Primary somesthetic cortex involvement in fibromyalgia: review of neuroimage studies
Envolvimento do córtex somestésico primário na fibromialgia: revisão de estudos de neuroimagem
Maria Mônica da Silva Menezes; Flavio José Neto Campos; Marília Silveira Maia; Felipe Ribeiro Fernandes da Silva; Jeffeson Hildo Medeiros de Queiroz
Abstract
BACKGROUND AND OBJECTIVES: The mechanisms underlying nociplastic pain, such as fibromyalgia (FM), are not fully understood, however, it is believed that altered sensory processing and pain modulation play prominent roles in the maintenance of nociplastic pain. The hypothesis is that changes in the primary somesthetic cortex (S1) contribute to the generalized pain character of FM. The objective of this study was to evaluate the involvement of the primary somesthetic cortex in humans with fibromyalgia, as well as to investigate possible associations between S1 changes and clinical signs and symptoms of FM.
CONTENTS: For this integrative review, the following databases were used: Pubmed and Web of Science, including observational studies carried out in humans with FM. In total, 541 studies were identified and four were included. The majority of studies are case-control studies, published between 2016 and 2022. In total, data from 161 individuals were included in this review. It was identified that there are morphological changes, hyperactivation and increased functional connectivity between S1 and periaqueductal gray matter and between S1 and anterior cingulate cortex.
CONCLUSION: Patients with FM present morphological changes and hyperactivation in S1, as well as increased functional connectivity between S1 and periaqueductal gray matter and S1 and limbic system. Furthermore, different bilateral somatotropic subregions (legs, chest, fingers, hands, face and back) showed reduced functional connectivity in patients with FM. These regions are often presented as “tender points” in FM.
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Resumo
JUSTIFICATIVA E OBJETIVOS: Os mecanismos subjacentes à dor nociplástica, como a fibromialgia (FM), não são totalmente compreendidos, contudo acredita-se que o processamento sensorial e a modulação da dor alterados desempenham papéis proeminentes para a manutenção da dor nociplástica. Com a hipótese de que alterações no córtex somestésico primário (S1) contribuam para o caráter de dor generalizada da FM, o objetivo deste estudo foi avaliar o envolvimento do córtex somestésico primário em humanos com FM, bem como investigar possíveis associações entre alterações de S1 com sinais e sintomas clínicos da FM.
CONTEÚDO: Para esta revisão integrativa, foram utilizadas as seguintes bases de dados: Pubmed e Web of Science, incluindo estudos observacionais realizados em humanos com FM. No total, 541 estudos foram identificados e quatro foram incluídos. A maioria dos estudos são do tipo caso-controle, publicados entre 2016 e 2022. Ao todo, dados de 161 indivíduos foram incluídos. Foi identificado que há alterações morfológicas, hiperativação e aumento da conectividade funcional entre S1 e substância cinzenta periaquedutal e entre S1 e córtex cingulado anterior.
CONCLUSÃO: Pacientes com FM apresentam alterações morfológicas e hiperativação em S1, bem como aumento da conectividade funcional entre S1 e substância cinzenta periaquedutal e S1 e sistema límbico. Ademais, diferentes sub-regiões somatotrópicas bilaterais (pernas, tórax, dedos, mãos, face e costas) apresentaram redução da conectividade funcional em pacientes com FM. Essas regiões são frequentemente apresentadas como “tender points” na FM.
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References
1 Henningsen P. Nociplastic pain is functional pain. Lancet. 2023;339(10335):1603-4.
2 Batista AS, Maia JB, Souza CG, Lins CA, Souza MC. Depression, anxiety and kinesiophobia in women with fibromyalgia practitioners or not of dance. BrJP. 2020;3(4):318-21.
3 Bittencourt JV, Corrêa LA, Bezerra MC, Reis FJ, Luca K, Nogueira LA. Patients with fibromyalgia present different pain phenotypes compared to patients with generalized pain. BrJP. 2022;5(2):119-26.
4 Cuenca Martínez F, Sempere Rubio N, Mollà Casanova S, Muñoz Gómez E, Fernández Carnero J, Sánchez Sabater A, Suso Martí L. Effects of repetitive-transcranial magnetic stimulation (rTMS) in fibromyalgia syndrome: an umbrella and mapping review. Brain Sci. 2023;13(7):1059.
5 Melo GA, Madruga ML, Oliveira MB, Torro N. Possíveis repercussões da pandemia da COVID-19 em mulheres com fibromialgia: estudo longitudinal. BrJP. 2022;5(3):195-9.
6 Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, Keefe FJ, Mogil JS, Ringkamp M, Sluka KA, Song XJ, Stevens B, Sullivan MD, Tutelman PR, Ushida T, Vader K. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain. 2020;161(9):1976-82.
7 DeSantana JM, Perissinotti DMN, Oliveira Junior JO, Correia LM, Oliveira CM, Fonseca PR. Revised definition of pain after four decades. BrJP. 2020;3(3):197-8.
8 Kuner R, Flor H. Structural plasticity and reorganisation in chronic pain. Nat Rev Neurosci. 2016;18(1):20-30.
9 Mosch B, Hagena V, Herpertz S, Diers M. Brain morphometric changes in fibromyalgia and the impact of psychometric and clinical factors: a volumetric and diffusion-tensor imaging study. Arthritis Res Ther. 2023;25(1):81. Erratum in: Arthritis Res Ther. 2023;25(1):89.
10 Kim J, Loggia ML, Cahalan CM, Harris RE, Beissner F Dr Phil Nat, Garcia RG, Kim H, Wasan AD, Edwards RR, Napadow V. The somatosensory link in fibromyalgia: functional connectivity of the primary somatosensory cortex is altered by sustained pain and is associated with clinical/autonomic dysfunction. Arthritis Rheumatol. 2015;67(5):1395-405.
11 Lim M, Roosink M, Kim JS, Kim HW, Lee EB, Son KM, Kim HA, Chung CK. Augmented pain processing in primary and secondary somatosensory cortex in fibromyalgia: a magnetoencephalography study using intra-epidermal electrical stimulation. PLoS One. 2016;11(3):e0151776.
12 Soldatelli M, Franco ÁO, Picon F, Duarte JÁ, Scherer R, Bandeira J, Zortea M, Torres ILDS, Fregni F, Caumo W. Primary somatosensory cortex and periaqueductal gray functional connectivity as a marker of the dysfunction of the descending pain modulatory system in fibromyalgia. Korean J Pain. 2023;36(1):113-27.
13 Lim M, Kim JS, Kim DJ, Chung CK. Increased lowand high-frequency oscillatory activity in the prefrontal cortex of fibromyalgia patients. Front Hum Neurosci. 2016;14(10):111.
14 Matias MG, Cavalcante AF, Mescouto KA, Silva Filho EM, Baptista AF, Okano AH, Pegado R. Does anodal transcranial direct current stimulation over left motor cortex show body side pain-related difference in fibromyalgia? BrJP. 2022;5(2):112-8.
15 Brasil. Diretrizes metodológicas: elaboração de revisões sistemáticas e metanálise de estudos observacionais. Ministério da saúde. 2012.
16 Souza MT, Silva MD, Carvalho R. Integrative review: what is it? How to do it? Einstein. 2010;8(1):102-6.
17 Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan - a web and mobile app for systematic reviews. Syst Rev. 2016;5:210.
Submitted date:
08/05/2023
Accepted date:
11/17/2023
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