Fibromyalgia and Cognitive Health
Patients suffering with fibromyalgia have numerous tender points or trigger points, often causing neck pain and other musculoskeletal problems. Fibromyalgia symptoms also include fatigue, ‘fibro fog’ and mental confusion, mood disturbances, sleep disruption, and mobility restrictions. Without really understanding the cause of the condition it is difficult to treat and many patients end up out of work, struggling with family life, and drawn into a depressive spiral. Often, diagnosis comes after things have become very difficult to cope with and so the correlation of fibromyalgia with anxiety, stress, and depression is complex and not simply causal. As fibromyalgia is more common in women there are also concerns regarding the nature of ‘hysteria’ and psychosomatic conditions as perceived by many doctors, caregivers, the general public, and patients themselves. Finding out more about the real causes of fibromyalgia would likely help to dispel these myths and provide patients with improved treatment options and a happier prognosis for fibromyalgia.
Brain Abnormalities in Fibromyalgia
This recent study found that those suffering with fibromyalgia had abnormalities in blood flow in the brain, particularly in areas of the brain that manage pain and detect pain intensity. Fibromyalgia patients have also been found to have a reduction in gray matter compared to healthy control subjects, leading researchers to question cause and effect. Loss of gray matter in the brain, which would explain some symptoms of fibromyalgia such as confusion, poor memory, and fatigue, could be a result of low levels of dopamine. This neurotransmitter is responsible for many functions of the central nervous system and is tied to many conditions including chronic fatigue syndrome and Alzheimer’s disease.
Working Memory in Fibromyalgia
Seo, et al (2012), looked specifically at blood flow in the brain in patients with fibromyalgia by using functional magnetic resonance imaging (MRI) to look at what happened in the brain when patients undertook specific mental tasks. Nineteen patients with fibromyalgia and twenty-two healthy subjects underwent fMRI scans whilst performing memory tests and the researchers observed differences in blood perfusion in the brain during the tests. Patients were also assessed using the Beck depression inventory and Beck anxiety inventory so as to control for these symptoms which are often blamed for fibromyalgia.
Functional MRI Scans
All the fibromyalgia patients met the criteria for diagnosis with fibromyalgia syndrome according to the American College of Rheumatology and seven of the nineteen were taking antidepressants, along with other medications such as milnacipran. The scan took just under five minutes for each participant and involved pressing a button when certain letters appeared in a given order that required use of memory centers in the brain. As well as testing memory and scanning the brain the patients were also assessed in terms of blood oxygenation level dependent (BOLD) contrast.
Fibromyalgia and Brain Scans
Results of the study showed that, after controlling for depression and anxiety, mild and moderate pain ratings were associated with the inferior parietal cortex. The left dorsolateral prefrontal cortex (DLPFC),right ventrolateral prefrontal cortex, and right inferior parietal cortex were associated with ratings of depression and anxiety. The authors concluded that the deficits in working memory in fibromyalgia patients could be attributable to the differences in neural activation of the frontoparietal memory network and could relate to pain and depression and anxiety related to pain.
Fibro-Fog CausesThe DLPFC is largely supplied by blood from the middle cerebral artery and this area of the brain is thought to be particularly reliant on dopamine The DLPFC is also connected to the thalamus, parts of the basal ganglia, the hippocampus, and the posterior temporal, parietal, and occipital areas. Thus, abnormal blood supply and neural activity in this area of the brain could create myriad symptoms of fibromyalgia, such as fibro fog, fatigue, memory deficits, and problems with sleep, mood, and pain. The DLPFC is a critical part of the brain as regards motor planning, organization, and regulation and damage to this area can lead to dysexecutive syndrome where social judgement, self-control, executive memory, abstract thinking, and intentionality are adversely affected. Interestingly, the DLPFC is thought to be involved in the processes of deception and lying and there is some evidence that inhibition of the DLPFC can affect a person’s ability to lie or tell the truth.
Brain Blood Flow in Fibromyalgia
Neuroimaging studies such as Seo’s provide evidence to support the symptom reports from fibromyalgia patients, demonstrating that areas of the brain, specifically the frontoparietal networks, are abnormal in various ways. SPECT scans of fibromyalgia patients have also found areas of hyperperfusion in the parietal area of the brain, as well as frontal hypoperfusion. Functional MRI scans have now demonstrated greater activation in the frontal and parietal cortex in fibromyalgia patients in response to nonpainful stimuli compared to healthy subjects.
Fibro is not just Pain Syndrome
Whilst musculoskeletal pain and tender points can link fibromyalgia and neck pain, many patients with FM also have cognitive symptoms such as problems ordering their thoughts and expressing themselves. Physicians diagnosing such patients may need to plan ahead so as to determine a good consultation strategy as many FM patients find it difficult to respond quickly to questions, suffer from attention deficits, and find it hard to remember details. This latest study supports the view that brain abnormalities in fibromyalgia are linked to pain receptivity and deficits in working memory and other cognitive processes. Better treatment of pain from fibromyalgia may, therefore, result in improvements in working memory and mental abilities.
Seo, J., Kim, S.H., et al, (2012), Working Memory Impairment in Fibromyalgia Patients Associated with Altered Frontoparietal Memory Network, PLoS One. 2012; 7(6): e37808., Published online 2012 June 8.