Brain grey matter atrophy in Fibromyalgia




There have been brain scans on fibromyalgia patients that have shown atrophy in specific areas on the brain. Does this suggest premature aging of the brain? We have to remember that these are not long term studies. They cannot determine for example if these areas were smaller to begin with which mean they would be more of a risk factor than an indication those areas are shrinking in size. Secondly they do not know the cause of the atrophy in the area. It is seen in other conditions just different locations of the brain. Stress and pain seem to be common factors but what neurotransmitters or mechanisms are causing the atrophy to occurs? Thirdly they do not know the rate of change over time. They have not taken individuals and looked at their brain changing over time and looked at how they are functioning. However, what it does tell us is what areas are being affected by FM and where the symptoms of FM are coming from and this is quite important for future research. They are looking to the brain. Studying it and seeing the differences and what effects that has. Researchers are looking at the where.

The game plan
The study published in The Journal of Neuroscience, 11 April 2007, 27(15) set out to use a voxel-based morphometric analysis of magnetic resonance brain images it see if there is brain atrophy in the brain of people with fibromyalgia. There was reason to believe so based on previous studies. Changes in the structure of the brain like this have been seen in other pain conditions. Since there are similarities with those conditions the researchers believed there might be similar atrophying as well. In particular they endeavored to find out whether FM subjects have atrophy in brain grey matter, in areas that would be involved with stress, pain modulation and pain perception.

The study: Accelerated Brain Gray Matter Loss in Fibromyalgia Patients: Premature Aging of the Brain?
The study included ten patients with fibromyalgia and ten healthy subjects of a similar age. It excluded smokers, use of recreational drugs, alcohol consumption over three times a week, pregnancy, and any major medical, neurological and psychiatric conditions such as depression. The FM subjects were not taking anticonvulsants or antidepressant treatment for their condition.

Results
There was no difference in volume of white matter or CSF in the brains of FM subjects and the healthy controls. The study results indicated that fibromyalgia subjects had significantly less grey matter volume and in fact demonstrated 3.3 times greater age-associated reduction in grey matter. Every year o f fibromalygia being equal to 9.5 times the loss in the normal aging process. The specific areas FM subjects showed less grey matter density where the cingulate, insular and medial frontal cortices, and parahippocampal gyri. According to the study the “The neuroanatomical changes that we see in fibromyalgia patients contribute additional evidence of CNS involvement in fibromyalgia. In particular, fibromyalgia appears to be associated with an acceleration of age-related changes in the very substance of the brain.” The Journal of Neuroscience, 11 April 2007, 27(15
Clearly this study shows fibromyalgia patients have grey matter atrophy that is more than three times the age matched controls. If this were the only study we might be inclined to say it was too small to be demonstrative but it is not alone in its conclusions.

In conclusion
It is a structural change that seems to be a response to how the brain is responding to chronic pain and stress. There are a many conditions (lower back pain, chronic fatigue syndrome) showing similar results but affecting different areas of the brain. What areas atrophy might help determine what the different symptoms we see in these conditions and it might even lead researchers to the mechanism behind the atrophy. Researchers in this study suggest a possible explanation might be “excitotoxicity and/or exposure to inflammation-related agents, such as cytokines.”
They also state it is interesting to note the grey matter loss occurs in areas “related to stress [parahippocampal gyrus and pain processing [cingulate, insular, and prefrontal cortices, which might reflect their long-term experience of these symptoms. Because cingulate and prefrontal cortices are particularly implicated in pain modulation (i.e., inhibition and facilitation of pain), structural changes in these systems could contribute to the maintenance of pain and symptom chronification in fibromyalgia. Furthermore, gray matter atrophy in areas such as parahippocampal and frontal cortices also appears consistent with cognitive deficits characteristic of fibromyalgia.” The Journal of Neuroscience, 11 April 2007, 27(15
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