Poster No:
1343
Submission Type:
Abstract Submission
Authors:
Laura Martín Herrero1, Maria Suñol1, Lucia Blanc1, Tracy Ting2, Jon Dudley2, Saül Pascual-Diaz1, Susmita Kashikar-Zuck2, Robert Coghill2, Marina López-Solà1
Institutions:
1University of Barcelona, Barcelona, Barcelona, 2Cincinnati Children's Hospital Medical Center, Cincinnati, OH
First Author:
Co-Author(s):
Maria Suñol
University of Barcelona
Barcelona, Barcelona
Lucia Blanc
University of Barcelona
Barcelona, Barcelona
Tracy Ting
Cincinnati Children's Hospital Medical Center
Cincinnati, OH
Jon Dudley
Cincinnati Children's Hospital Medical Center
Cincinnati, OH
Robert Coghill
Cincinnati Children's Hospital Medical Center
Cincinnati, OH
Introduction:
Juvenile Fibromyalgia (JFM) is a chronic pain condition characterized by persistent widespread musculoskeletal pain, fatigue, and sleep disturbances which predominantly affects adolescent girls (Yunus and Masi, 1985, kashikar-zuck, et al., 2016). JFM patients often report heightened unpleasantness to non-painful sensory stimuli (Ting et al. 2016, Bennett et al. 2014). In the same line, studies in adults with fibromyalgia (FM) (López-Solà et al., 2014; 2017; Wilbarger and Cook, 2011; Wang and Frey-Law, 2022) have shown that patients show greater unpleasantness to these stimuli. Furthermore, when compared to healthy peers, FM patients showed reduced responses in primary sensory cortices during multisensory stimulation, which correlated with multisensory hypersensitivities in daily life and FM symptoms. Conversely, they showed hyperactivation of the right insula and the right anterior lingual gyrus. The understanding of multisensory sensitivities may help improve our knowledge of the pathophysiological components of fibromyalgia and guide treatment selection on an individualized basis (Wang and Frey-Law, 2022). Here, we investigate whether patients with JFM exhibit reduced tolerance during a multisensory fMRI task and study the relationship between brain activity and core JFM symptoms and multisensory hypersensitivity in daily life.
Methods:
Forty-six adolescent girls (16.56 ± 1.01 years) diagnosed with JFM and forty-four healthy girls (16.09 ± 1.06 years) completed validated self-reported measures of multisensory hypersensitivity in daily life and core JFM symptoms. They also underwent a multisensory task inside the fMRI scanner that involved four trials of alternating 30 seconds of simultaneous multisensory stimulation (visual, auditory, and tactile-motor finger opposition task) and rest periods ranging from 20-30 seconds. The functional images were preprocess using CONN Toolbox running on MATLAB. At the subject level, we used a conventional general lineal model approach (GLM) implemented in SPM12 software to identify voxels that show significant changes in activity during the multisensory blocks compared to the baseline condition. The results from the first level analysis for all participants were used in a two-sample t-test model to assess the differences between groups in brain functional activity. We also performed regression model analysis in JFM patients group using the scores of the self-reported measures to assess the association between brain functional activity and these measures.
Results:
Compared to healthy participants, JFM patients reported higher levels of unpleasantness during the multisensory task, which positively correlated with sensory hypersensitivities in daily life and core JFM symptoms in patients. Nevertheless, there were no significant differences between groups in brain functional activity (pFWE<0.05 at cluster level and p<0.001 at voxel level). Among the JFM group, patients with greater hypersensitivities in daily life and JFM core symptoms (widespread pain index, functional disability, symptom severity and PROMIS fatigue) showed increased activation of sensory-motor, prefrontal and temporal cortex areas (pFWE<0.05 at cluster level and p<0.001 at voxel level).
Conclusions:
The findings in JFM patients parallel the symptom findings observed in adult patients with FM. Moreover, JFM patients reporting greater sensory hypersensitivities showed extensive hyperactivation of cortical prefrontal, sensory-motor and visual regions. The findings suggest that juvenile patients with fibromyalgia reporting less tolerance to non-painful sensory stimuli and exacerbated core clinical symptoms show amplified cortical responses in sensory integration and response-related brain regions during a multisensory task. These findings are partly different from what was observed in adult FM patients. Future studies should directly compare adult and juvenile patients to further elucidate these neurophysiological changes across the lifespan.
Modeling and Analysis Methods:
Activation (eg. BOLD task-fMRI) 1
Novel Imaging Acquisition Methods:
BOLD fMRI
Perception, Attention and Motor Behavior:
Perception: Multisensory and Crossmodal 2
Keywords:
FUNCTIONAL MRI
Pain
Other - Juvenile Fibromyalgia; Multisensory task; Adolescence
1|2Indicates the priority used for review
Provide references using author date format
Bennett, R. M. (2014), 'Criteria for the diagnosis of fibromyalgia: validation of the modified 2010 preliminary American College of Rheumatology criteria and the development of alternative criteria', Arthritis care & research, 66(9), 1364-1373.
Kashikar-Zuck, S. (2016), 'Juvenile fibromyalgia: different from the adult chronic pain syndrome?', Current rheumatology reports, 18(4), 19.
López‐Solà, M. (2014), 'Altered functional magnetic resonance imaging responses to nonpainful sensory stimulation in fibromyalgia patients', Arthritis & rheumatology, 66(11), 3200-3209.
López-Solà, M. (2017), 'Towards a neurophysiological signature for fibromyalgia', Pain, 158(1), 34.
Ting, T. V. (2016), '2010 American College of Rheumatology adult fibromyalgia criteria for use in an adolescent female population with juvenile fibromyalgia', The Journal of pediatrics, 169, 181-187.
Wang, D. (2022), 'Multisensory sensitivity differentiates between multiple chronic pain conditions and pain-free individuals', Pain, 10-1097.
Wilbarger, J. L. (2011), 'Multisensory hypersensitivity in women with fibromyalgia: implications for well being and intervention', Archives of physical medicine and rehabilitation, 92(4), 653-656.
Yunus, M. B. (1985), 'Juvenile primary fibromyalgia syndrome. A clinical study of thirty-three patients and matched normal controls', Arthritis & Rheumatology 28, 138–145