Department of Clinical and Health Psychology, McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL 32610-0221, USA.
J Pain. 2011 Apr;12(4):436-43. doi: 10.1016/j.jpain.2010.10.003. Epub 2010 Dec 13.
Fibromyalgia (FM) is a chronic, widespread musculoskeletal pain disorder that is very prevalent in the general population (approximately 5%). Accumulating evidence suggests that FM is associated with central pain processing abnormalities, ie, central sensitization. Several previous studies of chronic pain patients, including FM, have shown gray matter atrophy of brain areas associated with sensory and affective pain processing. These findings, however, have not been confirmed in all FM studies. In this study, we investigated gray matter volumes of brain areas associated with pain-related areas of FM patients identified by functional brain imaging. Using voxel-based morphometric (VBM) analysis of magnetic resonance brain images, we compared 19 pain-related brain areas of 14 female FM patients and 11 healthy controls (NC). We found that FM patients had significantly less gray matter volumes than NC in 3 of these brain regions, including the anterior and mid-cingulate, as well as mid-insular cortices. Importantly, FM patients demonstrated neither global gray matter atrophy nor gray matter changes associated with depression, as shown in some studies. Using a more stringent analysis than other VBM studies, we provide evidence for decreased gray matter volumes in a number of pain-related brain areas in FM. Although the mechanisms for these gray matter changes are presently unclear, they may contribute to some of the core features of this chronic disorder including affective disturbances and chronic widespread pain.
Increasing evidence supports the association of chronic pain with accelerated gray matter atrophy in pain disorders like low back pain, IBS, and FM syndrome. However, cause-effect relationships between chronic pain and decreased gray matter volumes have not been established yet and will require future prospective studies.
纤维肌痛（FM）是一种慢性、广泛的肌肉骨骼疼痛障碍，在普通人群中非常普遍（约 5%）。越来越多的证据表明，FM 与中枢疼痛处理异常有关，即中枢敏化。几项以前的慢性疼痛患者研究，包括 FM，已经显示与感觉和情感疼痛处理相关的大脑区域的灰质萎缩。然而，这些发现并非在所有 FM 研究中都得到证实。在这项研究中，我们通过功能脑成像研究了与 FM 患者疼痛相关的大脑区域的灰质体积。使用磁共振脑图像的基于体素的形态测量（VBM）分析，我们比较了 14 名女性 FM 患者和 11 名健康对照组（NC）的 19 个与疼痛相关的大脑区域。我们发现，FM 患者的这些大脑区域中的 3 个区域的灰质体积明显少于 NC，包括前扣带和中扣带以及中脑岛皮质。重要的是，与一些研究中的情况不同，FM 患者既没有表现出全脑灰质萎缩，也没有表现出与抑郁相关的灰质变化。与其他 VBM 研究相比，我们使用更严格的分析方法，为 FM 中与疼痛相关的许多大脑区域的灰质体积减少提供了证据。尽管这些灰质变化的机制目前尚不清楚，但它们可能有助于该慢性疾病的一些核心特征，包括情感障碍和慢性广泛疼痛。
越来越多的证据支持慢性疼痛与慢性疼痛障碍（如腰痛、IBS 和 FM 综合征）中的灰质萎缩加速之间的关联。然而，慢性疼痛和灰质体积减少之间的因果关系尚未建立，需要未来的前瞻性研究。
