Sensory Perception Quotient Reveals Visual, Scent and Touch Sensory Hypersensitivity in People With Fibromyalgia Syndrome

Multimodal hypersensitivity and somatic symptoms predict adolescent postmenarchal widespread pain

ABSTRACT

Widespread pain in adolescence is linked with poor mental health, pain, and somatic symptoms in childhood. This prospective study in 207 premenarchal adolescents used quantitative sensory testing (QST) and multimodal hypersensitivity (MMH) measures to assess somatosensory system function and identify predictors for widespread pain (≥3/7 sites). We hypothesized that premenarchal pain, somatic symptoms, psychological factors, and somatosensory system function would predict postmenarchal widespread pain, which would be associated with greater menstrual pain intensity. At premenarchal and postmenarchal study visits, participants completed measures of somatic symptoms, a pain body map, psychosocial questionnaires, QST, and experimental MMH measures including auditory, visual, and visceral stimulation. Electroencephalography (EEG) was collected during auditory and visual tasks to identify neural correlates of MMH. Premenarchal widespread pain was reported by 25% of participants, whereas 29% developed new incident widespread pain postmenarche. Adolescents with postmenarchal widespread pain reported greater menstrual pain intensity (median [interquartile range] 47 [28-61]; 0-100 visual analog scale) than those without (24 [8-50], P = 0.001). Elevated somatic symptoms (P = 0.012), stress (P = 0.015), and sensitivity to visceral (bladder filling) (P = 0.046) and unpleasant visual stimuli (P = 0.043) were significant predictors of postmenarche widespread pain. A multivariable regression model found premenarchal body map score (OR = 1.75, 95% CI [1.20, 2.55]), somatic symptoms (OR = 1.47, 95% CI [1.03, 2.11]), and visual hypersensitivity (OR = 1.62, 95% CI [1.12, 2.33]) predicted postmenarchal widespread pain. No EEG differences in early cortical sensory processing were found. Our results suggest that increased sensitivity to multimodal unpleasant and painful stimuli represents a novel risk factor for postmenarche widespread pain.

Sense of Smell in Individuals with Fibromyalgia: a Tractography Study

PURPOSE

The etiopathogenesis of fibromyalgia (FM), which affects millions of people worldwide, is still debated. Recent research provides significant evidence that there are changes in the functions of the central and peripheral nervous systems and the sense of smell. This study analyzed the clinical assessment results of the sense of smell in individuals with FM and examined the olfactory-related structures in the nervous system.

METHODS

Thirty patients with FM and 31 age- and sex-matched asymptomatic controls participated in this cross-sectional study. Participants' sense of smell was assessed with the Connecticut Chemosensory Clinical Research Center (CCCRC) including the Butanol threshold test (BET) and Smell Identification Tests. The total number of fibers, mean fiber length, the ratio of the number of fibers in this pathway to the number of fibers in the whole brain of the same individual, fractional anisotropy (FA), mean diffusion (MD), axial diffusion (AD) and radial diffusion (RD) values were calculated by tractography. Additionally, entorhinal cortex volume calculation was performed in MriStudio and MriCloud software using Diffusion tensor imaging (DTI) data in DICOM format.

RESULTS

The BET and CCCRC test scores were lower in the FM group (p < 0.05). Similarly, the mean FA values of the olfactory tract were lower on both the right and left sides in the FM group (p < 0.05). However, the entorhinal cortex volumes were similar, and there was no correlation between the right and left FA values of the olfactory tract and the BET scores or CCCRC scores in both groups (p > 0.05).

CONCLUSION

Our study, which included participants' self-assessments and data obtained from central nervous system (CNS) images, supports the idea that individuals with FM have a decreased olfactory function. Decreased FA values in individuals with FM may be an indicator of impaired myelin structure and axonal adaptation in individuals with FM.

