A new study indicates that fibromyalgia patients can fall on a spectrum driven by the peripheral nervous system on one end and the central nervous system on the other.
Fibromyalgia is a condition characterized by widespread muscle pain and multiple tender points on the neck, shoulders, back, hips, and upper and lower extremities that are especially painful to pressure or touch, with intensity of pain varying from one day to the next. While once thought to be “all in your head,” the pain is real, not imagined.
Symptoms. Fibromyalgia symptoms include pain and fatigue, headaches, irritable bowel syndrome, memory problems, morning stiffness, sleep disturbances, restless-legs syndrome, numbness or tingling in the extremities, temperature sensitivity, and depression. The condition may be undiagnosed for months or years, typically affects women, and causes pain ranging from mild to severe. Diagnosis is based on widespread pain of at least three months’ duration and the presence of multiple “tender” points—18 specific points in all, of which 11 or more are needed for diagnosis.
A recent study undertaken by Kathleen Sluka, researcher in the Department of Physical Therapy and Rehabilitation Sciences at the University of Iowa, and Daniel Clauw, MD, of the University of Michigan’s Department of Anesthesiology, focused on central sensitization and its association with certain pain conditions, such as fibromyalgia (others include irritable bowel syndrome and chronic pelvic pain).
The Findings. The study, published in Neuroscience in December 2016, found that fibromyalgia patients have a heightened sensitivity to pain (hyperalgesia) when presented with stimuli classified as “normal,” compared to their “healthy” counterparts. Studies using functional magnetic resonance imaging (fMRI) found changes to central neural processing in pain pathways, showing how fibromyalgia patients process pain. When experiencing a pressure stimulus, fibromyalgia patients showed increased levels of neuronal activity in the pain-processing regions of the brain compared to control groups. Understanding the pain mechanism of fibromyalgia will enable researchers to develop new treatments aimed at these underlying mechanisms, the authors say.
Study authors also suggest that systemic inflammation may contribute to development of fibromyalgia and other pain disorders, and that the immune system may play a role in originating pain. Researchers found substantial evidence that serotonin (a mood regulator) and noradrenaline (the main neurotransmitter of the sympathetic nervous system) neurotransmission is changed or diminished in people with fibromyalgia (and in animal models). Researchers said that non-pain symptoms, such as sleep disorders, also could contribute to development of fibromyalgia.
Treatment. A combination of two drugs, pregabalin (Lyrica, an anti-seizure drug) and duloxetine (Cymbalta, Irenka, anti-depressant drugs) have been found to offer pain relief, improved physical function and quality of life in fibromyalgia patients. Other pharmacological treatments include analgesics, antidepressants and benzodiazepines (Valium, for example). Nonsteroidal anti-inflammatory drugs, such as ibuprofen, aspirin, and naproxen, are not particularly effective in treating the condition. Non-pharmacologic treatments include acupuncture, low-impact aerobic exercise, stretching, acupressure/massage, heat on the tender points, cognitive behavioral therapy, and stress management techniques.
Patients with this disorder should receive multidisciplinary interventions, such as physical therapy, pain management, and psychological therapy.
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