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

纤维肌痛（FM）是一种病因不明的疾病，其特征是慢性广泛的肌肉骨骼疼痛，僵硬和多个压痛点。FM是仅次于骨关节炎的第二种最常见的风湿性疾病，在西方工业化国家有2 - 4%的人口受到影响，主要是女性。过去十年的研究表明，FM中的慢性疼痛主要源于或至少得到中枢疼痛通路增强的支持。除了疼痛，患者还经常抱怨记忆和注意力缺陷，最近被称为认知障碍。专门调查神经心理学问题的研究表明，FM中的认知障碍通常是基于工作记忆的缺陷。然而，目前还不清楚慢性疼痛和认知障碍是否只是伴随症状，或者他们是否有相同的潜在病理生理学。工作记忆和疼痛都已被广泛研究，使用功能性脑成像方法，如fMRI和PET。越来越多的证据表明，疼痛和认知招募相同的，部分重叠和/或相邻的神经网络。这两个系统之间的相互作用已经证明了几次使用功能性脑成像方法和实验（急性和紧张性）疼痛范例。然而，由于方法问题，有困难的自发性（慢性）疼痛的神经相关成像，只有最近的新方法，如静息状态功能磁共振成像，已经发展。已经表明，慢性疼痛是由人类疼痛网络的组分的增加的功能连接和静息活动引起和/或增强的。这种增加的静息活动也被认为是FM。然而，目前还不清楚这种增加的活动在多大程度上干扰了其他认知网络，如工作记忆系统。这项建议的长期目标是进一步研究FM的神经生物学基础，特别是研究人类疼痛系统和FM患者的工作记忆系统之间的相互作用，使用各种脑成像技术。在医疗期间，应监测系统和/或其相互作用的变化。

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.