Central Sensitivity Symptoms and Autistic Traits in Autistic and Non-Autistic Adults

Central sensitivity syndromes (CSSs) are a group of health conditions thought to include an underlying sensitisation of the central nervous system. Evidence suggests autistic adults experience poorer physical health than the general population and are more likely to have a CSS. This study examined CSS diagnoses and symptoms in autistic and non-autistic adults, to determine whether CSS symptoms were related to autistic traits, mental health, sensory sensitivity, age or gender. Participants included 534 adults with clinical diagnoses of autism, CSS, both diagnoses or neither (i.e., comparison group), who were recruited through social media, support groups and institutional affiliations. Participants completed online self-report validated questionnaires, including the Autism Spectrum Quotient (AQ), Central Sensitization Inventory (CSI), Sensory Perception Quotient (SPQ), and the PHQ-9 and GAD-7. Autistic people without a diagnosed CSS reported significantly more CSS symptoms than the comparison group, with a mean score above the clinical cut-off. Non-autistic participants with a CSS had significantly more autistic traits than the comparison group. Autistic people with a CSS reported the most sensory sensitivity, with autism only and CSS only groups reporting similar levels of sensory sensitivity and all diagnostic groups reporting more sensory sensitivity than the comparison group. Sensory sensitivity, anxiety, autistic traits, age and gender were all significant predictors of CSS symptoms. The overlap in symptoms between autistic individuals and those with CSS suggests diagnostic overshadowing and possible under-diagnosis or misdiagnosis. Furthermore, these symptoms may exacerbate or mask one another. Notwithstanding potential limitations of representativeness and selection bias, increased awareness of the association between autistic traits and CSS symptoms is important for clinicians to improve diagnostic accuracy and treatment.

Multisensory sensitivity in relation to pain: a scoping review of terminology and assessment

Chronic pain is a debilitating health problem affecting 20 million Americans annually. Most patients with chronic pain report negative impacts on daily function and quality of life, which can result in devastating emotional and financial stress. Although the causes of chronic pain remain elusive, there is increasing interest in sensitivity to everyday sensory stimuli as it relates to chronic pain, potentially serving as an indirect marker of altered central nervous system sensory processing. However, sensitivity to multiple sensory inputs, eg, bright lights, certain fabrics, loud noises, etc, is described using multiple terminologies. The lack of a common vocabulary makes it difficult to find and summarize related discoveries, potentially inhibiting scientific progress. Thus, the purpose of this scoping review was to identify and characterize the terminology used in publications assessing some form of multisensory sensitivity as it relates to pain (eg, a pain cohort or pain sensitivity). Our review of 6 databases (PubMed, Scopus, Embase, CINAHL, PsycINFO+, and Cochrane) comprehensively cataloged peer-reviewed studies published through March 2023 in this domain. Of 12,841 possible studies identified, 92 met all inclusion criteria, with over 80% being published in the last decade. A wide range of terminology has been used for this construct, likely in part a result of the many different professional disciplines represented. These results provide valuable insights for future development of a standardized vocabulary and serve as a resource to aid future investigators of multisensory sensitivity and pain in their study design.

Fibromyalgia is linked to increased subjective sensory sensitivity across multiple senses

Changes in subjective sensory sensitivity - reporting sensory stimuli as being atypically intense or weak - are a transdiagnostic symptom of several disorders. The present study documents for the first time the sensory sensitivity profile of fibromyalgia, taking a questionnaire measure that asks about different sensory modalities and both hyper- and hyposensitivity (the Glasgow Sensory Questionnaire, GSQ). The fibromyalgia group had higher overall scores on this measure. This was linked more strongly to sensory hypersensitivity and was pervasive across all senses that were surveyed. Although differences in hyposensitivity were found, these were sporadic (perhaps linked to the symptoms of fibromyalgia itself) and did not resemble the pattern documented for autism (e.g., self-stimulating and repetitive behaviours were not a feature of fibromyalgia). We suggest that individual differences in subjective sensory hypersensitivity may be a multisensory dispositional trait linked to fibromyalgia which ultimately becomes most pronounced for pain.

