Central pain modulatory mechanisms of attentional analgesia are preserved in fibromyalgia

Oliva, Valeria, Gregory, Robert, Brooks, Jonathan C. W. and Pickering, Anthony E. (2022) Central pain modulatory mechanisms of attentional analgesia are preserved in fibromyalgia. Pain, 163 (1). pp. 125-136. ISSN 0304-3959

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Abstract

Fibromyalgia is a prevalent pain condition that is associated with cognitive impairments including in attention, memory, and executive processing. It has been proposed that fibromyalgia may be caused by altered central pain processing characterised by a loss of endogenous pain modulation. We tested whether attentional analgesia, where cognitive engagement diminishes pain percept, was attenuated in patients with fibromyalgia (n = 20) compared with matched healthy controls (n = 20). An individually calibrated, attentional analgesia paradigm with a 2 × 2 factorial design was used with brain and brainstem-focussed functional magnetic resonance imaging. Patients with fibromyalgia had both lower heat pain thresholds and speeds in a visual attention task. When this was taken into account for both attentional task and thermal stimulation, both groups exhibited an equivalent degree of attentional analgesia. Functional magnetic resonance imaging analysis showed similar patterns of activation in the main effects of pain and attention in the brain and brainstem (with the sole exceptions of increased activation in the control group in the frontopolar cortex and the ipsilateral locus coeruleus). The attentional analgesic effect correlated with activity in the periaqueductal gray and rostral ventromedial medulla. These findings indicate that patients with fibromyalgia can engage the descending pain modulatory system if the attentional task and noxious stimulus intensity are appropriately titrated.

Item Type: Article
Additional Information: Funding Information: The authors thank Aileen Wilson (Lead Research Radiographer, CRiCBristol) for her support in running experiments and the subjects who kindly agreed to take part. Funding: this work was supported by the Elizabeth Blackwell Institute with a clinical primer scheme award to RG and by a MRC award JCWB (MR/N026969/1). This research was funded in whole, or in part, by the Wellcome Trust [VO: 203963/Z/16/Z and AEP: 088373/Z/09/A]. For the purpose of open access, the author has applied a CC BY public copyright licence to any author accepted manuscript version arising from this submission. AEP has conducted research with Lateral Pharma and Eli Lilly on unrelated projects and has sat on the advisory board of Lateral Pharma. Previous presentation of the research: IASP 2018.
Uncontrolled Keywords: analgesia,attention,brainstem,fmri,fibromyalgia,pain,neurology,clinical neurology,anesthesiology and pain medicine ,/dk/atira/pure/subjectarea/asjc/2800/2808
Faculty \ School: Faculty of Social Sciences > School of Psychology
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Depositing User: LivePure Connector
Date Deposited: 07 Aug 2021 00:10
Last Modified: 17 Jan 2022 10:30
URI: https://ueaeprints.uea.ac.uk/id/eprint/81007
DOI: 10.1097/j.pain.0000000000002319

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