Science

Fibromyalgia & The Brain

In fibromyalgia, sensory neurons in the brain become overactive.

Gentle movement, or light touch causes an extra strong response in the brain:
- too many nerve cells activate
- the nerve cells activate more strongly
- the nerve cells stay activated for too long

Image: Blue bars show higher brain activation in Fibromyalgia compared to healthy controls. From Lim, Manyoel, et al. "Augmented pain processing in primary and secondary somatosensory cortex in fibromyalgia: a magnetoencephalography study using intra-epidermal electrical stimulation." PloS one 11.3 (2016): e0151776.

Inhbitory Pathways

The brain has inhibitory pathways whose job it is to naturally control nerve firing.  

These pathways are like "brakes", and they prevent the nerves from firing too much.

In people with fibromyalgia, the inhibitory pathways do not work as well. This results in excessive nerve firing, and increased pain.

Top: Magnetoencephalography images demonstarting poor inhibitory control from Goldstein, Abraham, et al. "Brain responses to other people’s pain in fibromyalgia: A magnetoencephalography study." Clin. Exp. Rheumatol 37 (2019): 70-74.

Bottom: Graph of poor performance on temporal discrimination task reflecting lack of inhibition from Gunendi, Zafer, et al. "Somatosensory temporal discrimination is impaired in fibromyalgia." Journal of Clinical Neuroscience 60 (2019): 44-48.

Fibromyalgia Treatments

A primary goal of fibromyalgia treatment is to reduce excessive firing of sensory nerve cells in the brain.  

For example, FDA approved medications such as Lyrica, are used to reduce this brain hyper-excitability (but can cause side effects for some people).

Recently scientists have found that stimulating the brain’s inhibitory pathways with electrical or magnetic stimulation can reduce fibromyalgia symptoms.

Tactile Sensory Training

Drugs and brain stimulation are not the only ways to activate these inhibitory pathways.  

These inhibitory pathways can also be activated with tactile sensory training tasks.

In the TrainPain program, these inhibitory pathways are activated thousands of times, to promote the brain's ability to regulate nerve activity.

Magnetoencephalography image of tactile cued spatial attention task from Haegens, Saskia, Lisa Luther, and Ole Jensen. "Somatosensory anticipatory alpha activity increases to suppress distracting input." Journal of cognitive neuroscience 24.3 (2012)

Effects of Sensory Training

Over a dozen studies have shown that sensory training exercises can reduce the impact of chronic pain conditions.

Conditions that have been studied include fibromyalgia, complex regional pain syndrome, phantom limb pain, and back pain.

Typically, sensory training is applied by a therapist. TrainPain is the first digital tool for enabling people to perform sensory training exercises independently at home.

Clinical trials studying the TrainPain platform are ongoing at partner institutions including the Cleveland Clinic, Mt Sinai Hospital, and University of Liege.

References

Reduced Inhibition in Fibromyalgia

Lim, Manyoel, et al. "Augmented pain processing in primary and secondary somatosensory cortex in fibromyalgia: a magnetoencephalography study using intra-epidermal electrical stimulation." PloS one 11.3 (2016).

Fallon, Nicholas, et al. "Ipsilateral cortical activation in fibromyalgia patients during brushing correlates with symptom severity." Clinical Neurophysiology 124.1 (2013): 154-163.

Üçeyler, Nurcan, et al. "Increased cortical activation upon painful stimulation in fibromyalgia syndrome." BMC neurology 15.1 (2015): 210.

Goldstein, Abraham, et al. "Brain responses to other people’s pain in fibromyalgia: A magnetoencephalography study." Clin. Exp. Rheumatol 37 (2019): 70-74.

Jensen, Karin B., et al. "Patients with fibromyalgia display less functional connectivity in the brain's pain inhibitory network." Molecular pain 8 (2012): 1744-8069.

Lim, Manyoel, et al. "Disinhibition of the primary somatosensory cortex in patients with fibromyalgia." Pain 156.4 (2015): 666-674.

Glass, Jennifer M., et al. "Executive function in chronic pain patients and healthy controls: different cortical activation during response inhibition in fibromyalgia." The journal of pain 12.12 (2011): 1219-1229.

