Experimental Brain Research

, Volume 218, Issue 4, pp 619–628

Treatment-related changes in brain activation in patients with fibromyalgia syndrome

  • Martin Diers
  • Pinar Yilmaz
  • Mariela Rance
  • Kati Thieme
  • Richard H. Gracely
  • Claudia Rolko
  • Marcus T. Schley
  • Ulrike Kiessling
  • Haili Wang
  • Herta Flor
Research Article

DOI: 10.1007/s00221-012-3055-2

Cite this article as:
Diers, M., Yilmaz, P., Rance, M. et al. Exp Brain Res (2012) 218: 619. doi:10.1007/s00221-012-3055-2

Abstract

Little is known about the effects of successful treatment on brain function in chronic pain. This study examined changes in pain-evoked brain activation following behavioral extinction training in fibromyalgia patients. Using functional magnetic resonance imaging, brain activation to painful mechanical stimuli applied to the 2nd phalanx of the left 2nd digit (m. flexor digitorum) was assessed in 10 patients with fibromyalgia syndrome (FM) before and after behavioral extinction training. The behavioral treatment significantly reduced interference from pain in the FM patients. Mechanical pain threshold and pain tolerance increased significantly after treatment. Activation in the insula shifted bilaterally from a more anterior site before treatment to a more posterior location after treatment. The pre- to post-treatment reduction in both interference related to pain and pain severity were significantly associated with bilateral activation in pain-evoked activity in the posterior insula, the ipsilateral caudate nucleus/striatum, the contralateral lenticular nucleus, the left thalamus and the primary somatosensory cortex contralateral to the stimulated side. These data show a relation between successful behavioral treatment and higher activation bilaterally in the posterior insula and in the contralateral primary somatosensory cortex. Future studies should compare responders and non-responders for differential treatment effects and examine in more detail the mechanisms underlying these changes.

Keywords

Extinction training Fibromyalgia syndrome fMRI Mechanical stimulation Pain 

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Martin Diers
    • 1
  • Pinar Yilmaz
    • 1
  • Mariela Rance
    • 1
  • Kati Thieme
    • 1
    • 2
  • Richard H. Gracely
    • 2
  • Claudia Rolko
    • 1
  • Marcus T. Schley
    • 3
  • Ulrike Kiessling
    • 4
  • Haili Wang
    • 5
  • Herta Flor
    • 1
  1. 1.Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty MannheimUniversity of HeidelbergMannheimGermany
  2. 2.Center for Neurosensory Disorders and Thurston Arthritis Research CenterUniversity of North Carolina at Chapel HillChapel HillUSA
  3. 3.Department of Anesthesiology and Intensive Care, Medical Faculty MannheimUniversity of HeidelbergMannheimGermany
  4. 4.Otto-Selz-Institute for Applied PsychologyUniversity of MannheimManheimGermany
  5. 5.Orthopedic University Hospital HeidelbergHeidelbergGermany

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