Patients with fibromyalgia display less functional connectivity in the brain’s pain inhibitory network

Background: There is evidence for augmented processing of pain and impaired endogenous pain inhibition in Fibromyalgia syndrome (FM). In order to fully understand the mechanisms involved in FM pathology, there is a need for closer investigation of endogenous pain modulation. In the present study, we compared the functional connectivity of the descending pain inhibitory network in age-matched FM patients and healthy controls (HC). We performed functional magnetic resonance imaging (fMRI) in 42 subjects; 14 healthy and 28 age-matched FM patients (2 patients per HC), during randomly presented, subjectively calibrated pressure pain stimuli. A seed-based functional connectivity analysis of brain activity was performed. The seed coordinates were based on the findings from our previous study, comparing the fMRI signal during calibrated pressure pain in FM and HC: the rostral anterior cingulate cortex (rACC) and thalamus. Results: FM patients required significantly less pressure (kPa) to reach calibrated pain at 50 mm on a 0–100 visual analogue scale (p < .001, two-tailed). During fMRI scanning, the rACC displayed significantly higher connectivity to the amygdala, hippocampus, and brainstem in healthy controls, compared to FM patients. There were no regions where FM patients showed higher rACC connectivity. Thalamus showed significantly higher connectivity to the orbitofrontal cortex in healthy controls but no regions showed higher thalamic connectivity in FM patients. Conclusion: Patients with FM displayed less connectivity within the brain’s pain inhibitory network during calibrated pressure pain, compared to healthy controls. The present study provides brain-imaging evidence on how brain regions involved in homeostatic control of pain are less connected in FM patients. It is possible that the dysfunction of the descending pain modulatory network plays an important role in maintenance of FM pain and our results may translate into clinical implications by using the functional connectivity of the pain modulatory network as an objective measure of pain dysregulation

The interest of gait markers in the identification of subgroups among fibromyalgia patients

<p>Abstract</p> <p>Background</p> <p>Fibromyalgia (FM) is a heterogeneous syndrome and its classification into subgroups calls for broad-based discussion. FM subgrouping, which aims to adapt treatment according to different subgroups, relies in part, on psychological and cognitive dysfunctions. Since motor control of gait is closely related to cognitive function, we hypothesized that gait markers could be of interest in the identification of FM patients' subgroups. This controlled study aimed at characterizing gait disorders in FM, and subgrouping FM patients according to gait markers such as stride frequency (SF), stride regularity (SR), and cranio-caudal power (CCP) which measures kinesia.</p> <p>Methods</p> <p>A multicentre, observational open trial enrolled patients with primary FM (44.1 ± 8.1 y), and matched controls (44.1 ± 7.3 y). Outcome measurements and gait analyses were available for 52 pairs. A 3-step statistical analysis was carried out. A preliminary single blind analysis using k-means cluster was performed as an initial validation of gait markers. Then in order to quantify FM patients according to psychometric and gait variables an open descriptive analysis comparing patients and controls were made, and correlations between gait variables and main outcomes were calculated. Finally using cluster analysis, we described subgroups for each gait variable and looked for significant differences in self-reported assessments.</p> <p>Results</p> <p>SF was the most discriminating gait variable (73% of patients and controls). SF, SR, and CCP were different between patients and controls. There was a non-significant association between SF, FIQ and physical components from Short-Form 36 (p = 0.06). SR was correlated to FIQ (p = 0.01) and catastrophizing (p = 0.05) while CCP was correlated to pain (p = 0.01). The SF cluster identified 3 subgroups with a particular one characterized by normal SF, low pain, high activity and hyperkinesia. The SR cluster identified 2 distinct subgroups: the one with a reduced SR was distinguished by high FIQ, poor coping and altered affective status.</p> <p>Conclusion</p> <p>Gait analysis may provide additional information in the identification of subgroups among fibromyalgia patients. Gait analysis provided relevant information about physical and cognitive status, and pain behavior. Further studies are needed to better understand gait analysis implications in FM.</p

Verhulst (Michel) - Les Industries d'utilité publique.

Mainguy Yves. Verhulst (Michel) - Les Industries d'utilité publique.. In: Revue économique, volume 6, n°1, 1955. pp. 130-132

Verhulst (Michel) - Les Industries d'utilité publique.

Mainguy Yves. Verhulst (Michel) - Les Industries d'utilité publique.. In: Revue économique, volume 6, n°1, 1955. pp. 130-132

L’intégration au primaire d’élèves ayant une déficience intellectuelle : perceptions de directions d’école

Cette étude à caractère descriptif, effectuée auprès de quinze directions d’écoles primaires que fréquentent des élèves ayant une déficience intellectuelle moyenne, avait pour objectif de connaître leurs perceptions sur les points suivants : la formation et l’information reçue relativement à l’intégration de ces élèves, la préparation de l’ensemble du personnel de l’école, les services reçus par l’élève, l’efficacité de l’intégration sur les plans scolaire et social, le degré d’ouverture du personnel enseignant, des camarades de l’élève et des autres parents de l’école. Un questionnaire semi-ouvert d’entrevue a été utilisé.The objective of this descriptive study, conducted with the administrations of fifteen elementary schools attended by pupils with a medium degree of intellectual impairment, was to learn administrators' perceptions about the following matters: training and information received on the integration of these pupils; preparation of school personnel as a whole; services received by the pupils; the effectiveness of these pupils' integration, both academically and socially; and the openness of teaching staff, schoolmates, and other pupils' parents. A semi-open interview questionnaire was used.Este estudio, de carácter descriptivo, efectuado con quince directores de escuelas primarias frecuentadas por alumnos con deficiencias intelectuales medianas, tiene por objeto conocer sus percepciones sobre los siguientes puntos: La formación y la información recibida relacionada con la integración de estos alumnos, la preparación del conjunto del personal de la escuela, los servicios recibidos por el alumno, la eficacia de la integración en el plan escolar y social, el grado de apertura del personal docente, el de los compañeros del alumno y el de los demás padres de familia de la escuela. Se utilizó un cuestionario semi abierto.Diese deskriptive Untersuchung wurde bei fünfzehn Schulleitern von Grundschulen angestellt, die von Schülern mit mittlerer geistiger Behinderung besucht werden. Es ging dabei um ihre Auffassungen bezüglich folgender Punkte: die die Integration dieser Schüler betreffende Bildung und Information, die Vorarbeit mit dem gesamten Schulpersonal, die vom Schüler erhaltene Unterstützung, die Wirksamkeit der schulischen und sozialen Integration, die relative Aufgeschlossenheit des Lehrpersonals, der Mitschüler und der anderen Eltern der Schule. Es wurde ein halboffener Fragebogen verwendet