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Vol. 2. Núm. 5.
Páginas 251-260 (Septiembre - Octubre 2006)
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Vol. 2. Núm. 5.
Páginas 251-260 (Septiembre - Octubre 2006)
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Consideraciones acerca de las alteraciones de la actividad cerebral en pacientes con fibromialgia
Considerations on alterations in brain activity in patients with fibromyalgia
Visitas
...
Pedro Montoyaa,
Autor para correspondencia
pedro.montoya@uib.es

Correspondencia: Dr. P. Montoya. Departamento de Psicología. Universitat de les Illes Balears. Ctra. de Valldemossa, km 7,5. 07071 Palma de Mallorca. España.
, Carolina Sitgesa, Manuel García-Herrerab, Raúl Izquierdob, Magdalena Truyolsc, Dolores Colladob
a Departamento de Psicología e Instituto Universitario de Investigación en Ciencias de la Salud (IUNICS). Universitat de les Illes Balears. Palma de Mallorca. España
b Unidad Médica del Equipo de Valoración de Incapacidades (UMEVI). Instituto Nacional de la Seguridad Social. Dirección Provincial de les Illes Balears. Palma de Mallorca. España
c Unidad de Dolor. Hospital General. Palma de Mallorca. España
Información del artículo

La fibromialgia es un trastorno de dolor crónico osteomuscular de etiología desconocida y caracterizado por dolor generalizado. La investigación clínica y experimental ha demostrado que los pacientes con fibromialgia pueden presentar un aumento de la sensibilidad para el dolor en varias regiones corporales, junto con alteraciones neuroendocrinas y una activación anormal de regiones cerebrales implicadas en el dolor. Los datos recientes han demostrado también que el procesamiento afectivo y cognitivo de la información relacionada con el dolor se encuentra alterado en la fibromialgia. En nuestra opinión, todos estos resultados sugieren la presencia de un procesamiento anormal del dolor en el sistema nervioso central, que podría ser responsable del mantenimiento del dolor crónico en estos pacientes.

Palabras clave:
Cerebro
Dolor crónico
Emociones
Cognición
Hipersensibilidad

Fibromyalgia is a chronic musculoskeletal pain disorder of unknown etiology, characterized by widespread pain. Clinical and experimental research has demonstrated that patients with fibromyalgia may have enhanced pain sensitivity at several points of the body, together with neuroendocrine abnormalities, and abnormal activation of pain-related brain regions. Recent data have also shown that affective and cognitive processing of pain-related information could also be disturbed in fibromyalgia. In our opinion, all these findings suggest the existence of abnormal central pain processing, which could be responsible for the persistence of chronic pain in these patients.

Key words:
Brain
Chronic pain
Emotions
Cognition
Hypersensitivity
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BIbliografía
[1.]
F.W. Wolfe, H.A. Smythe, M.B. Yunas, R.M. Bennett, C. Bombardier, D.L. Goldenberg, et al.
The American College of Rheumatology 1990 criteria for the classification of fibromyalgia.
Arthritis Rheum, 33 (1990), pp. 160-172
[2.]
F. Wolfe.
What use are fibromyalgia control points?.
J Rheumatol, 25 (1998), pp. 546-550
[3.]
R.H. Gracely, M.A. Grant, T. Giesecke.
Evoked pain measures in fibromyalgia.
Best Pract Res Clin Rheumatol, 17 (2003), pp. 593-609
[4.]
T.J. Coderre, J. Katz, A.L. Vaccarino, R. Melzack.
Contribution of central neuroplasticity to pathological pain: review of clinical and experimental evidence.
Pain, 52 (1993), pp. 259-285
[5.]
T.J. Coderre, J. Katz.
Peripheral and central hyperexcitability: differential signs and symptoms in persistent pain.
Behav Brain Sci, 20 (1997), pp. 404-419
[6.]
E.M. Garry, E. Jones, S.M. Fleetwood-Walker.
Nociception in vertebrates: key receptors participating in spinal mechanisms of chronic pain in animals.
Brain Res Rev, 46 (2004), pp. 216-224
[7.]
M. Martínez-Lavín.
Fibromyalgia as a sympathetically maintained pain syndrome.
