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Fibromyalgia interacts with age to change the brain.

Ceko M, Bushnell MC, Fitzcharles MA, Schweinhardt P - Neuroimage Clin (2013)

Bottom Line: To examine their functional significance, gray matter differences were compared with experimental pain sensitivity.In both age groups, structural brain alterations were associated with experimental pain sensitivity, which was increased in older patients but normal in younger patients.These results suggest that brain structure and function shift from being adaptive in younger to being maladaptive in older patients, which might have important treatment implications.

View Article: PubMed Central - PubMed

Affiliation: Alan Edwards Centre for Research on Pain, McGill University, 3640 University Street, Montreal, Quebec H3A O7C, Canada ; Integrated Program in Neuroscience, McGilll University, 3801 University Street, Montreal Quebec H3A 2B4, Canada ; National Center for Complementary and Alternative Medicine (NCCAM), National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA.

ABSTRACT
Although brain plasticity in the form of gray matter increases and decreases has been observed in chronic pain, factors determining the patterns of directionality are largely unknown. Here we tested the hypothesis that fibromyalgia interacts with age to produce distinct patterns of gray matter differences, specifically increases in younger and decreases in older patients, when compared to age-matched healthy controls. The relative contribution of pain duration was also investigated. Regional gray matter was measured in younger (n = 14, mean age 43, range 29-49) and older (n = 14; mean age 55, range 51-60) female fibromyalgia patients and matched controls using voxel-based morphometry and cortical thickness analysis of T1-weighted magnetic resonance images. To examine their functional significance, gray matter differences were compared with experimental pain sensitivity. Diffusion-tensor imaging was used to assess whether white matter changed in parallel with gray matter, and resting-state fMRI was acquired to examine whether pain-related gray matter changes are associated with altered functional connectivity. Older patients showed exclusively decreased gray matter, accompanied by compromised white matter integrity. In contrast, younger patients showed exclusively gray matter increases, namely in the basal ganglia and insula, which were independent of pain duration. Associated white matter changes in younger patients were compatible with gray matter hypertrophy. In both age groups, structural brain alterations were associated with experimental pain sensitivity, which was increased in older patients but normal in younger patients. Whereas more pronounced gray matter decreases in the posterior cingulate cortex were related to increased experimental pain sensitivity in older patients, insular gray matter increases in younger patients correlated with lower pain sensitivity, possibly indicating the recruitment of endogenous pain modulatory mechanisms. This is supported by the finding that the insula in younger patients showed functional decoupling from an important pain-processing region, the dorsal anterior cingulate cortex. These results suggest that brain structure and function shift from being adaptive in younger to being maladaptive in older patients, which might have important treatment implications.

No MeSH data available.


Related in: MedlinePlus

Gray matter findings in fibromyalgia patients. A) Older patients had gray matter decreases compared to matched controls in the MPFC/ACC/FP (medial prefrontal cortex/anterior cingulate cortex/frontal pole), PCC/SMA (posterior cingulate cortex/supplementary motor area), VLPFC/OFC (ventrolateral prefrontal cortex/orbitofrontal cortex), DLPFC (dorsolateral prefrontal cortex), and PMC (premotor cortex); colorbar shows t-values for the contrast older controls > older patients. There were no significant clusters for the opposite contrast. B) Younger patients had gray matter increases compared to matched controls in the INS (insula), PUT (putamen), GP (globus pallidus), CAUD (caudate), NAc (nucleus accumbens), and VLPFC; colorbar shows t-values for the contrast younger patients > younger controls. There were no significant clusters for the opposite contrast. Significant clusters controlling for age (p < 0.05 corrected) are displayed on the study average brain; left side of the brain is on the left.
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f0010: Gray matter findings in fibromyalgia patients. A) Older patients had gray matter decreases compared to matched controls in the MPFC/ACC/FP (medial prefrontal cortex/anterior cingulate cortex/frontal pole), PCC/SMA (posterior cingulate cortex/supplementary motor area), VLPFC/OFC (ventrolateral prefrontal cortex/orbitofrontal cortex), DLPFC (dorsolateral prefrontal cortex), and PMC (premotor cortex); colorbar shows t-values for the contrast older controls > older patients. There were no significant clusters for the opposite contrast. B) Younger patients had gray matter increases compared to matched controls in the INS (insula), PUT (putamen), GP (globus pallidus), CAUD (caudate), NAc (nucleus accumbens), and VLPFC; colorbar shows t-values for the contrast younger patients > younger controls. There were no significant clusters for the opposite contrast. Significant clusters controlling for age (p < 0.05 corrected) are displayed on the study average brain; left side of the brain is on the left.

Mentions: Older fibromyalgia patients showed pronounced gray matter decreases compared to their controls: they had less gray matter in the bilateral anterior cingulate cortex (ACC)/medial prefrontal cortex (MPFC)/frontal pole (FP), right premotor cortex (PMC), VLPFC, right dorsolateral prefrontal cortex (DLPFC), and right posterior cingulate cortex (PCC) (Fig. 2A, Table 2). No region showed increased gray matter in older patients. Age and pain duration were significantly correlated in older patients (r = 0.60, p = 0.024) and after controlling for pain duration in addition to age, gray matter decreases were no longer significant except for the cluster in the DLPFC/PMC. Total native gray matter, white matter, and CSF did not differ significantly between older patients and controls.


