Thursday, July 8, 2010

More Brain Changes Found in Fibromyalgia Patients – A review of Several Recent Studies

Written by Anthony Hardie

( – A new study released this week suggests that changes in the brain in fibromyalgia patients not only can be seen with sophisticated brain imaging technology, but may have revealed important clues about the progression of the disease.

The study is a preliminary study with only a small number of study participants, so further research with a larger study will be needed, involving many more fibromyalgia patients and health patients used as controls.

The study’s authors suggested that dysfunction in a key region of the brain controlling emotions and memory, the hypothalamus, may explain why that depression is a common symptom of fibromyalgia.

And, concentrations of key brain chemicals, glutamate+glutamine (Glx)/creatine(Cr),  were found to be higher in those with fibromyalgia.  Increased levels of Glx/Cr have also been found in patients with Attention-Deficit/Hyperactivity Disorder, multiple sclerosis (MS),  ALS, and other neurodegenerative conditions.

Interestingly, one recent study (2010) suggests that stress decreases the level of these chemicals that are found to be increased in fibromyalgia patients, implying that stress is not a cause of the increased chemical levels.

Another study suggests that taking Creatine supplements may lower the Glx in the brain. 

Scientists believe that there may be close relationships between Gulf War Illness, Chronic Fatigue Syndrome, and Fibromyalgia, though there is much debate about the differences as well.

Fibromyalgia is a neurological (brain/nerve system) disease  characterized by chronic widespread pain and tenderness in the joints and/or muscles.  Other neurological symptoms are frequently present as well, including fatigue, cognitive issues, muscle weakness, paresthesias (uncomfortable to debiliating buzzing, tingling, numbness, twitching, tickling, itching, stabbing, and/or burning sensations, often in the legs, arms, feet, and/or hands), depression, and anxiety. 

Fibromyalgia is usually diagnosed after ruling out a number of other neurological, auto-immune, and rheumatological conditions through an array of medical tests, often with multiple specialists like neurologists, immunologists, rheumatologists.  Rheumatologists – doctors who specialize in diseases of the joints – can often make the diagnosis of fibromyalgia after other diseases and conditions have been ruled out. 

Having the right diagnosis can be important, since treating diseases like MS and lupus – both of which can cause chronic widespread pain, fatigue, cognitive issues, and muscle weakness –are treated differently than fibromyalgia and other neurodegenerative conditions.

Vitamin D supplements, moderate exercise (even though it hurts), self-pacing, and ensuring adequate and refreshing sleep (including through certain medications that help with sleep quality) have all been shown to have a positive impact on relieving some of the symptoms of fibromyalgia. 

Treating the resulting depression and anxiety in fibromyalgia, chronic fatigue syndrome, and Gulf War Illness/chronic multi-symptom illness are also important, and some of the treatments also affect parts of the brain related to sensing pain, so often one or a few medications can act to relieve multiple symptoms, including pain and sleep dysfunction.

For the more scientifically minded, the newest study’s abstract is below.  The other studies are hyperlinked inline in the preceding text.


Localised 1H NMR spectroscopy in patients with fibromyalgia: a controlled study of changes in cerebral glutamate/glutamine, inositol, choline and N-acetylaspartate

Nicolas Fayed , Javier Garcia-Campayo , Rosa Magallon , Helena Andres-Bergareche , Juan V Luciano , Eva Andres  and Julian Beltran

Arthritis Research & Therapy 2010, 12:R134doi:10.1186/ar3072

Published: 7 July 2010




The purpose of this study was to investigate whether single-voxel (SV) proton magnetic resonance spectroscopy (MRS), diffusion-weighted imaging (DWI) and diffusion tensor imaging (DTI) detected differences between fibromyalgia (FM) patients and healthy controls. We also searched for correlations between neuroimaging abnormalities and neuropsychological variables.


Ten patients with FM and ten gender- and age-matched control subjects were studied. A neuropsychological examination, DWI, DTI and proton MRS were performed on the brain areas known to be associated with pain processing.


Compared with healthy controls, FM patients had significantly higher levels of glutamate+glutamine (Glx) (mean +/- SD: 10.71 +/- 0.50 arbitrary institutional units versus 9.89 +/- 1.04; P=0.049) and higher glutamate+glutamine/creatine (Glx/Cr) ratios (1.90 +/- 0.12 versus 1.72 +/- 0.23; P=0.034) in the posterior gyrus. Myo-inositol (Ins) levels of the right and left hippocampi were significantly lower in FM patients (4.49 +/- 0.74 versus 5.17 +/- 0.62; P=0.008 and 4.91 +/- 0.85 versus 6.09 +/- 0.78; P=0.004, respectively). In FM patients, there were also decreased myo-inositol/creatine (Ins/Cr) ratios in the left sensory-motor area (P=0.05) and the left hippocampus (P=0.002) and lower levels of choline (P=0.019) and N-acetyl aspartate + N-acetyl aspartyl glutamate (NAA+NAG) (P=0.034) in the left hippocampus. Significant correlations between depression, pain and global function and the posterior gyrus Glx levels and Glx/Cr ratios were observed.


Glx within the posterior gyrus could be a pathological factor in FM. Hippocampal dysfunction may be partially responsible for the depressive symptoms of FM. Additional studies with larger samples are required to confirm these preliminary data.

1 comment:

Anonymous said...

The author notes that there may be core symptoms between Gulf War Syndrome, the neuroimmune disease of Chronic Fatigue Syndrome (CFS) and fibromyalgia.

Although depression is often considered one of the symptoms related to these diseases, the research is mixed.

Several explanations are possible.

The severe fatigue associated with these diseases may be confused with the considerably milder lack of energy found in depression. Rating scales used often have ceilings because they are designed to measure fatigue in the healthy population not pathogenic fatigue.

Depression is a common overlay in any organic disease. There are tremendous losses associated with the disease process. And depression may exacerbate disease symptoms, however it is secondary to the disease. Stigmatization by doctors can also contribute to depression.

Or it could be a combination of such factors.