Decreased neural inhibitory state in fibromyalgia pain: A cross-sectional study

Uygur-Kucukseymen, Elif; Castelo-Branco, Luís; Pacheco‐Barrios, Kevin; Luna-Cuadros, María Alejandra; Cardenas-Rojas, Alejandra; Giannoni‐Luza, Stefano; Zeng, Hui; Gianlorenço, Anna Carolyna Lepesteur; Gnoatto-Medeiros, Marina; Shaikh, Emad Salman; Caumo, Wolnei; Fregni, Felipe

doi:10.1016/j.neucli.2020.06.002

Cited by 27 publications

(37 citation statements)

References 62 publications

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“…The different contexts of evaluation brought by these two pain scales could explain the contradicting results in our model. Additionally, our finding regarding the VAS reinforces previous studies’ results, in which the same negative association between the ICF and VAS in patients with phantom limb pain was found 6 , 35 , 36 . All these finds may show that the VAS is not a good tool regarding cortex excitability.…”

Section: Discussionsupporting

confidence: 92%

“…Neuroplastic changes in pain-related circuits, resulting in maladaptive neuroplasticity, lead to a perpetuation of pain 3 , 4 . This process has been shown in other chronic pain conditions such as phantom limb pain, fibromyalgia, and low back pain, supporting the idea of a central nervous system modulation of chronic pain 5 , 6 . In these cases, central sensitization of nociceptive pathways may be present, which, along with an impairment in the descending pain modulation pathway, plays an essential role in how patients perceive pain in the long term 2 , 7 .…”

Section: Introductionsupporting

confidence: 61%

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Increased motor cortex inhibition as a marker of compensation to chronic pain in knee osteoarthritis

Simis

Imamura

Melo

et al. 2021

Sci Rep

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This study aims to investigate the associative and multivariate relationship between different sociodemographic and clinical variables with cortical excitability as indexed by transcranial magnetic stimulation (TMS) markers in subjects with chronic pain caused by knee osteoarthritis (OA). This was a cross-sectional study. Sociodemographic and clinical data were extracted from 107 knee OA subjects. To identify associated factors, we performed independent univariate and multivariate regression models per TMS markers: motor threshold (MT), motor evoked potential (MEP), short intracortical inhibition (SICI), intracortical facilitation (ICF), and cortical silent period (CSP). In our multivariate models, the two markers of intracortical inhibition, SICI and CSP, had a similar signature. SICI was associated with age (β: 0.01), WOMAC pain (β: 0.023), OA severity (as indexed by Kellgren–Lawrence Classification) (β: − 0.07), and anxiety (β: − 0.015). Similarly, CSP was associated with age (β: − 0.929), OA severity (β: 6.755), and cognition (as indexed by the Montreal Cognitive Assessment) (β: − 2.106). ICF and MT showed distinct signatures from SICI and CSP. ICF was associated with pain measured through the Visual Analogue Scale (β: − 0.094) and WOMAC (β: 0.062), and anxiety (β: − 0.039). Likewise, MT was associated with WOMAC (β: 1.029) and VAS (β: − 2.003) pain scales, anxiety (β: − 0.813), and age (β: − 0.306). These associations showed the fundamental role of intracortical inhibition as a marker of adaptation to chronic pain. Subjects with higher intracortical inhibition (likely subjects with more compensation) are younger, have greater cartilage degeneration (as seen by radiographic severity), and have less pain in WOMAC scale. While it does seem that ICF and MT may indicate a more acute marker of adaptation, such as that higher ICF and MT in the motor cortex is associated with lesser pain and anxiety.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionsupporting

confidence: 61%

Increased motor cortex inhibition as a marker of compensation to chronic pain in knee osteoarthritis

