Gray matter volume and pain in Fibromyalgia: A Study

This study 'Subtle changes of gray matter volume in fibromyalgia reflect chronic musculoskeletal pain rather than disease‐specific effects' was published in August 2019.

My take on the study
It did NOT show any difference in the 2 groups that were studied:
(a.) those with Fibromyalgia (b). those with osteoarthritis.

BOTH GROUPS had altered gray matter volume (GMV)

Both groups had increased gray matter volumes in the sensorimotor cortex.

Both groups had decreased GMV in the temporoparietal junction.

It was therefore concluded that these changes were from chronic pain in general.

"we did not identify significant and FMS‐specific GMV alterations when adopting a conservative statistical approach of multiple comparison correction. However, with a more liberal approach increased gray matter volumes in the sensorimotor cortex and decreased GMV in the temporoparietal junction in both pain groups in comparison with healthy controls were revealed. Since both pain groups showed nearly identical GMV changes in these areas, cortical GMV changes in FMS should not be interpreted as FMS‐ specific but might rather reflect changes in chronic pain in general."

It was a relatively small study done by a team of researchers at the University Hospital Muenster, in Germany.  25 women with fibromyalgia,  23 patients with osteoarthritis and 21 people with no chronic pain were assessed. 
General pain‐related GMV alterations
The sensorimotor system encompasses all of the sensory, motor, and central integration and processing components involved with maintaining joint stability during bodily movements.
The temporalparietal junction is responsible for sorts through information from the external environment as well as from within the body and processes it into a clear package. 
GMV changes in the frontal cortex near the region of the precentral/sensorimotor cluster have been previously shown in Fibromyalgia (Jensen et al., 2013).
These changes have also been seen in chronic pain in general (Smallwood et al., 2013).
This sensorimotor area, of the brain, is known to be important in pain intensity and repetitive painful stimulation in healthy controls. It causes increased GMV due to the pain input (Teutsch, Herken, Bingel, Schoell,; May, 2008). This has been interpreted as a sign of neuronal adaptation.

The function of the sensorimotor cortex UNIVERSITY OF FRIBOURG

The Temporalparietal Junction (TPJ) might play an interface function between the salience network and the executive control network for response inhibition and interference control (Kucyi, Salomons, & Davis, 2016).
It has been hypothesized to be the key region redirecting attention away from pain and attempting to keep unwanted thoughts about pain out of awareness (Kucyi et al., 2016). Therefore, abnormalities in this area may lead to dysfunctional control of pain such as an increased anxious expectation (Coppola et al., 2017) or altered affective regulation in chronic pain (Liotti et al., 2000).
A recent study showed reduced activity in the TPJ of adolescents compared to adults during an extinction task, suggesting a role for the TPJ in anxiety disorders. (Ganella et al., 2017)

A Nexus Model of the Temporal-Parietal Junction

If you want to read the full report of the study please go here to Wiley Online Library: 
Sundermann B, Dehghan Nayyeri M, Pfleiderer B, et al. Subtle changes of gray matter volume in fibromyalgia reflect chronic musculoskeletal pain rather than disease‐specific effects. Eur J Neurosci. 2019;00:1–10. https://doi.org/10.1111/ejn.14558
Please keep in mind that this is just my interpretation of the study and I am not a medical professional just a person with many health conditions, including fibromyalgia, who has an interest in helping others to understand medical research. Lee Good. 
I have 20+ years of experience helping people with chronic illness to understand research information. I am the WEGO winner, 2018/19 for building the best patient community around Fibromyalgia. You can join our private Fibromyalgia community, FIBRO CONNECT, here. 
RESOURCES: Function of the sensorimotor cortex image. University of Fribourg
Temporalparietal Junction. ScienceDirect
A Nexus Model of the Temporal-Parietal Junction. ResearchGate

14 reasons it may NOT be Fibromyalgia

The symptoms of fibromyalgia are found in so many other illnesses. That's why diagnosis is problematic. Here are 14 reasons why it may NOT be Fibromyalgia...

Fibromyalgia has many, varied and fluctuating symptoms. It should be considered when a patient describes a history of widespread pain, with no evident cause, that lasts three months or more. 

As well as this chronic musculoskeletal pain, whichaffects the bones, ligaments, muscles, nerves and tendons they have fatigue and sleep problems and stiffness. These symptoms are usually accompanied by a number of other conditions such as sensitivity to chemicals, irritable bowel or restless legs and depression or anxiety. The symptoms can often start, or worsen, during a period of severe psychosocial or physical stress.

