Neuroimaging as a Biomarker of Treatment Outcomes in Percutaneous Electrical Nerve Field Stimulation for Fibromyalgia Restricted; Files Only

Abstract

The opioid epidemic is a significant public health problem in the United States, and chronic pain is a primary contributor to opioid over-prescription. Fibromyalgia is a difficult to treat chronic multi-symptom disorder with pain as a primary component. Currently, fibromyalgia relies on clinical diagnosis without validated biomarkers to aid in diagnosis. In order to better assess and treat fibromyalgia, the development of novel biomarkers as well as novel therapeutics is necessary. Neuroimaging has arisen as a potential biomarker for the measurement of treatment response in fibromyalgia and chronic pain. For the present investigation, we used resting state functional connectivity magnetic resonance imaging (rs-fcMRI) as a biomarker to evaluate the feasibility of utilizing auricular percutaneous electrical nerve field stimulation (PENFS), a FDA-approved, non-pharmacologic device, to treat veterans with fibromyalgia who were enrolled in the Atlanta Veterans Affairs Healthcare System. This was a randomized, controlled, single-blind trial of twenty-one veterans with fibromyalgia who were randomized to standard therapy control or standard therapy with auricular PENFS treatment. Participants in each group attended weekly visits with a pain practitioner over 4 weeks, where they either received standard therapy or re-application of a PENFS device. At 12 weeks post-treatment, a trend towards improved pain scores was observed in the PENFS treatment group, with significant improvements in pain interference scores. Results of rs-fcMRI analysis using the differences in imaging data acquired from the PENFS group (Post – Pre treatment) revealed increased connectivity from the right posterior insula to left cerebellum lobule VIIB, Crus II, and right cerebellum lobule VIIB/Crus I-II, left inferior frontal gyrus, right superior frontal sulcus, middle temporal gyrus, left putamen, left anterior cingulate cortex, left brainstem, and right inferior parietal lobule, as compared to standard therapy (Post-Pre treatment).

Table of Contents

TABLE OF CONTENTS

INTRODUCTION…1

BACKGROUND…3

METHODS…9

RESULTS…17

DISCUSSION/CONCLUSIONS…20

REFERENCES…25

TABLES…30

FIGURES…37

About this Master's Thesis

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School	Laney Graduate School
Department	Clinical Research
Degree	M.S.
Submission	Master's Thesis
Language	English
Research Field	Military Studies
Keyword	Fibromyalgia
Committee Chair / Thesis Advisor	Bruce Crosson, Emory University
Committee Members	Matthew Magee, Emory University Daniel Harper, Emory University Roman Sniecinski, Emory University

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