Speaker
Dr
Eric Guedj
(Service Central de Biophysique et Médecine Nucléaire CHU Timone APHM)
Description
Fibromyalgia (FM) syndrome is a chronic pain illness characterized by widespread
musculoskeletal aches, pain and stiffness, soft tissue tenderness, general fatigue
and sleep disturbances, without clinically demonstrable peripheral nociceptive
cause. If a psychogenic trouble has been initially postulated, recent fMRI studies
clearly demonstrated a global dysfunction of central pain processing: similar
pressures in patients and controls resulted in no common cerebral regions of
activation and greater effects in patients. We evaluated, in this prospective
study, brain perfusion SPECT at rest (without noxious stimulation) in a homogenous
group of severe FM patients using 99mTc-ECD. We performed a voxel-based analysis in
comparison to a control group, matched for age and gender. In such conditions, we
hypothesized that significant perfusion abnormalities could be highlighted,
objectifying cerebral processing associated with spontaneous pain in FM patients.
Methods. 18 hyperalgesic FM women (48-years old; 25-63 yrs; ACR criteria; VAS for
pain: 82 ±4) and 10 healthy women matched for age were enrolled in the study. A
voxel-by-voxel analysis was performed using SPM2 (p<0.001c).
Results. Voxel-by-voxel perfusion analysis exhibited individual and collective
brain SPECT abnormalities, including hyperperfusions of the somatosensory cortex
and hypoperfusions of frontal, cingulate, medial temporal and cerebellar cortices.
Conclusions. In the present study performed at rest in hyperalgesic patients, we
found significant hyperperfusions in regions known to be involved in the sensory
dimension of pain and significant hypoperfusions in supposed affective dimension-
related areas. As current pharmacological and non-pharmacological therapies act
differently on both components of pain, we hypothesize that individual voxel-by-
voxel SPECT analysis could be a valuable and easily available tool to adapt
individual therapeutic strategy and perform an objective follow-up of pain
processing recovery under treatment.
Author
Dr
Eric Guedj
(Service Central de Biophysique et Médecine Nucléaire CHU Timone APHM)
Co-authors
Dr
Catherine de Laforte
(Service Central de Biophysique et Médecine Nucléaire CHU Timone APHM, Marseille, France)
Dr
David Lussato
(SService Central de Biophysique et Médecine Nucléaire CHU Timone APHM, Marseille, France)
Dr
David Taieb
(Service Central de Biophysique et Médecine Nucléaire CHU Timone APHM, Marseille, France)
Dr
Jean Niboyet
(Unité d’Etude et de Traitement de la Douleur, Clinique La Phocéanne, Marseille, France)
Prof.
Olivier Mundler
(Service Central de Biophysique et Médecine Nucléaire CHU Timone APHM, Marseille, France)
Dr
Serge Cammilleri
(Service Central de Biophysique et Médecine Nucléaire CHU Timone APHM, Marseille, France)