Investigating Neurometabolites and Pain in Fibromyalgia

Fibromyalgia (FM) is a complex, chronic pain disorder characterized by widespread musculoskeletal pain, fatigue, sleep disturbances, and cognitive difficulties. The exact cause of FM remains elusive, with factors like abnormal pain processing and central nervous system sensitization implicated in its pathophysiology. One hypothesis is that the immune system is frequently activated, prompting microglia to initiate a central inflammatory state. The purpose of this study was to use whole-brain magnetic resonance spectroscopic imaging (MRSI) to investigate whether abnormal inflammation in the central nervous system may be associated with symptoms of FM. We hypothesized that FM patients would show higher brain Choline (Cho), myo-inositol (Mi), lactate (Lac), Glutamate + Glutamine (Glx), brain temperature, and lower creatine (Cr) and N-acetylaspartate (Naa) than healthy controls (HC). We further hypothesized that the metabolite levels would be correlated with self-reported pain, fatigue, mood, and FIQR. Fifteen women with FM and 15 age- and gender-matched healthy controls completed pain, fatigue, and mood symptom questionnaires and underwent MRSI scans. All metabolites were quantified in 47 brain regions, expressed as ratios over water, and compared between FM patients and controls using independent-sample t-tests. In FM patients, we found a significantly lower Cr, Cho, Glx, Mi, and Naa in several brain regions, including the Supplementary Motor and Anterior Cingulate Cortex. We also found brain metabolites correlated with mood, pain, and fatigue measurements in several regions. Our results suggest that an abnormal metabolic pathophysiology is present in patients with FM. Funded by the American Fibromyalgia Syndrome Association.