Fibromyalgia interacts with age to change the brain.

Ceko M, Bushnell MC, Fitzcharles MA, Schweinhardt P - Neuroimage Clin (2013)

Gray matter findings in fibromyalgia patients. A) Older patients had gray matter decreases compared to matched controls in the MPFC/ACC/FP (medial prefrontal cortex/anterior cingulate cortex/frontal pole), PCC/SMA (posterior cingulate cortex/supplementary motor area), VLPFC/OFC (ventrolateral prefrontal cortex/orbitofrontal cortex), DLPFC (dorsolateral prefrontal cortex), and PMC (premotor cortex); colorbar shows t-values for the contrast older controls > older patients. There were no significant clusters for the opposite contrast. B) Younger patients had gray matter increases compared to matched controls in the INS (insula), PUT (putamen), GP (globus pallidus), CAUD (caudate), NAc (nucleus accumbens), and VLPFC; colorbar shows t-values for the contrast younger patients > younger controls. There were no significant clusters for the opposite contrast. Significant clusters controlling for age (p < 0.05 corrected) are displayed on the study average brain; left side of the brain is on the left.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3814958&req=5

f0010: Gray matter findings in fibromyalgia patients. A) Older patients had gray matter decreases compared to matched controls in the MPFC/ACC/FP (medial prefrontal cortex/anterior cingulate cortex/frontal pole), PCC/SMA (posterior cingulate cortex/supplementary motor area), VLPFC/OFC (ventrolateral prefrontal cortex/orbitofrontal cortex), DLPFC (dorsolateral prefrontal cortex), and PMC (premotor cortex); colorbar shows t-values for the contrast older controls > older patients. There were no significant clusters for the opposite contrast. B) Younger patients had gray matter increases compared to matched controls in the INS (insula), PUT (putamen), GP (globus pallidus), CAUD (caudate), NAc (nucleus accumbens), and VLPFC; colorbar shows t-values for the contrast younger patients > younger controls. There were no significant clusters for the opposite contrast. Significant clusters controlling for age (p < 0.05 corrected) are displayed on the study average brain; left side of the brain is on the left.
Mentions: Older fibromyalgia patients showed pronounced gray matter decreases compared to their controls: they had less gray matter in the bilateral anterior cingulate cortex (ACC)/medial prefrontal cortex (MPFC)/frontal pole (FP), right premotor cortex (PMC), VLPFC, right dorsolateral prefrontal cortex (DLPFC), and right posterior cingulate cortex (PCC) (Fig. 2A, Table 2). No region showed increased gray matter in older patients. Age and pain duration were significantly correlated in older patients (r = 0.60, p = 0.024) and after controlling for pain duration in addition to age, gray matter decreases were no longer significant except for the cluster in the DLPFC/PMC. Total native gray matter, white matter, and CSF did not differ significantly between older patients and controls.

Bottom Line: To examine their functional significance, gray matter differences were compared with experimental pain sensitivity.In both age groups, structural brain alterations were associated with experimental pain sensitivity, which was increased in older patients but normal in younger patients.These results suggest that brain structure and function shift from being adaptive in younger to being maladaptive in older patients, which might have important treatment implications.

View Article: PubMed Central - PubMed

Affiliation: Alan Edwards Centre for Research on Pain, McGill University, 3640 University Street, Montreal, Quebec H3A O7C, Canada ; Integrated Program in Neuroscience, McGilll University, 3801 University Street, Montreal Quebec H3A 2B4, Canada ; National Center for Complementary and Alternative Medicine (NCCAM), National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA.

ABSTRACT
Although brain plasticity in the form of gray matter increases and decreases has been observed in chronic pain, factors determining the patterns of directionality are largely unknown. Here we tested the hypothesis that fibromyalgia interacts with age to produce distinct patterns of gray matter differences, specifically increases in younger and decreases in older patients, when compared to age-matched healthy controls. The relative contribution of pain duration was also investigated. Regional gray matter was measured in younger (n = 14, mean age 43, range 29-49) and older (n = 14; mean age 55, range 51-60) female fibromyalgia patients and matched controls using voxel-based morphometry and cortical thickness analysis of T1-weighted magnetic resonance images. To examine their functional significance, gray matter differences were compared with experimental pain sensitivity. Diffusion-tensor imaging was used to assess whether white matter changed in parallel with gray matter, and resting-state fMRI was acquired to examine whether pain-related gray matter changes are associated with altered functional connectivity. Older patients showed exclusively decreased gray matter, accompanied by compromised white matter integrity. In contrast, younger patients showed exclusively gray matter increases, namely in the basal ganglia and insula, which were independent of pain duration. Associated white matter changes in younger patients were compatible with gray matter hypertrophy. In both age groups, structural brain alterations were associated with experimental pain sensitivity, which was increased in older patients but normal in younger patients. Whereas more pronounced gray matter decreases in the posterior cingulate cortex were related to increased experimental pain sensitivity in older patients, insular gray matter increases in younger patients correlated with lower pain sensitivity, possibly indicating the recruitment of endogenous pain modulatory mechanisms. This is supported by the finding that the insula in younger patients showed functional decoupling from an important pain-processing region, the dorsal anterior cingulate cortex. These results suggest that brain structure and function shift from being adaptive in younger to being maladaptive in older patients, which might have important treatment implications.

No MeSH data available.


Related in: MedlinePlus