Researchers have reported for the first time that they have found inflammation in the brains of patients with fibromyalgia.

Daniel S. Albrecht, PhD, a postdoctoral fellow with the Department of Radiology at Massachusetts General Hospital, and Harvard Medical School, Boston, and colleagues, joined with a research team led by Anton Forsberg, PhD, of the Department of Clinical Neuroscience at the Karolinska Institute in Stockholm, Sweden, to broaden generalizability and boost statistical power of the study.

The researchers write that although there has been mounting evidence that brain inflammation plays some role in fibromyalgia, this research is the first to show direct evidence of brain glial activation in the poorly understood and difficult-to-treat chronic condition.

The findings were published online September 14 in Brain, Behavior, and Immunity.

In a news release, study coauthor Marco Loggia, PhD, from the Martinos Center for Biomedical Imaging, Massachusetts General Hospital, explains, "The activation of glial cells we observed in our studies releases inflammatory mediators that are thought to sensitize pain pathways and contribute to symptoms such as fatigue."

The evidence may open the door to new treatments and give comfort to those who have been told their symptoms are psychological.

"We don't have good treatment options for fibromyalgia, so identifying a potential treatment target could lead to the development of innovative, more effective therapies. And finding objective neurochemical changes in the brains of patients with fibromyalgia should help reduce the persistent stigma that many patients face, often being told their symptoms are imaginary and there's nothing really wrong with them."

A group of 31 patients who met the American College of Rheumatology definition for fibromyalgia diagnosis (29 women, average age 50.7 ± 11 years old) and 27 healthy controls (25 women, average age 49.4 ± 11 years old) received a hybrid magnetic resonance/positron-emission tomography (MR/PET) brain scan. The study excluded patients with fibromyalgia if they had any pain conditions other than fibromyalgia.

Using the imaging results, researchers found higher levels of the glial marker TSPO, a translocator protein, in several regions of the brain in patients with fibromyalgia relative to healthy controls. They also found that the degree of glial activation was related to the degree of fatigue the patients reported.

"Overall, our data support glial modulation as a potential therapeutic strategy," the authors write.

Fibromyalgia affects about 4 million US adults, according to the Centers for Disease Control and Prevention.

The study was supported by the International Association for the Study of Pain, Martinos Center Pilot Grant for Postdoctoral Fellows, and Harvard Catalyst Advance Imaging Pilot. The Swedish part of the study received funding from Stockholm County Council, Swedish Research Council, Swedish Rheumatism Association, and Fibromyalgiförbundet. The study was also funded by the European Union Seventh Framework Programme and a donation from the Lundblad family. The authors have disclosed no relevant financial relationships.

Brain Behav Immun. Published online September 14, 2018. Full text

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