Fibromyalgia is a chronic disorder that presents in many misunderstood and misdiagnosed ways. The most common symptoms are unexplained widespread pain, bone pain, muscle pain, and joints pain or soreness, memory fog/issues, frequent migraine, irritable bowel syndrome, fatigue, and sleep issues. Although these symptoms are real to the patient, there is no physical cause for these pains, hence the reason this disorder is often misunderstood and mistreated. Until recently, fibromyalgia was not recognized as a legitimate illness, therefore there has been very little research on it. Due to the recent validation of the disorder, more research and studies have been conducted and it has been concluded that it seems to be related to the pain pathways in the brain.
The directive of this study was to understand the neural mechanism which controls the occipital nerves’ ability to suppress general pain in patients diagnosed with fibromyalgia. Five diagnostic criteria were used in the study’s data collection: fatigue, memory interruptions, abdominal cramps, depression, and headache. The patient’s pregenual anterior cingulate cortex activity was studied with PET scans and EEG imaging. As preliminary information revealed by other studies, it was gathered and stated that some patients of the study also had migraine disorders and that the pain inhibitory pathways (pregenual anterior cingulate cortex) are actually altered in fibromyalgia patients. The stimulation used is an implant called “ONS” (occipital nerve field stimulation), which is an implanted electrical stimulation device placed in the occipital nerve field. A marketable treatment was a goal to be explored with this study since there is no specific treatment, medication, or therapy for fibromyalgia.
The tests used in this study, as mentioned before, were PET scans and EEG imaging. A PET (positron emission tomography) scan is a visual analysis of brain function with the help of a radioactive contrast solution. PET scans are able to show the development of certain diseases before physical symptoms show, therefore it is appropriate to use to see how well a fibromyalgia patient’s pain inhibitory pathways are working. EEG (electroencephalography) imaging is the measurement of electrical activity in the brain. This type of imaging is good for experimental studies because it is non-invasive and yields clear results. With these tests, the researchers were able to evaluate the patient’s brain activity while they were being treated with the ONS, actively evaluating if the implant was helping to restore the pain inhibitory pathways’ functionality on improving the patient’s quality of life.
The fibromyalgia patients were chosen from the Department of Physical Medicine and Rehabilitation at the University Hospital in Belgium. They were administered a baseline assessment of their pain, symptoms, and the pain’s impact on their quality of life. The same questionnaire was administered at 4-weeks, 12-weeks, 18-weeks, and 24-weeks of treatment. The questionnaire categories of fibromyalgia pain were: bone pain, non-specific pain, and headache-related pain and how all of these symptoms affected the patients quality of life.
The patient’s pregenual anterior cingulate cortex activity was imaged with the PET scan at 2-minute intervals at “on” and “off” (settings of the stimulus of the pain inhibitory mechanism) conditions for a total of six minutes of imaging for each patient. The EEG imaging was conducted using the same process: 2-minute intervals with “on” and “off” for a total of 6 minutes of imaging. These imaging sessions were conducted at the same intervals as the questionnaire so responses were concurrently measured with the images.
The study’s data yielded information that the stimulation of the occipital nerve proved to decrease pain and improve the patients’ quality of life. This means that the stimulation of the nerve positively affected the physical and mental effects of the fibromyalgia pain and its impact on daily life for the sufferers. This finding, in turn, upholds the idea that a defect of the pain pathways causes spontaneous and widespread pain. The PET and EEG images were also found to be congruent with the decreases in pain complaints reported on the questionnaires. The conclusion of the study was that the ONS reversed the defective pain inhibition pathway- this will hopefully lead to further studies and marketable treatments.
Although this was quite a successful study, it does not take into consideration many symptoms of fibromyalgia that severely affect the quality of life such as anxiety, muscle pain, joint pain, sleep disturbances, mood changes, and irritable bowel syndrome. This study shed important light on the pain mechanism that could very well control the symptoms of fibromyalgia but it, unfortunately, did not cover a vast enough threshold of categorical pain to conclusively say that this treatment would be successful enough to be marketable. Further, the patients that were chosen most likely had already tried several treatment options since when they were selected they were patients of a physical medicine and rehabilitation center; this could have skewed the results of the study. Overall, the study was created, performed, and produced data that was necessary to the understanding and treatment of fibromyalgia.
From a personal point of view, as a fibromyalgia patient, this is a very interesting and exciting study. There are few solid treatments that completely alleviate fibromyalgia pain or that are not black label medications so if this method is found to be successful enough for marketing, it will be a huge breakthrough for the fibromyalgia community. The uncertain causation of fibromyalgia makes it hard to treat, the simple stimulation of the occipital nerve system could be a relatively simple treatment with the possibility of great improvements of the quality of life for these patients.
Demitri, Michael. “Types of Brain Imaging Techniques.” Psych Central, 8 Oct. 2018, psychcentral.com/lib/types-of-brain-imaging-techniques/.
“Positron Emission Tomography Scan.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 27 Mar. 2018, www.mayoclinic.org/tests-procedures/pet-scan/about/pac-
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