• Andrea Truini, Emanuele Tinelli, Maria Chiara Gerardi, Valentina Calistri, Cristina Iannuccelli, Silvia La Cesa, Lorenzo Tarsitani, Caterina Mainero, Piercarlo Sarzi-Puttini, Giorgio Cruccu, Francesca Caramia, and Manuela Di Franco.
• Department of Neurology and Psychiatry, Sapienza University of Rome, Italy.
• Clin Exp Rheumatol. 2016 Mar 1; 34 (2 Suppl 96): S129-33.

ObjectivesEmerging evidence associates chronic pain syndrome, such as fibromyalgia, with endogenous pain modulatory system dysfunction, leading to an impaired descending pain inhibition. In this study, using resting-state functional magnetic resonance imaging (fMRI), we aimed at seeking possible functional connectivity changes of the periaqueductal gray (PAG), a brainstem area that belongs to the endogenous pain modulatory system, in patients with fibromyalgia.MethodsIn 20 patients with fibromyalgia and 15 healthy subjects, we investigated PAG functional connectivity using resting-state fMRI. We also analysed the correlation between clinical variables, such as pain severity, disease duration, and depressive personality traits with PAG functional connectivity.ResultsCompared with control subjects, we identified that patients with fibromyalgia had an increased PAG connectivity with insula, anterior cingulate cortex, and anterior prefrontal cortex. The functional connectivity between PAG and the rostral ventral medulla, however, was not concordantly increased. PAG functional connectivity correlated with pain severity, disease duration, and the depressive personality trait rating.ConclusionsOur fMRI study showing abnormal resting state functional connectivity of the PAG suggests that patients with fibromyalgia have an endogenous pain modulatory system dysfunction, possibly causing an impaired descending pain inhibition. This abnormal PAG functioning might underlay the chronic pain these patients suffer from.

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