Simis

Imamura

Melo

et al. 2021

Sci Rep

Self Cite

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“…Actual concepts of FMS suggest a multifactorial pathology including disruption of inhibitory pain modulation (Uygur‐Kucukseymen et al., 2020), altered BDNF expression (Polli et al., 2020), central sensitization (Vecchio et al., 2020), peripheral neuropathies (Leinder et al., 2016), post‐traumatic stress disorder and corresponding behavioural features (Conversona et al., 2019) as well a variety of psychological and social stress factors and chronic fatigue (Haeuser, 2016).…”

Section: Discussionmentioning

confidence: 99%

High‐dose spironolactone lacks effectiveness in treatment of fibromyalgia (RCT)

Böhm¹,

Westermann

Gleim

et al. 2021

European Journal of Pain

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“…Several studies have shown that patients with FMS present hyperactivity and hyperexcitability of their CNS, suggesting that it is supported by continuous nociceptive peripheral inputs [19]. Recent neuroimaging and biochemical studies have shown a reduction in serotonin (5HT) and noradrenalin (NA) in cerebrospinal fluid [20] that may support continuous and widespread pain in FMS due to dysfunction in the descending inhibitory systems [21]. In addition, the activity of the insula lobe was shown to increase, producing higher levels of the neurotransmitter glutamate in the posterior insula, which has been associated with chronic pain [22].…”

Section: Introductionmentioning

confidence: 99%

Virtual Reality-Based Therapy Reduces the Disabling Impact of Fibromyalgia Syndrome in Women: Systematic Review with Meta-Analysis of Randomized Controlled Trials

Cortés‐Pérez

Zagalaz-Anula

Ibancos-Losada

et al. 2021

JPM

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Background: Virtual reality-based therapy (VRBT) is a novel therapeutic approach to be used in women with fibromyalgia syndrome (FMS). The aim of our study is to assess the effect of VRBT to reduce the impact of FMS in outcomes such as pain, dynamic balance, aerobic capacity, fatigue, quality of life (QoL), anxiety and depression. Methods: Systematic review with meta-analysis was conducted from a bibliographic search in PubMed, Scopus, PEDro, Web of Science and CINAHL until April 2021 in accordance with PRISMA guidelines. We included randomized controlled trials (RCTs) that compare VRBT versus others to assess the mentioned outcomes in women with FMS. Effect size was calculated with standardized mean difference (SMD) and its 95% confidence interval (95% CI). Results: Eleven RCTs involving 535 women with FMS were included. Using the PEDro scale, the mean methodological quality of the included studies was moderate (6.63 ± 0.51). Our findings showed an effect of VRBT on the impact of FMS (SMD −0.62, 95% CI −0.93 to −0.31); pain (SMD −0.45, 95% CI −0.69 to −0.21); dynamic balance (SMD −0.76, 95% CI −1.12 to −0.39); aerobic capacity (SMD 0.32, 95% CI 0.004 to 0.63); fatigue (SMD −0.58, 95% CI −1.02 to −0.14); QoL (SMD 0.55, 95% CI 0.3 to 0.81); anxiety (SMD −0.47, 95% CI −0.91 to −0.03) and depression (SMD −0.46, 95% CI −0.76 to −0.16). Conclusions: VRBT is an effective therapy that reduces the impact of FMS, pain, fatigue, anxiety and depression and increases dynamic balance, aerobic capacity and quality of life in women with FMS. In addition, VRBT in combination with CTBTE showed a large effect in reducing the impact of FMS and fatigue and increasing QoL in these women.

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Decreased neural inhibitory state in fibromyalgia pain: A cross-sectional study

Cited by 27 publications

References 62 publications

Increased motor cortex inhibition as a marker of compensation to chronic pain in knee osteoarthritis

Increased motor cortex inhibition as a marker of compensation to chronic pain in knee osteoarthritis

High‐dose spironolactone lacks effectiveness in treatment of fibromyalgia (RCT)

Virtual Reality-Based Therapy Reduces the Disabling Impact of Fibromyalgia Syndrome in Women: Systematic Review with Meta-Analysis of Randomized Controlled Trials

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