Doctors' Choice Physical Medicine

Pleasure/Pain Signals Short Circuited in Fibromyalgia Patients

In 2010, it was discovered that fibromyalgia patients (FM) suffer from increased pain sensitivity.  That simply means that everyday normal activity causes them pain. These everyday normal activities would not cause pain in a normal person.

Brain Dysfunction In Fibromyalgia Patients

The VTA Dysfunctional Pleasure Center

This 2010 research suggested that fibromyalgia patients suffer from abnormal pain processing by the brain.  Fibromyalgia patients show a poor response to opioids, injections of medications, and topical pain treatments. Fibromyalgia patients may also suffer from sleep disturbances, fatigue, thinking difficulties, and a host of additional symptoms.

Now new research suggests that the increase in pain may be related to how the brain of fibromyalgia patients processes reward and punishment.

Fibromyalgia Patients Process Reward And Punishment Differently

To study how brain function may play a role in pain processing, researchers studied 31 patients with fibromyalgia and 14 healthy controls. In order to measure their response to pain, researchers conducted pressure pain tests in which participants wore a cuff on their legs that tightened and loosened to apply more or less pressure-producing pain. Prior to an increase in cuff pressure to increase pain, different colors would appear on a screen.  This continued until participants were trained to expect pain with certain colors and pain relief with other colors. The participants rated their pain throughout the tests by pressing different buttons, and researchers monitored brain activity using a functional MRI scans.

The researchers found that during periods of pain anticipation or relief, the fibromyalgia patients had poorer responses to the anticipated relief in areas in the brain.  In particular, they noticed a difference at the center of the brain in an area called the ventral tegmental area (VTA).  The VTA is a group of nerve cells involved in processing punishment and reward. In the healthy subjects, the VTA was activated as participants anticipated and experienced pain, and deactivated during pain relief.  But in patients with fibromyalgia, the activation of the VTA was substantially reduced, regardless of whether more or less pressure (pain) was applied.

Fibromyalgia Patients Should Stay Away From Opioid Painkillers

These findings provide some clues as to why fibromyalgia patients experience widespread chronic pain, and why so many fail to respond to opioid painkillers. In fact recent research has suggested opioids painkillers may do more harm than good for treating fibromyalgia patients.

This certainly goes a long way to explain why we get good changes, sometimes-dramatic changes, with fibromyalgia patients using some of the specialized treatments we use, namely transcranial electrical stimulation to increase alpha waves and cranial pulsed electromagnetic stimulation.

If you have not tried these therapies you have not tried “everything” for fibromyalgia.


 Loggia, ML, et al. Disrupted brain circuitry for pain-related reward/punishment in fibromyalgia. Arthritis & Rheumatism2013. DOI: 10.1002/art.38191).

Peters D. Pleasure and pain brain signals disrupted in fibromyalgia patients. Science Newsroom Wiley. Press Release. November 5, 2013.