Commentary on: Neuroimaging in Breast Implant Illness: An fMRI Pilot Study.

Abstract

Breast implant illness (BII) is characterized by subjective symptoms, suffering, and disability rather than consistently demonstrable clinical findings or biomarkers. We are now seeing a much more scientific approach to the investigation of this problem than we have at any other stage in its history. This paper is a novel and topical approach to investigating a new thread of inquiry into these concerns and has added to the accumulating body of science.1 In order to understand the rationale behind this study, it is helpful to consider how the broad array of symptoms in affected women who have systemic symptoms that they feel are caused by their breast implants have many similarities to the situation of patients with chronic pain. In 2011 the Institute of Medicine noted that some common or highly prevalent chronic pain conditions appear to coexist with a high degree of related symptomatology.2 These conditions include temporomandibular disorder, chronic migraine, chronic tension-type headache, fibromyalgia (FM), chronic fatigue syndrome, irritable bowel syndrome (IBS), vulvodynia, interstitial cystitis, endometriosis, and chronic lower-back pain. Collectively these conditions have been called functional somatic syndromes,3 idiopathic pain disorders,4 and more recently chronic overlapping pain conditions (COPCs).5 COPCs vary significantly in clinical presentation in terms of the unique anatomic pathophysiology; however, there are other common symptoms including widespread pain, polysomatic illness burden, fatigue, sleep impairment, problems with cognition, physical dysfunction, and disturbances in affect. These conditions are more common in women, are frequently associated with increased pain sensitivity and pain amplification, have risk factors that include depression, anxiety, and psychological stress, and having 1 chronic pain condition increases the risk of getting another.5