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Brief Project Description:

I work at the Dept. of Psychosomatic Medicine and Psychotherapy of Klinikum rechts der Isar (KRDI), Technische Universität München, under the supervision of Prof. Peter Henningsen and Dr. Martin Sack and in close collaboration with other colleagues from the same department as well as colleagues from other departments of KRDI and also with Prof. Steven Laureys and other colleagues from the Coma Science Research Group of the University of Liège, Liège, Belgium, as well as with Prof. Walter Bongartz from the University of Constance, Constance, Germany.

My responsibilities include: development of the theoretical background of the project, experimental design, writing of the research proposal, recruitment and pre-testing of patients for the study, coordination of the activities allocated to different members of the project, programming of stimuli using Presentation or E-Prime, statistical analysis of MRI and psychophysiological data (e.g. HRV, etc) as well as data from standardized tests and the publication and presentation of the results through papers and oral presentations.

My research in the DISCOS project is focused mainly on the examination of neural and psychophysiological correlates of medically unexplained physical symptoms. Medically unexplained physical symptoms (MUPS) refer to bodily symptoms that "lack an obvious organic base" (Mayou, 1991). MUPS were also earlier known as functional somatic symptoms, a term falling in disuse because of its perceived derogatory connotations (Mayou, 1991). Common symptoms not only include negative symptoms such as pain, fatigue and dizziness, but also positive ones such as psychogenic non-epileptic seizures. Pathogenesis is unknown and therefore their whole definition hinge on negative data, in other words we know what they are not, but we do not know what they really are (Cohen, 1991). Although MUPS are often linked to mental disorders at least a third of them present themselves with no obvious mental disorder (Prince et al, 2007). In fact, meta-analytic data indicates that MUPS are not dependent on the co-occurrence of depression and anxiety, which suggests that they should not be labeled as purely mental disorders (Henningsen et al, 2003). As described by Mayou (1991) they remain "diagnostic puzzles", which constitute a significantly common occurrence in daily clinical practice around the world (Prince et al, 2007).

We are currently focusing on particular set of such symptoms known as chronic widespread pain. Chronic widespread pain is part of the clinical picture of the fibromyalgia syndrome and it is defined based on classification criteria of the American College of Rheumatology (ACR). In order for chronic pain to be considered widespread it must be present in contralateral body quadrants and in the skeletal axis (Hunt et al., 1999). Unlike the fibromyalgia syndrome, points "tender" to digital palpation play no role in the diagnosis of chronic widespread pain. It must be noted that "the use of tender points for diagnostic and classification purposes remain controversial. Their reliability is low due to a lack of standardization of the verbal instructions patients should received before and during the examination and of the duration of the pressure that must be exerted. Furthermore the ambiguity surrounding the operationalization of "tenderness" constitutes yet another problem related to their reliability (Häuser, Eich, Herrmann, Nutzinger, Schiltenwolf, Henningsen, 2009)". In order to avoid the controversy connected to "tender points" we have decided to focus on chronic widespread pain rather than on the fibromyalgia syndrome.

As far as brain research is concerned, a review on the fibromyalgia syndrome by Schweinhardt et al. (2008), has found that results from psychophysiological, functional magnetic resonance imaging (fMRI), neurotransmission as well as neuroanatomic studies strongly suggest that:

1. normal pain modulatory systems are seriously affected
2. subjective reports of increased pain are confirmed by concomitant enhanced cerebral activations in brain imaging studies
3. dopaminergic, opioidergic, and serotoninergic systems are altered
4. a decrease of gray matter is commonly observed

However, Schweinhardt et al. concluded that fibromyalgia is most likely not a primary brain disorder, but "a consequence of early life stress or prolonged or severe stress, affecting brain modulatory circuitry of pain and emotions in genetically susceptible individuals" (p.415). We focus consequently in our research not merely on the neurobiology of medically unexplained pain, but also on the effect of interpersonal factors in the clinical history of the patient.

According to Henningsen (2003), the convergent findings in the neurobiological research of medically unexplained pain have an important limitation in their validity, namely, they focus on peripherical painful stimulation, and not directly on the subjective symptoms of pain of the patient suffering from chronic widespread pain or fibromyalgia. Henningsen emphasizes that if we are to develop an explanation that considers central neural generators of medically unexplained pain (Apkarian et al. 2005), we should use internal, central stimuli rather than external, peripheral ones. Therefore, our efforts are currently concentrated on developing a stimulation method for fMRI studies, which is amenable to the examination of central neural generators.

References

• Apkarian, A.V., Bushnell, M.C., Treedec, R., Zubietad, J. (2005) Human brain mechanisms of pain perception and regulation in health and disease. European Journal of Pain, 9, 4, 463-484.
• Cohen, S. (1991) Medically unexplained physical symptoms. BMJ, 303, 26, 1062.
• Henningsen, P. (2003) The body in the brain: towards a representational neurobiology of somatoform disorders. Acta Neuropsychiatrica, 15, 157?160.
• Häuser, W., Eich, W., Herrmann, M., Nutzinger, D.O., Schiltenwolf, M., Henningsen, P. (2009) Fibromyalgiesyndrom ? Klassifikation, Diagnose und Behandlungsstrategien. Deutsches Ärzteblatt, 106, 23, 383-391.
• Hunt, I.M., Silman, A.J., Benjamin, S., McBeth, J., Macfarlane, G.J. (1999) The prevalence and associated features of chronic widespread pain in the community using the "Manchester" definition of chronic widespread pain, Rheumatology, 38, 275?279.
• Mayou, R. (1991) Medically unexplained physical symptoms: Do not overinvestigate. BMJ, 303, 7, 534-35.
• Prince, M., Patel, V., Saxena, S., Maj M., Maselko, J., Phillips, M.R.,Rahman, A. (2007). Global Mental Health 1: No health without mental health. Lancet, 370: 859-77.
• Schweinhardt, P., Sauro, K. M., Bushnell, C. (2008) Fibromyalgia: A Disorder of the Brain? The Neuroscientist, 415, 14, 5.