background Fibromyalgia is a centralized multidimensional chronic pain syndrome, but its pathophysiology is not fully understood. Methods We applied 3D magnetic resonance spectroscopic imaging (MRSI), covering multiple cortical and subcortical brain regions, to investigate the association between neuro‐metabolite (e.g. combined glutamate and glutamine, Glx; myo‐inositol, mIno; and combined (total) N‐acetylaspartate and N‐acetylaspartylglutamate, tNAA) levels and multidimensional clinical/behavioural variables (e.g. pain catastrophizing, clinical pain severity and evoked pain sensitivity) in women with fibromyalgia ( N = 87). Results Pain catastrophizing scores were positively correlated with Glx and tNAA levels in insular cortex, and negatively correlated with mIno levels in posterior cingulate cortex (PCC). Clinical pain severity was positively correlated with Glx levels in insula and PCC, and with tNAA levels in anterior midcingulate cortex (aMCC), but negatively correlated with mIno levels in aMCC and thalamus. Evoked pain sensitivity was negatively correlated with levels of tNAA in insular cortex, MCC, PCC and thalamus. Conclusions These findings support single voxel placement targeting nociceptive processing areas in prior 1 H‐MRS studies, but also highlight other areas not as commonly targeted, such as PCC, as important for chronic pain pathophysiology. Identifying target brain regions linked to multidimensional symptoms of fibromyalgia (e.g. negative cognitive/affective response to pain, clinical pain, evoked pain sensitivity) may aid the development of neuromodulatory and individualized therapies. Furthermore, efficient multi‐region sampling with 3D MRSI could reduce the burden of lengthy scan time for clinical research applications of molecular brain‐based mechanisms supporting multidimensional aspects of fibromyalgia. Significance This large N study linked brain metabolites and pain features in fibromyalgia patients, with a better spatial resolution and brain coverage, to understand a molecular mechanism underlying pain catastrophizing and other aspects of pain transmission. Metabolite levels in self‐referential cognitive processing area as well as pain‐processing regions were associated with pain outcomes. These results could help the understanding of its pathophysiology and treatment strategies for clinicians.