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MGH Study Discovers Brain Inflammation-Fibromyalgia Connection: The research may lead to a more effective treatment for this challenging condition.

Fibromyalgia is a perplexing condition. It causes severe aches and pains, and can affect sleep, mood and memory. There is no simple diagnostic test and no cure. And treatments that help control symptoms in one person may not work for another with the same condition.

But researchers at Massachusetts General Hospital (MGH) have new insight into fibromyalgia that could lead to the development of more effective treatments. Working with a team from Sweden's Karolinska Institutet MGH researchers documented for the first time widespread inflammation in the brains of people with fibromyalgia. Their research was published in the journal Brain, Behavior and Immunity.

"We don't have good treatment options for fibromyalgia, so identifying a potential treatment target could lead to the development of innovative, more effective therapies," says study co-author Marco Loggia, PhD, with the Martinos Center for Biomedical Imaging at MGH. "And finding objective neurochemical changes in the brains of patients with fibromyalgia should help reduce the persistent stigma that many patients face, often being told their symptoms are imaginary and there's nothing really wrong with them."

What is Fibromyalgia?

Fibromyalgia is believed to alter the way the brain processes pain signals. One of the effects is to amplify painful sensations. Some researchers also believe that the brain's pain receptors may develop a type of memory to the pain, which makes them more sensitive to pain signals.

However, doctors don't know what causes fibromyalgia, though it could be a combination of a few key factors.

Fibromyalgia tends to run in families, so a genetic mutation may at least raise the risk of developing the condition. Fibromyalgia often develops after an infection or after physical trauma, such as a car accident. Psychological stress is also associated with developing fibromyalgia.

Other risk factors include having conditions such as rheumatoid arthritis, lupus, and osteoarthritis. Women are also more likely than men to develop fibromyalgia, though there is no obvious reason why.

Because fibromyalgia can cause both pain and sleep problems, people with the condition may be more likely to miss work or withdraw from social interactions. Complications of the disease can also lead to depression and health-related anxiety, in large part because the course of the disease is unpredictable and most people don't understand the symptoms or much about the disease itself.

Whether brain inflammation sparks fibromyalgia symptoms or whether the disease contributes to inflammation is still unclear. But it is an exciting area of study, carrying with it the possibility of a treatment that has eluded researchers for many years.

The Role of Inflammation

In the MGH-Karolinska study, researchers used a highly detailed imaging process called magnetic resonance/positron emission tomography (MR/PET) to document neuroinflammation. The focus was on inflammation in the glial cells, which have important roles in the brain and spinal cord. Among their jobs are to protect and support neurons--cells that transmit nerve signals.

Researchers observed greater glial cell activation in the brains of fibromyalgia patients compared with people who did not have fibromyalgia. Cell activation is the triggering of a cell to perform its function. While glial cells normally help protect neurons, when they are activated, they can also cause the release of chemicals that promote chronic pain.

"The activation of glial cells we observed in our studies releases inflammatory mediators that are thought to sensitize pain pathways and contribute to symptoms such as fatigue," says Dr. Loggia.

What's Ahead?

Further research will be needed to better understand the triggers of inflammation associated with fibromyalgia. It's not yet known whether reducing neuroinflammation in someone with fibromyalgia would actually reduce symptom severity.

Current treatments focus primarily on reducing pain and improving function. These include pain relievers as well as antidepressants to help with sleep problems and psychological complications. The anti-seizure medication pregabalin (Lyrica) was the first drug approved by the U.S. Food and Drug Administration to treat fibromyalgia. Pregabalin works in the central nervous system, but isn't effective for everyone.

But inflammation in the brain does present a possible target for medications, vaccines or other treatments. For those who struggle with fibromyalgia, any type of relief would be a welcome development.
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Publication:Mind, Mood & Memory
Date:Jan 1, 2019
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