Monday, June 18, 2012

New UW Research Provides Images of Brain Dysfunction in ill Gulf War Veterans

Written by Anthony Hardie,

( - Cutting edge research from the University of Wisconsin-Madison is providing new pictorial evidence of marked brain dysregulation in Gulf War veterans suffering from chronic widespread musculoskeletal pain (CMP), one of the most commonly reported symptoms of Gulf War Illness.  

According to lead researcher Dr. Dane Cook of the University of Wisconsin-Madison and the Madison VA Hospital, his research team’s findings also suggest potential avenues for treatment aimed at “resettting” the dysregulated functioning in the brains of ill Gulf War veterans.

Cook’s team’s findings, including powerful images of important brain functional differences, were presented at the opening of public meetings being held this week by the Congressionally chartered Research Advisory Committee on Gulf War Veterans’ Illnesses (RAC-GWVI) at the Boston University Medical Center in Boston, Mass.

In addition to new preliminary findings, Cook presented excerpts of his team’s past research and related research on fibromyalgia (a disease characterized by chronic widespread pain).  Much of Cook’s team’s work has focused on functional Magnetic Resonance Imaging (fMRI) of the brains of Gulf War veterans, including before and after exercise, and during application of painful stimuli.    

Cook says his data show the functioning of the brains of his principal study subjects -- Gulf War veterans who have chronic musculoskeletal pain (CMP) -- differ in important ways from healthy study subjects.  For the purposes of the studies, “Chronic” was defined as long-term, with pain unrelenting for at least six months or longer; most of the study subjects have been experiencing pain for many years.  The pain must also have been widespread, affecting at least three of four body quadrants, so as to rule out a localized injury where pain only affects one part of the body.  

The research results show that Gulf War veterans with CMP are significantly more sensitive to heat pain than healthy Gulf War veteran controls, and fMRI images provide objective confirmation of this.  And, this hypersensitivity to heat pain is magnified following exercise in the Gulf War veterans with CMP, in some cases as much as tripling.  For the healthy Gulf War veterans, sensitivity to heat pain did not change relative to before and after exercise.

Cook said the research findings, including detailed fMRI pictures are, “suggestive of less white matter integrity [density] in the brain,” meaning the brain is not functioning normally in the ill veterans.  

Cook’s research also looked at fatigue in his Gulf War veteran subjects, another major Gulf War Illness symptom.  He said his team’s findings show that the greater the feelings of fatigue in the ill patients, the less the white matter integrity [density]  in brain regions known to be central to pain processing.   In general, Gulf War veterans with CMP show decreased brain white matter integrity (density; “lower FA and higher MD”) in several regions of the brain associated with fatigue and pain processing.  Cook said these objective brain imaging and correlated findings are suggestive of altered communication along spinal tracts that are involved in pain processing and pain modulation.  

Dr. Cook’s team has also been working to examine similarities and differences between fibromyalgia patients and Gulf War veterans with CMP.  In a 2012 study (Shields et al), FM patients’ brains were found to be unable to communicate between brain regions to properly regulate pain.  FM patients were found to be more sensitive to all types of pain, and their brains less able to regulate pain properly.  Interestingly, Dr. Cook’s research has shown Gulf War veterans with CMP show excessive pain sensitivity to one type of painful stimuli -- heat pain -- but not to another, pressure pain.  According to Dr. Cook, the body of fibromyalgia research shows fibromyalgia (FM) patients have hypersensitivity to both heat pain and pressure pain, an important difference between the two groups. ''

And, his team’s research hopes to show whether Gulf War veterans are similar to fibromyalgia patients in another area, too. Research shows that FM patients who are more sedentary -- those who sit for at least 60 minutes at a time during their daily lives, as measured during extended testing -- exhibited more pain processing dysregulation in the brain.  Whether this sedentary behavior is a symptom or -- or is part of the cause of FM's worsened pain symptoms -- remains unclear.  However, Cook expressed hope that additional research related to exercise therapies should help resolve this question.  

Cook suggested that areas for future treatment exploration might include, “anything that might help reset a dysregulated [pain regulation] system” in the brain and central nervous system, including brain stimulation methods.

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