The Korean Journal of Pain

The Korean Pain Society (대한통증학회)
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Primary somatosensory cortex and periaqueductal gray functional connectivity as a marker of the dysfunction of the descending pain modulatory system in fibromyalgia

  • Matheus, Soldatelli (School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS)) ;
  • Alvaro, de Oliveira Franco (Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA)) ;
  • Felipe, Picon (Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA)) ;
  • Juliana Avila, Duarte (Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS)) ;
  • Ricardo, Scherer (Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA)) ;
  • Janete, Bandeira (Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA)) ;
  • Maxciel, Zortea (Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA)) ;
  • Iraci Lucena, da Silva Torres (Laboratory of Pharmacology in Pain and Neuromodulation: Pre-clinical Investigations, Experimental Research Center, HCPA) ;
  • Felipe, Fregni (Pain and Palliative Care Service, HCPA) ;
  • Wolnei, Caumo (Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS))
  • Received : 2022.07.04
  • Accepted : 2022.11.09
  • Published : 2023.01.01
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Abstract

Background: Resting-state functional connectivity (rs-FC) may aid in understanding the link between painmodulating brain regions and the descending pain modulatory system (DPMS) in fibromyalgia (FM). This study investigated whether the differences in rs-FC of the primary somatosensory cortex in responders and non-responders to the conditioned pain modulation test (CPM-test) are related to pain, sleep quality, central sensitization, and the impact of FM on quality of life. Methods: This cross-sectional study included 33 females with FM. rs-FC was assessed by functional magnetic resonance imaging. Change in the numerical pain scale during the CPM-test assessed the DPMS function. Subjects were classified either as non-responders (i.e., DPMS dysfunction, n = 13) or responders (n = 20) to CPM-test. A generalized linear model (GLM) and a receiver operating characteristic (ROC) curve analysis were performed to check the accuracy of the rs-FC to differentiate each group. Results: Non-responders showed a decreased rs-FC between the left somatosensory cortex (S1) and the periaqueductal gray (PAG) (P < 0.001). The GLM analysis revealed that the S1-PAG rs-FC in the left-brain hemisphere was positively correlated with a central sensitization symptom and negatively correlated with sleep quality and pain scores. ROC curve analysis showed that left S1-PAG rs-FC offers a sensitivity and specificity of 85% or higher (area under the curve, 0.78, 95% confidence interval, 0.63-0.94) to discriminate who does/does not respond to the CPM-test. Conclusions: These results support using the rs-FC patterns in the left S1-PAG as a marker for predicting CPM-test response, which may aid in treatment individualization in FM patients.

Keywords

Acknowledgement

The following Brazilian funding agencies supported the present research: 1. Committee for the Development of Higher Education Personnel-CAPES (PROEX). To Wolnei Caumo. 2. National Council for Scientific and Technological Development - CNPq (grant to WC number: 420826/2018-1; 302688/2017-0). 3. Postgraduate Research Group at the Hospital de Clinicas de Porto Alegre, to Wolnei Caumo (FIPE, project number 2018-0353). 4. Foundation for the Support of Research at the Rio Grande do Sul (FAPERGS)Array of state of Rio Grande do Sul, Brazil (SEARS) n. 03/2017 (PPSUS), to Wolnei Caumo. number: 17/2551-0001. 5. Brazilian Innovation Agency (FINEP [Financiadora de Estudos e Projetos]); process number 1245/13 to Iraci LS Torres and Wolnei Caumo). Wolnei Caumo agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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