Abstract
Physical exercise is one of the most efficient interventions to mitigate chronic pain symptoms in fibromyalgia (FM). However, little is known about the neurophysiological mechanisms mediating these effects. In this study we investigated resting-state connectivity using functional magnetic resonance imaging (fMRI) before and after a 15 week standardized exercise program supervised by physical therapists. Our aim was to gain an understanding of how physical exercise influences previously shown aberrant patterns of intrinsic brain activity in FM. Fourteen FM patients and eleven healthy controls successfully completed the physical exercise treatment. We investigated post- versus pre-treatment changes of brain connectivity, as well as changes in clinical symptoms in the patient group. FM patients reported improvements in symptom severity. Although several brain regions showed a treatment-related change in connectivity, only the connectivity between the right anterior insula and the left primary sensorimotor area was significantly more affected by the physical exercise among the fibromyalgia patients compared to healthy controls. Our results suggest that previously observed aberrant intrinsic brain connectivity patterns in FM are partly normalized by the physical exercise therapy. However, none of the observed normalizations in intrinsic brain connectivity were significantly correlated with symptom changes. Further studies conducted in larger cohorts are warranted to investigate the precise relationship between improvements in fibromyalgia symptoms and changes in intrinsic brain activity.
Highlights
Fibromyalgia (FM) is a condition characterized by widespread chronic pain and is often accompanied by cognitive dysfunction and fatigue
In this study we have shown that the previously reported abnormal patterns of resting state connectivity in FM patients are partly normalized after a 3 month schedule of regular physical exercise
Several intrinsic brain connectivity patterns underwent longitudinal change, only the connectivity between the right insula and primary sensorimotor cortex displayed a selectively greater change for FM compared to HC
Summary
Fibromyalgia (FM) is a condition characterized by widespread chronic pain and is often accompanied by cognitive dysfunction and fatigue. A promising complement to the traditional task-based fMRI studies employing subtraction designs that disregard the brain activity reflecting sustained pain states. Resting state fMRI studies have reported altered intrinsic brain activity in FM patients including: decreased connectivity between insula and prefrontal areas (Ichesco et al, 2014) and the periaqueductal grey (PAG) (Pujol et al, 2014), increased connectivity between insula and medial regions of the default mode network (DMN) (Napadow et al, 2010), and decreased connectivity between somatosensory regions and visual and auditory cortices (Pujol et al, 2014). Using a comprehensive set of analytical approaches to characterize intrinsic brain activity in FM, we recently showed a decreased connectivity between pain-related and sensorimotor brain areas during rest (Flodin et al, 2014)
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