Fibromyalgia is a disorder characterized by chronic widespread pain and other distressing symptoms including sleep disturbances, cognitive dysfunction, and fatigue. Around 75-90% of fibromyalgia patients are women. In addition to physical problems, fibromyalgia patients frequently suffer from mental health issues like depression and anxiety. Alexithymia, difficulty identifying and describing emotions, is also common.
The high prevalence of emotional disturbances suggests altered emotion processing and regulation likely contribute to fibromyalgia symptoms and comorbidities[1]Balducci T, Garza-Villarreal EA, Valencia A, Aleman A, van Tol MJ. Abnormal functional neurocircuitry underpinning emotional processing in fibromyalgia. European Archives of Psychiatry and Clinical … Continue reading.
Understanding the neural underpinnings of emotion processing in fibromyalgia could aid treatment development. In a new study published in European Archives of Psychiatry and Clinical Neuroscience, researchers investigated brain activation and connectivity during emotion processing and regulation in fibromyalgia using functional magnetic resonance imaging (fMRI).
Thirty women with fibromyalgia and 31 healthy women underwent fMRI while viewing positive, negative and neutral images. They were instructed to simply attend to the images, or use cognitive reappraisal to increase or decrease emotional responses. Outside the scanner, questionnaires assessed clinical variables including pain, alexithymia, depression and anxiety severity.
The study found heightened activation in the left lateral occipital cortex during emotional image viewing in fibromyalgia patients compared to controls, unrelated to image valence. The occipital cortex activation also correlated with depression and anxiety severity. This region is involved in visual attention and pain modulation, suggesting visual processing differences and altered visual contributions to affective pain processing in fibromyalgia.
Additionally, altered connectivity of the pregenual anterior cingulate cortex (pACC), important for emotion and pain processing, was uncovered in fibromyalgia. The pACC showed increased connectivity with sensorimotor areas during positive emotion processing, but decreased connectivity during negative emotion processing. As patients also reported more negative emotions behaviorally, the results indicate valence-specific pACC network dysfunction, which could disrupt integration of emotion, sensory and motor information.
While cognitive reappraisal instructions did not alter brain activation or produce clear behavioral effects, likely reflecting task difficulty for the sample, the abnormal emotion-related pACC connectivity suggests inherent differences in emotion processing circuitry in fibromyalgia. As pACC activation and connectivity is further linked to pain modulation, the identified pACC abnormalities likely contribute to affective pain disturbances in fibromyalgia.
Overall, the findings point to altered visual and pACC contributions to emotion processing in fibromyalgia, which may underlie affective imbalance and pain comorbidities. The data highlights candidate brain systems that could be targeted by emerging fibromyalgia treatments like neurostimulation and mindfulness-based therapies aimed at improving emotion regulation and associated symptoms. Further research should investigate whether abnormal brain function and connectivity during emotion processing normalizes following successful treatment.
MD, PhD. Physical Medicine & Rehabilitation Physician from São Paulo - Brazil. Pain Fellowship in University of São Paulo.
References
| ↑1 | Balducci T, Garza-Villarreal EA, Valencia A, Aleman A, van Tol MJ. Abnormal functional neurocircuitry underpinning emotional processing in fibromyalgia. European Archives of Psychiatry and Clinical Neuroscience. 2023 Mar 24:1-4. |
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