• Ishtiaq Mawla, Zirui Huang, Chelsea M Kaplan, Eric Ichesco, Noah Waller, Tony E Larkin, Helge J Zöllner, EddenRichard A ERAE0000-0002-0671-7374Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, United States.F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieg, Steven E Harte, Daniel J Clauw, George A Mashour, Vitaly Napadow, and Richard E Harris.
• Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI, United States.
• Pain. 2023 Dec 1; 164 (12): 273727482737-2748.

AbstractFibromyalgia has been characterized by augmented cross-network functional communication between the brain's sensorimotor, default mode, and attentional (salience/ventral and dorsal) networks. However, the underlying mechanisms of these aberrant communication patterns are unknown. In this study, we sought to understand large-scale topographic patterns at instantaneous timepoints, known as co-activation patterns (CAPs). We found that a sustained pressure pain challenge temporally modulated the occurrence of CAPs. Using proton magnetic resonance spectroscopy, we found that greater basal excitatory over inhibitory neurotransmitter levels within the anterior insula orchestrated higher cross-network connectivity between the anterior insula and the default mode network through lower occurrence of a CAP encompassing the attentional networks during sustained pain. Moreover, we found that hyperalgesia in fibromyalgia was mediated through increased occurrence of a CAP encompassing the sensorimotor network during sustained pain. In conclusion, this study elucidates the role of momentary large-scale topographic brain patterns in shaping noxious information in patients with fibromyalgia, while laying the groundwork for using precise spatiotemporal dynamics of the brain for the potential development of therapeutics.Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the International Association for the Study of Pain.

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