Motor Dysfunctions in Fibromyalgia Patients: The Importance of Breathing

The classification of fibromyalgia (FM) is not always immediate and simple, with the time from the first diagnosis, compared to the onset of symptoms, of a few years. Currently, we do not have instrumental or biochemical tests considered as gold standards; the clinician will make a diagnosis of FM based on the patient's medical history and subjective assessment. The symptoms can involve physical, cognitive and psychological disorders, with the presence of pain of different origins and classifications: nociplastic, nociceptive and neuropathic pain. Among the symptoms highlighted, postural disorders and neuromotor uncoordination emerge, whose functional dysfunctions can increase the mortality and morbidity rate. An alteration of the diaphragm muscle could generate such functional motor problems. Considering that the current literature underestimates the importance of breathing in FM, the article aims to highlight the relationship between motor and diaphragmatic difficulties in the patient, soliciting new points of view for the clinical and therapeutic framework.

Exploring sensory sensitivity, cortical excitability, and habituation in episodic migraine, as a function of age and disease severity, using the pattern-reversal task

BACKGROUND

Migraine is a cyclic, neurosensory disorder characterized by recurrent headaches and altered sensory processing. The latter is manifested in hypersensitivity to visual stimuli, measured with questionnaires and sensory thresholds, as well as in abnormal cortical excitability and a lack of habituation, assessed with visual evoked potentials elicited by pattern-reversal stimulation. Here, the goal was to determine whether factors such as age and/or disease severity may exert a modulatory influence on sensory sensitivity, cortical excitability, and habituation.

METHODS

Two similar experiments were carried out, the first comparing 24 young, episodic migraine patients and 28 healthy age- and gender-matched controls and the second 36 middle-aged, episodic migraine patients and 30 healthy age- and gender-matched controls. A neurologist confirmed the diagnoses. Migraine phases were obtained using eDiaries. Sensory sensitivity was assessed with the Sensory Perception Quotient and group comparisons were carried out. We obtained pattern-reversal visual evoked potentials and calculated the N1-P1 Peak-to-Peak amplitude. Two linear mixed-effects models were fitted to these data. The first model had Block (first block, last block) and Group (patients, controls) as fixed factors, whereas the second model had Trial (all trials) and Group as fixed factors. Participant was included as a random factor in both. N1-P1 first block amplitude was used to assess cortical excitability and habituation was defined as a decrease of N1-P1 amplitude across Blocks/Trials. Both experiments were performed interictally.

RESULTS

The final samples consisted of 18 patients with episodic migraine and 27 headache-free controls (first experiment) and 19 patients and 29 controls (second experiment). In both experiments, patients reported increased visual hypersensitivity on the Sensory Perception Quotient as compared to controls. Regarding N1-P1 peak-to-peak data, there was no main effect of Group, indicating no differences in cortical excitability between groups. Finally, significant main effects of both Block and Trial were found indicating habituation in both groups, regardless of age and headache frequency.

CONCLUSIONS

The results of this study yielded evidence for significant hypersensitivity in patients but no significant differences in either habituation or cortical excitability, as compared to headache-free controls. Although the alterations in patients may be less pronounced than originally anticipated they demonstrate the need for the definition and standardization of optimal methodological parameters.

Diagnosing nociplastic pain in cancer survivors: a major step forward

Nociplastic pain syndromes include particular fibromyalgia, irritable bowel syndrome, headache, complex regional pain syndrome, and idiopathic orofacial pain. Several mechanisms have been proposed to account for nociplastic pain including central sensitisation, alterations of pain modulatory controls, epigenetic changes, and peripheral mechanisms. Importantly, nociplastic pain might also be present in patients with cancer pain, particularly those with pain related to complications of cancer treatment. Increased awareness of nociplastic pain associated with cancer should have important implications for monitoring and managing such patients.