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KMID : 0363120230360010113
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Korean Journal of Pain
2023 Volume.36 No. 1 p.113 ~ p.127
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Primary somatosensory cortex and periaqueductal gray functional connectivity as a marker of the dysfunction of the descending pain modulatory system in fibromyalgia
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Soldatelli Matheus
de Oliveira Franco Alvaro
Picon Felipe
Duarte Juliana Avila
Scherer Ricardo
Bandeira Janete
Zortea Maxciel
da Silva Torres Iraci Lucena
Fregni Felipe
Caumo Wolnei
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Abstract
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Background: Resting-state functional connectivity (rs-FC) may aid in understanding the link between pain-modulating brain regions and the descending pain modulatory system (DPMS) in fibromyalgia (FM). This study investigated whether the differences in rs-FC of the primary somatosensory cortex in responders and non-responders to the conditioned pain modulation test (CPM-test) are related to pain, sleep quality, central sensitization, and the impact of FM on quality of life.
Methods: This cross-sectional study included 33 females with FM. rs-FC was assessed by functional magnetic resonance imaging. Change in the numerical pain scale during the CPM-test assessed the DPMS function. Subjects were classified either as non-responders (i.e., DPMS dysfunction, n = 13) or responders (n = 20) to CPM-test. A generalized linear model (GLM) and a receiver operating characteristic (ROC) curve analysis were performed to check the accuracy of the rs-FC to differentiate each group.
Results: Non-responders showed a decreased rs-FC between the left somatosensory cortex (S1) and the periaqueductal gray (PAG) (P < 0.001). The GLM analysis revealed that the S1-PAG rs-FC in the left-brain hemisphere was positively correlated with a central sensitization symptom and negatively correlated with sleep quality and pain scores. ROC curve analysis showed that left S1-PAG rs-FC offers a sensitivity and specificity of 85% or higher (area under the curve, 0.78, 95% confidence interval, 0.63?0.94) to discriminate who does/does not respond to the CPM-test.
Conclusions: These results support using the rs-FC patterns in the left S1-PAG as a marker for predicting CPM-test response, which may aid in treatment individualization in FM patients.
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KEYWORD
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Central Nervous System Sensitization, Chronic Pain, Fibromyalgia, Functional Neuroimaging, Magnetic Resonance Imaging, Neural Pathways, Pain Perception, Periaqueductal Gray, Psychophysics, Somatosensory Cortex
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