Curr Pain Headache Rep, 8 (2004), pp. 385-389
[8.]
M. Martínez-Lavín, A.G. Hermosillo, M. Rosas, M.E. Soto.
Circadian studies of automatic nervous balance in patients with fibromyalgia: A heart rate variability analysis.
[9.]
M. Martínez-Lavín, M. Vidal, R.E. Barbosa, C. Pineda, J.M. Casanova, A. Nava.
Norepinephrine-evoked pain in fibromyalgia. A randomised pilot study (ISCRTN 70707830).
BMC Musculoskelet Disord, 3 (2002), pp. 2
[10.]
M.O. Urban, G.F. Gebhart.
Supraspinal contributions to hyperalgesia.
Proc Natl Acad Sci USA, 96 (1999), pp. 7687-7692
[11.]
I.J. Russell, M.D. Orr, B. Littman, G.A. Vipraio, D. Alboukrek, J.E. Michalek, et al.
Elevated cerebrospinal fluid levels of substance P in patients with the fibromyalgia syndrome.
Arthritis Rheum, 37 (1994), pp. 1593-1601
[12.]
T. Graven-Nielsen, L. Arendt-Nielsen.
Peripheral and central sensitization in musculoskeletal pain disorders: an experimental approach.
Curr Rheumatol Rep, 4 (2002), pp. 313-321
[13.]
E. Kosek, J. Ekholm, P. Hansson.
Sensory dysfunction in fibromyalgia patients with implications for pathogenic mechanisms.
Pain, 68 (1996), pp. 375-383
[14.]
L. Bendtsen, J. Norregaard, R. Jensen, J. Olesen.
Evidence of qualitatively altered nociception in patients with fibromyalgia.
Arthritis Rheum, 40 (1997), pp. 98-102
[15.]
E. Kosek, P. Hansson.
Modulatory influence on somatosensory perception from vibration and heterotopic noxious conditioning stimulation (HNCS) in fibromyalgia patients and healthy subjects.
Pain, 70 (1997), pp. 41-51
[16.]
J. Sorensen, T. Graven-Nielsen, K.G. Henriksson, M. Bengtsson, L. Arendt-Nielsen.
Hyperexcitability in fibromyalgia.
J Rheumatol, 25 (1998), pp. 152-155
[17.]
R. Staud, C.J. Vierck, R.L. Cannon, A.P. Mauderli, D.D. Price.
Abnormal sensitization and temporal summation of second pain (wind-up) in patients with fibromyalgia syndrome.
Pain, 91 (2001), pp. 165-175
[18.]
R. Staud, D.D. Price, M.E. Robinson, A.P. Mauderli, C.J. Vierck.
Maintenance of windup of second pain requires less frequent stimulation in fibromyalgia patients compared to normal controls.
[19.]
A.J. McDermid, G.B. Rollman, G.A. McCain.
Generalized hypervigilance in fibromyalgia: evidence of perceptual amplification.
Pain, 66 (1996), pp. 133-144
[20.]
J.M. Mountz, L.A. Bradley, J.G. Modell, R.W. Alexander, M. Triana-Alexander, L.A. Aaron, et al.
Fibromyalgia in women. Abnormalities of regional cerebral blood flow in the thalamus and the caudate nucleus are associated with low pain threshold levels.
Arthritis Rheum, 38 (1995), pp. 926-938
[21.]
A. Okifuji, D.C. Turk, D.A. Marcus.
Comparison of generalized and localized hyperalgesia in patients with recurrent headache and fibromyalgia.
Psychosom Med, 61 (1999), pp. 771-780
[22.]
D. Maquet, J.L. Croisier, C. Demoulin, J.M. Crielaard.
Pressure pain thresholds of tender point sites in patients with fibromyalgia and in healthy controls.
Eur J Pain, 8 (2004), pp. 111-117
[23.]
M. Mikkelsson, P. Latikka, H. Kautiainen, R. Isomeri, H. Isomaki.
Muscle and bone pressure pain threshold and pain tolerance in fibromyalgia patients and controls.
Arch Phys Med Rehabil, 73 (1992), pp. 814-818
[24.]
G. Granges, G. Littlejohn.
Pressure pain threshold in pain-free subjects, in patients with chronic regional pain syndromes, and in patients with fibromyalgia.
Arthritis Rheum, 36 (1993), pp. 642-646
[25.]
S. Lautenbacher, G.B. Rollman, G.A. McCain.
Multi-method assessment of experimental and clinical pain in patients with fibromyalgia.
Pain, 59 (1994), pp. 45-53
[26.]
A. Okifuji, D.C. Turk.
Stress and psychophysiological dysregulation in patients with fibromyalgia syndrome.
Appl Psychophysiol Biofeedback, 27 (2002), pp. 129-141
[27.]
F. Petzke, A. Khine, D. Williams, K. Groner, D.J. Clauw, R.H. Gracely.
Dolorimetry performed at 3 paired tender points highly predicts overall tenderness.
J Rheumatol, 28 (2001), pp. 2568-2569
[28.]
F. Petzke, D.J. Clauw, K. Ambrose, A. Khine, R.H. Gracely.
Increased pain sensitivity in fibromyalgia: effects of stimulus type and mode of presentation.
Pain, 105 (2003), pp. 403-413
[29.]
P. Montoya, P. Pauli, A. Batra, G. Wiedemann.
Altered processing of pain-related information in patients with fibromyalgia.
Eur J Pain, 9 (2005), pp. 293-303
[30.]
J. Lorenz, K. Grasedyck, B. Bromm.
Middle and long latency somatosensory evoked potentials after painful laser stimulation in patients with fibromyalgia syndrome.
Electroencephalogr Clin Neurophysiol, 100 (1996), pp. 165-168
[31.]
L. Chang, E.A. Mayer, T. Johnson, L.Z. FitzGerald, B. Naliboff.
Differences in somatic perception in female patients with irritable bowel syndrome with and without fibromyalgia.
Pain, 84 (2000), pp. 297-307
[32.]
R.J. Ferguson, T.A. Ahles.
Private body consciousness, anxiety and pain symptom reports of chronic pain patients.
Behav Res Ther, 36 (1998), pp. 527-535
[33.]
M.L. Peters, J.W. Vlaeyen, C. Van Drunen.
Do fibromyalgia patients display hypervigilance for innocuous somatosensory stimuli? Application of a body scanning reaction time paradigm.
Pain, 86 (2000), pp. 283-292
[34.]
R. Peyron, B. Laurent, L. García-Larrea.
Functional imaging of brain responses to pain. A review and meta-analysis (2000).
Neurophysiol Clin, 30 (2000), pp. 263-288
[35.]
R.C. Coghill, C.N. Sang, J.M. Maisog, M.J. Iadarola.
Pain intensity processing within the human brain: a bilateral, distributed mechanism.
J Neurophysiol, 82 (1999), pp. 1934-1943
[36.]
P. Rainville.
Brain mechanisms of pain affect and pain modulation.
Curr Opin Neurobiol, 12 (2002), pp. 195-204
[37.]
P. Rainville, G.H. Duncan, D.D. Price, B. Carrier, M.C. Bushnell.
Pain affect encoded in human anterior cingulate but not somatosensory cortex.
Science, 277 (1997), pp. 968-971
[38.]
E.T. Rolls, J. O’Doherty, M.L. Kringelbach, S. Francis, R. Bowtell, F. McGlone.
Representations of pleasant and painful touch in the human orbitofrontal and cingulate cortices.
Cereb Cortex, 13 (2003), pp. 308-317
[39.]
R. Peyron, L. García-Larrea, M.C. Gregoire, N. Costes, P. Convers, F. Lavenne, et al.
Haemodynamic brain responses to acute pain in humans: sensory and attentional networks.
Brain, 122 (1999), pp. 1765-1780
[40.]
M.E. Faymonville, L. Roediger, G. Del Fiore, C. Delgueldre, C. Phillips, M. Lamy, et al.
Increased cerebral functional connectivity underlying the antinociceptive effects of hypnosis.
Cogn Brain Res, 17 (2003), pp. 255-262
[41.]
K.D. Davis, S.J. Taylor, A.P. Crawley, M.L. Wood, D.J. Mikulis.
Functional MRI of pain- and attention-related activations in the human cingulated cortex.
J Neurophysiol, 77 (1997), pp. 3370-3380
[42.]
S.W. Derbyshire, B.A. Vogt, A.K. Jones.
Pain and Stroop interference tasks activate separate processing modules in anterior cingulate cortex.
Exp Brain Res, 118 (1998), pp. 52-60
[43.]
C.L. Kwan, A.P. Crawley, D.J. Mikulis, K.D. Davis.
An fMRI study of the anterior cingulate cortex and surrounding medial wall activations evoked by noxious cutaneous heat and cold stimuli.
Pain, 85 (2000), pp. 359-374
[44.]
A. Ploghaus, L. Becerra, C. Borras, D. Borsook.
Neural circuitry underlying pain modulation: expectation, hypnosis, placebo.
Trends Cogn Sci, 7 (2003), pp. 197-200
[45.]
J.C. Hsieh, S. Stone-Elander, M. Ingvar.
Anticipatory coping of pain expressed in the human anterior cingulate cortex: a positron emission tomography study.
Neurosci Lett, 262 (1999), pp. 61-64
[46.]
C.A. Porro, V. Cettolo, M.P. Francescato, P. Baraldi.
Functional activity mapping of the mesial hemispheric wall during anticipation of pain.
Neuroimage, 19 (2003), pp. 1738-1747
[47.]
C.A. Porro, P. Baraldi, G. Pagnoni, M. Serafini, P. Facchin, M. Maieron, et al.
Does anticipation of pain affect cortical nociceptive systems?.
J Neurosci, 22 (2002), pp. 3206-3214
[48.]
M.C. Bushnell, G.H. Duncan, R.K. Hofbauer, B. Ha, J.I. Chen, B. Carrier.
Pain perception: is there a role for primary somatosensory cortex?.
Proc Natl Acad Sci USA, 96 (1999), pp. 7705-7709
[49.]
R.C. Coghill, J.G. McHaffie, Y.F. Yen.
Neural correlates of interindividual differences in the subjective experience of pain.
Proc Natl Acad Sci USA, 100 (2003), pp. 8538-8542
[50.]
A. Ferretti, C. Babiloni, C.D. Gratta, M. Caulo, A. Tartaro, L. Bonomo, et al.
Functional topography of the secondary somatosensory cortex for nonpainful and painful stimuli: an fMRI study.
Neuroimage, 20 (2003), pp. 1625-1638
[51.]
M.J. Iadarola, K.F. Berman, T.A. Zeffiro, M.G. Byas-Smith, R.H. Gracely, M.B. Max, et al.
Neural activation during acute capsaicin-evoked pain and allodynia assessed with PET.
Brain, 121 (1998), pp. 931-947
[52.]
J.D. Greenspan, R.R. Lee, F.A. Lenz.
Pain sensitivity alterations as a function of lesion location in the parasylvian cortex.
Pain, 81 (1999), pp. 273-282
[53.]
A. Ploghaus, I. Tracey, S. Clare, J.S. Gati, J.N. Rawlins, P.M. Matthews.
Learning about pain: the neural substrate of the prediction error for aversive events.
Proc Natl Acad Sci USA, 97 (2000), pp. 9281-9286
[54.]
S.W. Derbyshire, A.K. Jones.
Cerebral responses to a continual tonic pain stimulus measured using positron emission tomography.
Pain, 76 (1998), pp. 127-135
[55.]
A.V. Apkarian, P.S. Thomas, B.R. Krauss, N.M. Szeverenyi.
Prefrontal cortical hyperactivity in patients with sympathetically mediated chronic pain.
Neurosci Lett, 311 (2001), pp. 193-197
[56.]
S.W. Derbyshire, A.K. Jones, F. Creed, T. Starz, C.C. Meltzer, D.W. Townsend, et al.
Cerebral responses to noxious thermal stimulation in chronic low back pain patients and normal controls.
Neuroimage, 16 (2002), pp. 158-168
[57.]
A.K. Jones, S.W. Derbyshire.
Reduced cortical responses to noxious heat in patients with rheumatoid arthritis.
Ann Rheum Dis, 56 (1997), pp. 601-607
[58.]
R. Kwiatek, L. Barnden, R. Tedman, R. Jarrett, J. Chew, C. Rowe, et al.
Regional cerebral blood flow in fibromyalgia: single-photon-emission computed tomography evidence of reduction in the pontine tegmentum and thalami.
[59.]
D.B. Cook, G. Lange, D.S. Ciccone, W.C. Liu, J. Steffener, B.H. Natelson.
Functional imaging of pain in patients with primary fibromyalgia.
J Rheumatol, 31 (2004), pp. 364-378
[60.]
R.H. Gracely, F. Petzke, J.M. Wolf, D.J. Clauw.
Functional magnetic resonance imaging evidence of augmented pain processing in fibromyalgia.
Arthritis Rheum, 46 (2002), pp. 1333-1343
[61.]
A. Mailis-Gagnon, I. Giannoylis, J. Downar, C.L. Kwan, D.J. Mikulis, A.P. Crawley, et al.
Altered central somatosensory processing in chronic pain patients with “hysterical” anesthesia.
Neurology, 60 (2003), pp. 1501-1507
[62.]
R.H. Gracely, M.E. Geisser, T. Giesecke, M.A. Grant, F. Petzke, D.A. Williams, et al.
Pain catastrophizing and neural responses to pain among persons with fibromyalgia.
Brain, 127 (2004), pp. 835-843
[63.]
A.K. Rosenstiel, F.J. Keefe.
The use of coping strategies in chronic low back pain patients: relationship to patient characteristics and current adjustment.
Pain, 17 (1983), pp. 33-44
[64.]
C. Eccleston, G. Crombez, S. Aldrich, C. Stannard.
Attention and somatic awareness in chronic pain.
Pain, 72 (1997), pp. 209-215
[65.]
B. Dick, C. Eccleston, G. Crombez.
Attentional functioning in fibromyalgia, rheumatoid arthritis, and musculoskeletal pain patients.
Arthritis Rheum, 47 (2002), pp. 639-644
[66.]
S.J. Gibson, G.O. Littlejohn, M.M. Gorman, R.D. Helme, G. Granges.
Altered heat pain thresholds and cerebral event related potentials following painful CO2 laser stimulation in subjects with fibromyalgia syndrome.
Pain, 58 (1994), pp. 185-193
[67.]
M. Granot, D. Buskila, Y. Granovsky, E. Sprecher, L. Neumann, D. Yarnitsky.
Simultaneous recording of late and ultra-late pain evoked potentials in fibromyalgia.
Clin Neurophysiol, 112 (2001), pp. 1881-1887
[68.]
M. Eimer, B. Forster.
Modulations of early somatosensory ERP components by transient and sustained spatial attention.
Exp Brain Res, 151 (2003), pp. 24-31
[69.]
J. Polich, K.L. Herbst.
P300 as a clinical assay: rationale, evaluation, and findings.
Int J Psychophysiol, 38 (2000), pp. 3-19
[70.]
S. Ozgocmen, T. Yoldas, A. Kamanli, H. Yildizhan, R. Yigiter, O. Ardicoglu.
Auditory P300 event related potentials and serotonin reuptake inhibitor treatment in patients with fibromyalgia.
Ann Rheum Dis, 62 (2003), pp. 551-555
[71.]
P. Montoya, C. Sitges, M. García-Herrera, R. Izquierdo, M. Truyols, N. Blay, et al.
Abnormal affective modulation of somatosensory brain processing among fibromyalgia patients.
Psychosom Med, 67 (2005), pp. 957-963
[72.]
P. Montoya, W. Larbig, C. Braun, H. Preissl, N. Birbaumer.
Influence of social support and emotional context on pain processing and magnetic brain responses in fibromyalgia.
Arthritis Rheum, 50 (2004), pp. 4035-4044
[73.]
M.E. Geisser, K.L. Casey, C.B. Brucksch, C.M. Ribbens, B.B. Appleton, L.J. Crofford.
Perception of noxious and innocuous heat stimulation among healthy women and women with fibromyalgia: association with mood, somatic focus, and catastrophizing.
Pain, 102 (2003), pp. 243-250
[74.]
R. Staud, M.E. Robinson, C.J. Vierck Jr, R.C. Cannon, A.P. Mauderli, D.D. Price.
Ratings of experimental pain and pain-related negative affect predict clinical pain in patients with fibromyalgia syndrome.
Pain, 105 (2003), pp. 215-222
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