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(Oct 26 2003) -- There appears to be no direct association between depression, extreme sensitivity to pain stimulus and how pain is processed in the brain in fibromyalgia patients with and without a diagnosis of clinical depression, according to research presented this week at the American College of Rheumatology Annual Scientific Meeting in Orlando, Florida.
It is well known that many people with chronic pain conditions such as fibromyalgia also develop depression. In some cases, physicians treating such patients first treat the depression, thinking that is the primary problem and is causing the pain. This study suggests that pain and depression are quite separate processes, and that patients who suffer from chronic pain and have depression do not process pain differently than those who do not have depression.
Using functional MRI scans to record brain activity, calibrated pressure stimuli sufficient to produce slightly intense pain were applied to the left thumb of 30 fibromyalgia patients. Researchers were unable to find any significant association between the level of depressive symptomatology and the intensity of activity in areas of the brain previously shown to be involved in pain processing. However, researchers did find a link between the severity of depressive symptoms and brain activity in two areas of the brain not believed to be involved in pain intensity coding. In addition, researchers compared brain activity patterns of a subgroup of seven fibromyalgia patients with concurrent major depression (rather than increased symptoms of common depression) to a subgroup of seven fibromyalgia patients without depression and to seven patients in a control group. The study did not show any difference in the degree of pressure pain sensitivity and patterns of pain-elicited brain activity between fibromyalgia patients with depression and fibromyalgia patients without depression.
“This study challenges the notion that psychiatric symptoms such as depression cause or influence the pain seen in fibromyalgia and other chronic pain conditions,” said Thorsten Giesecke, MD, of the Chronic Pain and Fatigue Research Program, University of Michigan, Ann Arbor, Michigan, and lead investigator in the study, “and instead suggests that depression is a separate and somewhat independent process.”
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