Investigations on the interaction between chronic pain and cognition in fibromyalgia patients under medica treatment applying functional and morphometric brain imaging

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Fibromyalgia (FM) is a disorder of unknown etiology, characterized by chronic widespread musculoskeletal pain, stiffness and multiple tender points. FM is the second most common rheumatologic disorder, behind osteoarthritis, with 2 – 4 percent of the population affected in western industrialised countries, predominately women. Research of the past ten years suggests that chronic pain in FM arises primarily from or is at least supported by augmentation of central pain pathways. In addition to pain, patients often complain of memory and attention deficits, which has recently be termed as dyscognition. Studies specifically investigating neuropsychological issues suggest that dyscognition in FM is often based on deficits in working memory. However, it is unclear whether chronic pain and dyscognition are just concomitant symptoms or whether they share the same underlying pathophysiology.Both working memory and pain have extensively been studied using functional brain imaging methods, such as fMRI and PET. There is mounting evidence that pain and cognition recruit the same, partially overlapping and/or neighbouring neural networks. The interaction between the two systems has been demonstrated several times using functional brain imaging methods and experimental (acute and tonic) pain paradigms. However, due to methodological issues there are difficulties in imaging the neural correlates of spontaneous (chronic) pain and only recently new methods, such as resting state fMRI, have evolved. It has been suggested that chronic pain is caused and/or enhanced by an increased functional connectivity and resting activity of components of the human pain network. Such increased resting activity has also been assumed for FM. However it is unclear to which degree this increased activity interferes with other cognitive networks, such as the working memory system. The long-term objective of this proposal is to further investigate the neurobiological underpinnings of FM, specifically to investigate the interaction between the human pain system and the working memory system in FM patients, using various brain imaging techniques. Changes in either system and/or their interaction shall be monitored during medical treatment.