Primary somesthetic cortex involvement in fibromyalgia: review of neuroimage studies

Menezes, Maria Mônica da Silva; Campos, Flavio José Neto; Maia, Marília Silveira; Silva, Felipe Ribeiro Fernandes da; Queiroz, Jeffeson Hildo Medeiros de

doi:10.5935/2595-0118.20240002-en

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REVIEW ARTICLE • BrJP 7 • 2024 • https://doi.org/10.5935/2595-0118.20240002-en copy

Primary somesthetic cortex involvement in fibromyalgia: review of neuroimage studies

Authorship SCIMAGO INSTITUTIONS RANKINGS

HIGHLIGHTS

Fibromyalgia is associated with morphological and functional brain alterations, such as changes in activity in the primary somesthetic cortex;
Given that the somesthetic cortex has the function of somatosensory identification of the body, such as identifying the location and intensity of pain, the study proposes the hypothesis that alterations in S1 may contribute to the perception of generalized pain, allodynia and hyperalgesia in patients with fibromyalgia;
Understanding encephalic alterations in fibromyalgia patients could help us understand signs and symptoms in order to adapt and develop interventions and treatments for the syndrome.

ABSTRACT

BACKGROUND AND OBJECTIVES:

The mechanisms underlying nociplastic pain, such as fibromyalgia (FM), are not fully understood, however, it is believed that altered sensory processing and pain modulation play prominent roles in the maintenance of nociplastic pain. The hypothesis is that changes in the primary somesthetic cortex (S1) contribute to the generalized pain character of FM. The objective of this study was to evaluate the involvement of the primary somesthetic cortex in humans with fibromyalgia, as well as to investigate possible associations between S1 changes and clinical signs and symptoms of FM.

For this integrative review, the following databases were used: Pubmed and Web of Science, including observational studies carried out in humans with FM. In total, 541 studies were identified and four were included. The majority of studies are case-control studies, published between 2016 and 2022. In total, data from 161 individuals were included in this review. It was identified that there are morphological changes, hyperactivation and increased functional connectivity between S1 and periaqueductal gray matter and between S1 and anterior cingulate cortex.

CONCLUSION:

Patients with FM present morphological changes and hyperactivation in S1, as well as increased functional connectivity between S1 and periaqueductal gray matter and S1 and limbic system. Furthermore, different bilateral somatotropic subregions (legs, chest, fingers, hands, face and back) showed reduced functional connectivity in patients with FM. These regions are often presented as “tender points” in FM.

Keywords
Brain; General symptoms; Musculoskeletal pain

Authors	Type of study	Sample	Results
Kim et al.¹⁰10 Kim J, Loggia ML, Cahalan CM, Harris RE, Beissner F Dr Phil Nat, Garcia RG, Kim H, Wasan AD, Edwards RR, Napadow V. The somatosensory link in fibromyalgia: functional connectivity of the primary somatosensory cortex is altered by sustained pain and is associated with clinical/autonomic dysfunction. Arthritis Rheumatol. 2015;67(5):1395-405.	Case-control	35 patients and 14 controls	Altered S1 functional connectivity in different bilateral S1 somatotropic subregions (legs, back, chest, hand, finger, face) with fibromyalgia (FM), showing reduced connectivity at rest between several different S1 regions, patients also showed greater reduction of functional connectivity in S1 during sustained pain stimuli and outside the seed cortical presentation.
Lim et al.¹¹11 Lim M, Roosink M, Kim JS, Kim HW, Lee EB, Son KM, Kim HA, Chung CK. Augmented pain processing in primary and secondary somatosensory cortex in fibromyalgia: a magnetoencephalography study using intra-epidermal electrical stimulation. PLoS One. 2016;11(3):e0151776.	Case-control	19 patients and 21 controls	Increased activity in S1 was observed in FM patients when compared to perceptionand intensity-controlled activation in CH subjects. Intracortical inhibition in S1 is impaired in FM patients. Rostral anterior cingulate cortex activity is increased in FM patients after painful pressure stimulation.
Soldatelli et al.¹²12 Soldatelli M, Franco ÁO, Picon F, Duarte JÁ, Scherer R, Bandeira J, Zortea M, Torres ILDS, Fregni F, Caumo W. Primary somatosensory cortex and periaqueductal gray functional connectivity as a marker of the dysfunction of the descending pain modulatory system in fibromyalgia. Korean J Pain. 2023;36(1):113-27.	Cross-sectional study	33 patients	Resting-state functional connectivity (rs-FC) between the left somatosensory cortex (S1) and the periaqueductal gray matter is significantly related to dysfunction of the descen-ding pain modulator system. S1, rs-FC, and periaqueductal gray matter may be able to distinguish patients with descending pain modulator system failure according to groups of responders and non-responders to the conditioned pain modulation test. The S1, rs-FC and periaqueductal gray matter were negatively associated with a lower quality of life, poor sleep quality, and more intense pain in women with FM, and were positively associated with central sensitivity. Increased connectivity may indicate “pain sensitiza-tion” rather than “pain intensity”. The S1, rs-FC and periaqueductal gray matter may be a marker to distinguish individuals with FM with greater dysfunction of the descending pain modulator system.
Lim et al.¹³13 Lim M, Kim JS, Kim DJ, Chung CK. Increased lowand high-frequency oscillatory activity in the prefrontal cortex of fibromyalgia patients. Front Hum Neurosci. 2016;14(10):111.	Case-control	19 patients and 20 controls	S1 amplitudes were increased in patients compared to controls.

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Primary somesthetic cortex involvement in fibromyalgia: review of neuroimage studies

HIGHLIGHTS

ABSTRACT

BACKGROUND AND OBJECTIVES:

CONTENTS:

CONCLUSION: