Lady Gaga’s Diagnosis Helps Shed Light on a Perplexing Chronic Pain Disorder

Despite her celebrity status, Lady Gaga has been remarkably honest and open about her struggles with fibromyalgia, a chronic pain disorder. The star announced her diagnosis on social media earlier this month, and just recently canceled tour dates due to disorder-related complications.

Fibromyalgia has traditionally been a challenge to diagnose and treat, because there is no test for it. Doctors make the diagnosis based on patient reported symptoms. Researchers at Mass General are hoping to change that by using imaging techniques to demonstrate brain changes in fibromyalgia patients and investigating potential causes for the disease.

What is fibromyalgia and what are the symptoms?

Fibromyalgia is a common chronic pain disorder that can be extremely debilitating. The disorder is characterized by widespread pain, accompanied with un-refreshing sleep, fatigue, memory and cognitive problems, sensitivity to temperatures, light, and sound, and headaches. It can also co-exist with other conditions including depression, anxiety and irritable bowel syndrome.

These symptoms severely impact the 5-10 million Americans living with this disorder. The pain and fatigue of fibromyalgia can make it difficult to maintain work and social obligations. Symptoms also come in waves at seemingly random intervals, which can blindside individuals.

What causes fibromyalgia?

It’s thought that disturbances in the central nervous system affect the way the brain processes pain signals, which amplifies the painful sensations that fibromyalgia patients experience. But why these disturbances occur remains a mystery.

Experts suggest that the disorder could be driven by several factors, including physical or emotional trauma, prior illness or infection, and genetics. Women are also more likely to develop fibromyalgia than are men, though researchers don’t know why.

In an effort to find answers to these questions, Marco Loggia, PhD, Associate Director of the Center for Integrative Pain NeuroImaging and a researcher in the Martinos Center for Biomedical Imaging at Massachusetts General Hospital, studies the brain mechanisms of pain in patients with fibromyalgia. His research suggests that some degree of brain inflammation may be at play, given that brain inflammation is common among chronic back pain sufferers and most fibromyalgia patients suffer from chronic back pain.

How is it treated?

There is no cure for fibromyalgia. As a result, the focus of treatment is on managing pain and improving quality of life for patients. However, patients often struggle to find the right combination of treatments to manage their condition.

Clinicians often recommend medications including pain relievers, anti-depressants, and anti-seizure drugs to reduce pain and improve sleep. Some patients also utilize therapies such as physical therapy or counseling and alternative treatments like massage therapy, yoga or acupuncture.

Is there stigma associated with fibromyalgia?

Because there are no lab tests to diagnose fibromyalgia, patients are frequently met with skepticism, even by their own primary care team. The pain they report is often dismissed as being “all in their head.”

In a recent interview with HealthDay News, Loggia said, “Many studies—and particularly those using brain imaging techniques such as functional magnetic resonance imaging—have now provided substantial support to the notion that the excessive sensitivity to pain that these patients demonstrate is genuine. I think that it is time to stop dismissing these patients.”

With celebrities like Lady Gaga raising awareness of this disease and researchers like Loggia investigating its causes and progression, could individuals suffering from fibromyalgia soon see advances in treatment and care—as well as more public understanding of this debilitating disorder?

To read more on this topic:

Research Awards and Honors: September 2017

Massachusetts General Hospital’s talented and dedicated researchers are working to push the boundaries of science and medicine every day. In this series we highlight a few individuals who have recently received awards or honors for their achievements:

Aguirre

Aaron Aguirre, MD, PhD, of the Cardiology Division and the Center for Systems Biology, has received a 2017 Physician/Scientist Development Award for “Morphology and Dynamic Functions of Pericytes in the Heart.” Aguirre’s project will use state-of-the-art microscopy techniques to better understand the role of pericytes—unique cells that line the outer walls of the smallest blood vessels in the heart. Funding for the Physician/Scientist Development Awards is provided by the Executive Committee on Research along with the Center for Diversity and Inclusion.

“I am grateful for the research support provided by the MGH Physician Scientist Development Award. It will allow me to expand my current research into a new direction and to generate critical preliminary data necessary for future grant applications.”

 

Chung

David Chung, MD, PhD, attending neurointensivist in the Neurology Department, has been awarded the Timothy P. Susco Chair of Research and the Andrew David Heitman Foundation Chair of Research from The Brain Aneurysm Foundation for his work, “Impact of Spreading Depolarizations and Subarachnoid Hemorrhage on Brain Connectivity.” He is one of 14 awardees, given to those whose work is impacting a disease that affects one in 50 people in the United States, often leading to death or lifelong disability.

My immediate reaction to receiving this award was gratitude towards my mentors in the Department of Neurology at MGH: Cenk Ayata, Jonathan Rosand, Guy Rordorf, and Leigh Hochberg. Without their support, this work would not be possible. A major question in Neurocritical Care is how to prevent poor outcome after a ruptured brain aneurysm. Even when we successfully repair the aneurysm, many patients will develop a syndrome of progressive brain damage for unknown reasons. This award will enable us to examine unexplored causes of brain damage and poor outcome with the goal of improving quality of life in survivors of the disease.”

 

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Julie Levison, MD, MPhil, MPH, of the Division of General Internal Medicine, has received a CFAR ADELANTE Award from the National Institutes of Health, the Office of AIDS Research and the NIH-funded Centers for AIDS Research to support new  investigators working on HIV research in Latinos. Hispanic/Latino populations in the U.S. currently bear a disproportionate burden of the HIV/AIDS epidemic. The ADELANTE team is composed of Dr. Levison (principle investigator), Dr. Margarita Alegría, chief MGH Disparities Research Unit, and Carmen Rios, Respite Case Manager at the Barbara McGinnis House.

“The ADELANTE award is a special type of research award because it recognizes the value of community-academic collaborations in overcoming disparities in HIV outcomes in Latino populations. In this study, we will use qualitative research to solicit the needs and priorities of HIV-infected Latino migrants with substance use disorders or who report male-to-male sex and we will use that feedback to tailor and evaluate a community-based intervention we have developed for HIV-infected Latinos with inconsistent HIV primary care attendance.”

 

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Fatima Cody Stanford, MD, MPH, MPA, adult and pediatric obesity medicine physician of the MGH Weight Center, Department of Medicine-Gastroenterology and Department of Pediatrics-Endocrinology, has received a 2017 Physician-Scientist Development Award from the MGH Center for Diversity and Inclusion for “Exploring Referral Patterns and Shared Decision Making Regarding Weight Loss Surgery in Adolescents and Young Adults with Moderate to Severe Obesity.” Funding for the Physician/Scientist Development Awards is provided by the Executive Committee on Research in conjunction with the Center for Diversity and Inclusion. Stanford also has been selected to the inaugural class of Emory University Alumni Association’s “40 Under Forty,” a selected group of outstanding young alumni with impressive track records who are “go-to” leaders.

“I am delighted to be the recipient of the MGH Physician Scientist Development award in partnership with the MGH Center for Diversity and Inclusion and ECOR. I believe that we are just at the beginning of discerning issues associated with addressing obesity in the pediatric and adult populations. This award allows me to ascertain information about shared decision making in adolescents and young adults with moderate to severe obesity in which weight loss surgery might be utilized to help them achieve a healthy weight. To our knowledge, no one has investigated the use of shared decision making regarding weight loss surgery in young people. This awards allows us to do just that.”

 

Temel GreerJennifer Temel, MD, director of the Cancer Outcomes Research Program and Hostetter MGH Research Scholar, along with Joseph Greer, PhD, program director of the Center for Psychiatric Oncology & Behavioral Sciences, have received a research funding award from the Patient-Centered Outcomes Research Institute (PCORI) for their research “Comparative Effectiveness of Early Integrated Telehealth Versus In-Person Palliative Care for Patients with Advanced Lung Cancer.” The new awards were given to those whose work specifically focuses on community-based palliative care delivery. The goal of this project is to determine if telehealth is an effective, patient-centered, and accessible delivery modality for early palliative care.

“We are overjoyed to receive this research award from PCORI. By testing novel models of care using telemedicine, we hope to demonstrate that greater numbers of patients with advanced cancer and their families can access and benefit from essential palliative care services closer to the time of diagnosis.”

 

Whetstine.jpgJohnathan Whetstine, PhD, of the MGH Cancer Center and Tepper Family MGH Research Scholar, has received a Lung Cancer Discovery Award from the American Lung Association. This award supports investigators at any level of research experience focusing on novel treatments or a cure for lung cancer. His goal is to use studies about histone modifiers to provide insights into tumor heterogeneity and emerging drug resistance so that better molecular diagnostics, epigenetic therapeutic molecules, or use of novel therapeutic combinations can be achieved in cancer treatment.

“We are very excited to receive this award from the ALA.  This support allows my group to continue to expand our lung cancer research program in the area of tumor heterogeneity and drug resistance. Most importantly, these resources allow us the opportunity to explore novel regulatory pathways driving heterogeneity and copy gains of regions affiliated with resistant lung cancer, which provides insights into novel diagnostics and therapeutic opportunities in this hard-to-treat cancer.”

 

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Alik Widge, MD, PhD, director of the Translational NeuroEngineering Laboratory, Division of Neurotherapeutics, has received the 2017 One Mind/Janssen Rising Star Translational Research Award from the One Mind Institute and Janssen Research & Development, LLC. This award identifies and funds pivotal, innovative research on the causes of and cures for brain disorders. Toward boosting the recovery of patients with illnesses such as schizophrenia, major depression or obsessive-compulsive disorder, Widge proposes to identify precisely the brain circuits that govern the inflexibility of thinking common among patients with such illnesses, and to test whether neurostimulation of these circuits could improve mental flexibility.

“I was very excited about the Rising Star award, for two reasons. First, it brings much-needed seed funding to our lab for an unconventional but possibly high-yield project. We have found that electrical brain stimulation in humans can improve mental flexibility — the ability to “take the road less traveled by” and explore new behavior strategies. That ability is impaired in many mental illnesses. Our problem is that we don’t yet know how the electrical stimulation improves flexibility. The Rising Star award will let us set up animal experiments to identify the circuit basis of the effect, findings we could then translate back into humans. 

Second, this is a really important award in psychiatric research. It’s brought our lab’s other work into the spotlight, which will help those projects progress. I’m grateful both to the OneMind Institute for the award and to the MGH team that helped me get the preliminary data that made it possible.”

Could an App Ease the Stress of Managing Heart Failure?

A heart failure diagnosis can be an unsettling experience. Add in a deluge of new medication regimens and lifestyle changes to implement, and the entire episode can begin to feel very overwhelming for a heart failure patient.

A new smartphone app from Jana Care, called Heart Habits, was created in the hopes of streamlining cardiac care management. Now a team at Massachusetts General Hospital wants to test out the app with patients.

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Screen shots of the Heart Habits app (photo courtesy of Jana Care)

“Heart failure patients are pretty complex,” Nasrien Ibrahim, MD, a cardiologist at Mass General and one of the lead investigators, said in a recent interview with MobiHealthNews. “We’re always looking for ways to improve patient care, reduce morbidity and mortality, to keep these patients out of the hospital or the emergency department, and just improve their overall quality of life.”

The Heart Habits app prompts patients to track their symptoms twice a week and provides alerts if any signs or symptoms, such as shortness of breath, suggest a problem that may require medical attention.

The app also provides information on and tracks other important factors including weight. Patients are prompted to record their weight on a daily basis. The data is then translated into graph form, which the patients’ care teams—who have access to the app—can easily view and interpret. The Heart Habits app also enables two-way communication with a messaging feature that allows patients to contact their physicians.

Ibrahim and her team want to investigate how patients respond to using the app and if its use improves patient symptoms. Their initial pilot will include 24 patients randomized to either the app or the standard of care—paper documents given to patients to take home—for six weeks.

“If the pilot study works, meaning the app is user-friendly, we see improvement in scores, that the patients like it, and that their symptoms have improved, a larger study would involve biomarker testing, outcome measures such as hospital readmissions and emergency department visits, and, essentially, cost as well,” Ibrahim said.

Thank You Postdocs!

As National Postdoc Appreciation Week comes to a close, we want to thank postdocs across the country, and especially those at Mass General, for all their hard work and dedication to research and scientific discovery.

Here at Mass General, we have over 1800 postdoctoral fellows who collectively contribute to over 6100 active research projects.

Earlier this week we celebrated our postdoc cohort with an ice cream social and asked them what they love most about research. Here’s what a few of them had to say…

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Meet a Mass General Postdoc: Amy Tsurumi

In honor of National Postdoc Appreciation Week, all this week we’ll be sharing profiles of just a few of our amazing Mass General postdocs to highlight their research and what inspires them.

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Our fourth and final featured postdoc this year is Amy Tsurumi, PhD, a research fellow in the Rahme Lab.

Where did you get your PhD from?

University of Rochester School of Medicine and Dentistry

What questions are you asking in your current research? What do you hope to find out?

My research is elucidating epigenetic mechanisms of host susceptibility and response to infections using Drosophila, mice and tissue culture Pseudomonas aeruginosa infection models.  I hope to identify specific histone post-translational modification marks and genomic loci that are relevant and explore the possibility of alleviating the negative impact of pathogenic encounters by reversing these epigenetic marks.  Given the rise of antibiotic resistant bacteria, developing host-targeted methods as an alternative approach may be significant.  I also conduct epidemiological and biomarker studies for prediction of vulnerability to infections and infections-related outcomes in burn and trauma patient cohorts. 

What drew you to this field?

My father was a physician-scientist with a microbiology research background and fascination in human genetics, so I grew up being curious about the field of biomedical sciences.  As a graduate student, I learned about epigenetics for the first time and studied histone lysine demethylases, a relatively novel class of epigenetic regulators back then, which I found to be absolutely exciting.  I was thrilled to join the Rahme lab where I was lucky to have been given the opportunity to continue to conduct epigenetics research that I am interested in, but shift from the context of Drosophila development to host-microbe interactions using a variety of model organisms and also incorporate patient cohort clinical research.

What is a typical day like for you?

It is difficult to define a “typical” day, which I actually enjoy. Most days, I spend the majority of the time running experiments on the bench or conducting patient data analyses.  When there are grant/fellowship deadlines, I spend the day focusing on writing.  I find myself to be extremely lucky that there are many different types of experimental methods I get to do and various model organisms available in the Rahme lab.  The variety of techniques offered has given me an incredible learning experience thus far.

What do you like most about being a postdoc at MGH?

I am awed by the highly collaborative environment at MGH.  The Rahme lab is diverse in terms of scientific background (and home countries!) and I am very thankful to my mentor for the excellent mentorship and also to other postdocs around me, especially labmates and floormates for the invaluable input and help I receive daily.  I also feel fortunate to be part of collaborative projects with various PIs within MGH and around the globe, as well as the vast amount of resources offered by neighboring labs, MGH core facilities and other Harvard campuses.  All the research that goes on every day at MGH is stimulating and my mentor and colleagues I have the opportunity to work with are inspiring.

Meet a Mass General Postdoc: Xavier Fernando Vela Parada

In honor of National Postdoc Appreciation Week, all this week we’ll be sharing profiles of just a few of our amazing Mass General postdocs to highlight their research and what inspires them.

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Xavier Fernando Vela Parada is a research fellow in the Thadhani Lab in the Nephrology Division.

Where did you get your MD from?

I studied medicine in my home country El Salvador, Central America.

What questions are you asking in your current research? What do you hope to find out?

At the Thadhani lab we focus on finding new ways to detect and treat various forms of kidney disease. We hope that we will be able to find new markers and new therapeutic agents that will allow us to treat and detect kidney disease in its early stages as well as its complications.

What drew you to this field?

Nephrology is the basis of medicine. Since I was in med school I was impressed at the way the kidneys tightly regulate the human physiology; this was my favorite subject while studying to become a physician. Chronic kidney disease is problem of enormous proportions and I feel committed to work towards finding a solution for our patients.

What is a typical day like for you?

A typical day will include discussion with my PIs about new research questions and future directions for our research. Also, when working with patients I make sure they understand how much we value them and how important their contribution is to science. I also work closely with other staff, making sure our study samples are collected and stored properly. Normally I will also reach out to younger staff to share my passion for kidney research.

What do you like most about being a postdoc at MGH?

I love the fact that being at MGH gives me the exposure to a vast array of fantastic clinicians, scientists, service and administrative personnel. Each one of them contribute in one way or another in order to achieve our end goal which is to improve patient care. At the same time MGH made me feel welcome from the very first day; in a place so diverse like this I encountered a new family.

Meet a Mass General Postdoc: Echoe Bouta

In honor of National Postdoc Appreciation Week, all this week we’ll be sharing profiles of just a few of our amazing Mass General postdocs to highlight their research and what inspires them.

Meet Echoe Bouta, PhD, a research fellow in the Department of Radiation Oncology.

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Where did you get your PhD from?

University of Rochester

What questions are you asking in your current research? What do you hope to find out?

Lipedema is a chronic disorder that results in increased fat in the lower limbs and manifests as dramatic, painful swelling. Clinical studies demonstrate that patients present with at least partial lymphatic dysfunction, which worsens until lymphedema occurs. As the etiology is largely unknown, treatments are often ineffective, demonstrating the need to understand the relationship between fat and lymphatic capability.  The questions I hope to answer are:

      •  How does increased adiposity impair lymphatic function in an animal model of obesity?
      • Can we target key pathways in this process to improve lymphatic function?

The answer to this questions will hopefully catalyze new treatments for lipedema.

What drew you to this field?

The lymphatic research field is relatively young compared to other research fields.  I believe that we have only started to discover the importance of the lymphatic system in multiple disease states and it is exciting to be part of that.

What is a typical day like for you?

Much of my project involves imaging of the lymphatic system under different contexts, such as obesity or after delivery of a drug. Therefore, a typical day for me is a mix of in vivo experiments, data analysis and writing.

What do you like most about being a postdoc at MGH?

The people.  We are surrounded by talented scientists from a variety of fields that results in a very interdisciplinary research environment.