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Is the Brainstem the Central Pain Conductor for Fibromyalgia?

Fibromyalgia is a chronic medical condition that involves extensive musculoskeletal pain, fatigue, and tension headaches. It also typically interferes with sleep, memory, and mood. One of the key elements of fibromyalgia is its amplification of pain and how it impacts the brain and spinal cord’s process of nerve signals. Someone can develop this condition after physical or psychological trauma, surgery, or another health concern. The condition can also happen gradually without a specific original cause.

Most understanding of fibromyalgia indicates that the central nervous system is primarily responsible for widespread and chronic pain. Previous research showed that the spinal cord and the brainstem cause the main symptoms of the condition and create “central sensitization,” according to the “Altered Pain in the Brainstem and Spinal Cord of Fibromyalgia Patients During the Anticipation and Experience of Experimental Pain” study.

Although other research has challenged some of that understanding and showed the role of the brainstem in people who do not have fibromyalgia, a recent study has exposed new information on the role the brainstem plays in fibromyalgia pain.

What Is the Brainstem?

The brainstem is located at the bottom of the brain, which makes it challenging to capture with MRI technology. This part of the brain has a strong regulating function on the autonomic nervous system and determines the number of pain signals the brain receives.

Recent studies have shown that even in healthy individuals, the blood flow and pain signals in the spinal cord and brainstem change all the time, including before, during, and after experiencing pain. These fluctuations even happen when the person experiences no stimulus, which suggests a relationship between the brainstem, the spinal cord, and what we are currently focusing our attention on.

Engaging in cognitive tasks such as reading, knitting, or puzzles, can create “attentional analgesia” and effectively reduce pain. The brainstem is a key component of that process.

Recent research unexpectedly discovered that the brainstem pathways that support attentional analgesia remain intact in people with fibromyalgia. Although using this process to alleviate pain is a challenge for those with fibromyalgia, it is a possibility.

Pain assessment, especially in regard to the brainstem and autonomic nervous system regulation, confirmed the brainstem’s role as the “pain conductor” in the brain. Recent studies show that people with fibromyalgia had their brainstem activated even when they were at rest. In addition to this continuous activity, their brainstem affected blood circulation in the autonomic nervous system and an unusual section of the brainstem, the gigantocellular reticular nucleus or gigantocellularis neurons. These neurons are deeply involved in pain sensitivity, wakefulness, and blood circulation in the brain.

These findings show a potential relationship between the brainstem and both the autonomous nervous system issues and chronic pain that fibromyalgia creates. This possible connection calls for further studies on how the brainstem impacts fibromyalgia, and what it means for the pain processing system altogether.

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