Differential dopamine function in fibromyalgia

Abstract

Approximately 30 % of Americans suffer from chronic pain disorders, such as fibromyalgia (FM), which can cause debilitating pain. Many pain-killing drugs prescribed for chronic pain disorders are highly addictive, have limited clinical efficacy, and do not treat the cognitive symptoms reported by many patients. The neurobiological substrates of chronic pain are largely unknown, but evidence points to altered dopaminergic transmission in aberrant pain perception. We sought to characterize the dopamine (DA) system in individuals with FM. Positron emission tomography (PET) with [(18)F]fallypride (FAL) was used to assess changes in DA during a working memory challenge relative to a baseline task, and to test for associations between baseline D2/D3 availability and experimental pain measures. Twelve female subjects with FM and 11 female controls completed study procedures. Subjects received one FAL PET scan while performing a "2-back" task, and one while performing a "0-back" (attentional control, "baseline") task. FM subjects had lower baseline FAL binding potential (BP) in several cortical regions relative to controls, including anterior cingulate cortex. In FM subjects, self-reported spontaneous pain negatively correlated with FAL BP in the left orbitofrontal cortex and parahippocampal gyrus. Baseline BP was significantly negatively correlated with experimental pain sensitivity and tolerance in both FM and CON subjects, although spatial patterns of these associations differed between groups. The data suggest that abnormal DA function may be associated with differential processing of pain perception in FM. Further studies are needed to explore the functional significance of DA in nociception and cognitive processing in chronic pain.

Keywords: Chronic pain; Dopamine; Fallypride; Fibromyalgia; Imaging; Pain; Positron emission tomography.

Figure 1

Voxel-wise results from the CON BL_BP > FM BL_BP full factorial model contrast. Display threshold is p < 0.005, k > 10.

Figure 2

Voxel-wise results from the linear regression between baseline VAS pain and baseline FAL BP. Display threshold is p < 0.005, k > 10.

Figure 3

Voxel-wise results from the linear regression between FAL BL_BP and average algometry sensitivity in FM (left) and CON (right) subjects. Display threshold is p < 0.005, k < 10. For each group, slice selection was chosen to illustrate results from the largest cluster extent (see Online Resource 5).

Figure 4

Voxel-wise results from the linear regression between FAL BL_BP and average algometry tolerance in FM (left) and CON (right) subjects. Display threshold is p < 0.005, k < 10. For each group, slice selection was chosen to illustrate results from the largest cluster extent (see Online Resources 6 and 7).