Gunendi, Zafer, et al. "Somatosensory temporal discrimination is impaired in fibromyalgia." Journal of Clinical Neuroscience 60 (2019): 44-48.

Correa, Ángel, et al. "Temporal preparation and inhibitory deficit in fibromyalgia syndrome." Brain and cognition 75.3 (2011): 211-216.

Stimulating Inhibitory Pathways Reduces Fibromyalgia Pain

Tiwari, Vikas Kumar, et al. "Effect of repetitive transcranial magnetic stimulation in male patients of fibromyalgia." Indian Journal of Rheumatology 15.2 (2020): 134.

Sampson, Shirlene M., Jeffrey D. Rome, and Teresa A. Rummans. "Slow-frequency rTMS reduces fibromyalgia pain." Pain Medicine 7.2 (2006): 115-118.

Short, E. Baron, et al. "Ten sessions of adjunctive left prefrontal rTMS significantly reduces fibromyalgia pain: a randomized, controlled pilot study." Pain 152.11 (2011): 2477-2484.

Cheng, Chih‐Ming, et al. "Analgesic effects of repetitive transcranial magnetic stimulation on modified 2010 criteria‐diagnosed fibromyalgia: Pilot study." Psychiatry and clinical neurosciences 73.4 (2019): 187-193.

Brietzke, Aline P., et al. "Large Treatment Effect With Extended Home-Based Transcranial Direct Current Stimulation Over Dorsolateral Prefrontal Cortex in Fibromyalgia: A Proof of Concept Sham-Randomized Clinical Study." The Journal of Pain (2019).

Tactile Somatosensory Tasks Activate Inhibitory Pathways

Haegens, Saskia, Lisa Luther, and Ole Jensen. "Somatosensory anticipatory alpha activity increases to suppress distracting input." Journal of cognitive neuroscience 24.3 (2012): 677-685.

Sacchet, Matthew D., et al. "Attention drives synchronization of alpha and beta rhythms between right inferior frontal and primary sensory neocortex." Journal of neuroscience 35.5 (2015): 2074-2082.

Jones, Stephanie R., et al. "Cued spatial attention drives functionally relevant modulation of the mu rhythm in primary somatosensory cortex." Journal of Neuroscience 30.41 (2010): 13760-13765.

Haegens, Saskia, Barbara F. Händel, and Ole Jensen. "Top-down controlled alpha band activity in somatosensory areas determines behavioral performance in a discrimination task." Journal of Neuroscience 31.14 (2011): 5197-5204.

Hannula, Henri, et al. "Increasing top-down suppression from prefrontal cortex facilitates tactile working memory." Neuroimage 49.1 (2010): 1091-1098.

Gogulski, Juha, et al. "A segregated neural pathway for prefrontal top-down control of tactile discrimination." Cerebral Cortex 25.1 (2015): 161-166.

Effects of Tactile Somatosensory Training on Chronic Pain

Flor, Herta, et al. "Effect of sensory discrimination training on cortical reorganisation and phantom limb pain." The lancet 357.9270 (2001): 1763-1764.

Moseley, G. Lorimer, Nadia M. Zalucki, and Katja Wiech. "Tactile discrimination, but not tactile stimulation alone, reduces chronic limb pain." PAIN® 137.3 (2008): 600-608.

Paolucci, Teresa, et al. "A new rehabilitation tool in fibromyalgia: The effects of perceptive rehabilitation on pain and function in a clinical randomized controlled trial." Evidence-Based Complementary and Alternative Medicine 2016 (2016).

Schmid, Anne-Christine, et al. "Pain reduction due to novel sensory-motor training in Complex Regional Pain Syndrome I–A pilot study." Scandinavian journal of pain 15.1 (2017): 30-37.

Wand, Benedict M., et al. "Managing chronic nonspecific low back pain with a sensorimotor retraining approach: exploratory multiple-baseline study of 3 participants." Physical therapy 91.4 (2011): 535-546.

Filbrich, Lieve, et al. "The focus of spatial attention during the induction of central sensitization can modulate the subsequent development of secondary hyperalgesia." Cortex 124 (2020): 193-203.

Zhang, Libo, et al. "Pavlov’s pain: the effect of classical conditioning on pain perception and its clinical implications." Current pain and headache reports 23.3 (2019): 19.