Fibromyalgia

Fibromyalgia is a rheumatic disorder characterized by musculoskeletal pain and tender points. Patients report substantial fatigue. They may be depressed. Some of them have sleep disturbances and poor cognitive function. It’s differentiated from chronic fatigue syndrome in that these patients universally report pain and have tender points. The etiology of fibromyalgia is unknown. There’s almost universal reports of cognitive decline in fibromyalgia patients. Long term memory is your ability to remember lists of words over time. And word fluency refers to how rapidly you can produce words from a category like animals or all the letters that begin with f. And they did find deficits in fibromyalgia patients but they concluded that only severely depressed fibromyalgia patients showed these deficits. However, when I looked at their data it seemed that the non-depressed fibromyalgia performed really quite a lot worse than the controls, although not significantly worse because they had relatively low power.

In terms of what we think is the cause of fibromyalgia, or the etiology. We are not taking a strong position on that. We really believe that it’s a chronic disorder that hasn’t neuro-chemical mediators but is stress induced. Tramadol is a non-opioid pain relief medication that is meant to help alleviate moderate to moderately severe pain. The facilitating stressor could be a physical illness or an injury, or it could be an emotional stressor such as a loss or difficulty that results in a high load situation for the affected individual. And we believe for the vulnerable individual this has neuro-biological consequences and because neurobiology is involved, this could conceivably translate into actual memory dysfunction in fibromyalgia patients. Something that isn’t, certainly, universally accepted or even documented thus far in the literature.

The relationship among aging cognition and fibromyalgia: as I said, these patients have a lot of memory complaints and I started thinking about fibromyalgia in terms of my work with older adults. Older adults do have reliable memory dysfunction. It appears that in terms of the neurobiology that areas that are particularly sensitive in older adults are the hippocampus and the frontal lobes. Frontal lobes control decision-making executive processing and other control mechanisms for cognitive system. And the hippocampus is more of a storage system for memories. Interesting, the HPA access, which is a neuro-chemical pathway, is disturbed in FM and it’s also disturbed in normal elderly adults. So the notion that both fibromyalgia patients and elderly adults have these disturbed HPA access have added some credibility to the notion that perhaps this could be … that cognitive aging might be a feasible model for understanding fibromyalgia. So we hypothesized in our initial approach to this problem, that fibromyalgia patients would have the cognitive function of adults 20-30 years older than themselves.

What I am going to talk about today is the first step in what we hope to be a long-term research program. First we want to document whether or not cognitive function, dysfunction, actually exists in fibromyalgia patients. And we decided to give fibromyalgia patients a battery of tests in areas that are maximally sensitive to aging. I’ll be showing some examples of that. And we decided primarily rather than using sort of cooked-up laboratory tests, to use a lot of neuro-psychological tests that map onto specific brain regions, primarily the frontal lobe and the hippocampus because we thought those were likely sites where the fibromyalgia patients might have problems. I’ll mainly be focusing on these issues today. We are also interested in what factors mediate this dysfunction. Several possibilities include disruption of the HPA access, on sleep disorders, on depression. And we posed the notion that the actual management of pain could drain cognitive resource in fibromyalgia patients. All of us know that when we have some kind of pain or don’t feel well that we have a lot more trouble managing our daily work loads, and it’s surprising to me, but no one has really looked at the impact of managing chronic pain on cognitive function. And that’s actually another project that’s actively going on in my lab right now.

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