Fibromyalgia presents a unique medical problem: 

• Its symptoms are so common, that it is both underdiagnosed and misdiagnosed. 
• Because there are no blood tests or scans to easily diagnose it, many physicians have trouble detecting the disorder. 
• It can NOT be easily confirmed or ruled out with a simple blood test. 
• It can't be seen on an X-ray or MRI. 
• Instead, fibromyalgia appears to be linked to changes in how the brain and spinal cord process pain signals.

Because there is no test for fibromyalgia, your doctor must rely solely on your group of symptoms to make a diagnosis and rule out other conditions.

The key symptoms of fibromyalgia are also commonly found in many other illnesses, and a thorough examination and investigation needs to be undertaken in order to ensure there is not another pathological cause for the symptoms – particularly if there are any ‘red flags’ in the patient’s history suggestive of another serious pathology (Table 1).

Table 1. Red flags

Older age at new symptom onset Weight loss Night pain Focal pain Fever or sweats Neurological features History of malignancy

Doctors need to rule out:

1. arthritis 
2. lupus 
3. multiple sclerosis 
4. chronic fatigue syndrome 
5. polymyalgia rheumatica 
6. hypothyroidism
7. depression
8. polymyositis
9. hyperparathyroidism
10. adrenal insufficiency
11. myasthenia gravis
12. cushing’s syndrome
13. sjogren's syndrome
14. Infection: chronic viral infection, HIV, hepatitis, Lyme disease

So if a doctor asks you about your mood, or skin rashes, or sends you for a blood test of your antibodies or an MRI they are just doing their job. They are ruling out these 14 conditions which have similar symptoms to Fibromyalgia. It is important to do so because these 14 conditions have specific treatments.

Symptoms NOT usually found in Fibromyalgia include:

1. arthritis: swelling and redness, loss of motion in joints
2. lupus: butterfly-shaped rash across cheeks and nose, anemia, abnormal blood clotting
3. multiple sclerosis: brain lesions on an MRI
4. chronic fatigue syndrome: profound fatigue that is more intense than pain, sore thoat
5. polymyalgia rheumatica: average age of onset is 70, elevated levels of inflammatory proteins in blood.
6. hypothyroidism: thyroid autoantibodies are common
7. depression:
8. polymyositis: muscle weakness in proximal muscles: upper arms, thighs.
9. hyperparathyroidism: presence of hypercalcemia
10. adrenal insufficiency: severe exhaustion, not typically associated with chronic widespread pain.
11. myasthenia gravis: neurologic signs characteristic of specific disease.
12. cushing’s syndrome: characteristic facial and skin signs of Cushing’s syndrome
13. sjogren's syndrome: dry eyes and dry mouth, presence of anti bodies specific to Sjogren's
14. Infection: chronic viral infection, HIV, hepatitis, Lyme disease

Getting a Diagnosis
I suggest that you keep a diary of your symptoms. This should make it easier to talk to your doctor or specialist. Especially if you have memory problems, writing things down will provide the doctor with the information that they need to make a correct diagnosis.

When you go to a consultation go with:

• a list of questions 
• a list of current medications 
• a brief medical history including your parents main conditions
• a list of your symptoms

When writing the list of your symptoms try and remember what were your first symptoms and what year they started and then the next symptoms and the year etc. as many doctors ask these questions.

More clues for fibromyalgia diagnosis (from MayoClinic)

People who have fibromyalgia also often wake up tired, even after they've slept continuously for more than eight hours. Brief periods of physical or mental exertion may leave them exhausted. They may also have problems with short-term memory and the ability to concentrate. If you have these problems, your doctor may ask you to rank how severely they affect your day-to-day activities.

Fibromyalgia often coexists with other health problems, so your doctor may also ask if you experience:

• Irritable bowel syndrome
• Headaches
• Jaw pain
• Anxiety or depression
• Frequent or painful urination

Remember that all ongoing pain should be evaluated. I am saying this because after a while of not getting a diagnosis you may start to question whether the pain is all in your head. 

Lee Good has 20+ years of experience helping people with chronic illness to understand research information and is recognized as a leader in patient advocacy. She is the WEGO winner, 2018/19 for building the best patient community around Fibromyalgia and editor at Fibro Blogger Directory, which is a community of fibromyalgia bloggers.

RESOURCES:

Fibromyalgia: Understand the diagnosis process MayoClinic
Diagnostic challenges: Australian Family Physician

Musculoskeletal Pain: Cleveland Clinic