Fibro info

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from Cheryl in CA

Fibromyalgia Pain: Do We

Know the Source?

Posted 04/08/2004

Abstract and Introduction

Abstract

Purpose of review:

Fibromyalgia Syndrome (FMS) is a chronic pain condition of unknown origin.

Multiple abnormalities have been described, including peripheral tissue and

central nervous system changes. The relation of these mechanisms, however, is

likely bidirectional. FMS pain clearly depends on peripheral nociceptive input

as well as abnormal central pain processing. This review will focus on the role

of peripheral nociceptive input for pain in FMS.

Recent findings: There is

strong evidence for abnormal central pain processing in FMS. Sensitized spinal

cord neurons in the dorsal horn are responsible for augmented pain processing

of nociceptive signals from the periphery. In addition, glial activation,

possibly by cytokines and excitatory amino acids may play a role in the

initiation and perpetuation of this sensitized state.

Summary: Nociceptive input

clearly plays an important role in FMS. Acute or repetitive tissue injury has

been associated with FMS pain. Cytokines related to such injuries may be

responsible for long-term activation of spinal cord glia and dorsal horn

neurons, thus resulting in central sensitization. A better understanding of

these important neuro-immune interactions may provide relevant insights into

future effective therapies.

Introduction

Chronic pain and tenderness

exist as a continuum in the general population and the severity of these

symptoms appears to be normally distributed with more women than men affected.

In 1990 the American

College of Rheumatology

convened a group of experts to better characterize the large number of chronic

musculoskeletal pain patients diagnosed with Fibrositis that crowded the

offices of rheumatologists. The experts agreed on several criteria for the new

syndrome Fibromyalgia, which captures this chronic pain population with

excellent sensitivity and specificity.[1] In addition, the new FMS criteria of

widespread chronic pain (> 3 months) and tender points (>/= 11 of 18)

provide a useful characterization of patients with chronic musculoskeletal pain

for research studies. The use of the same FMS criteria for clinical practice,

however, turned out to be problematic because chronic musculoskeletal pain

patients fulfilling the FMS criteria differ mostly in symptom severity from

pain patients who do not satisfy the same criteria. Although this criticism has

led many physicians to question the usefulness of the FMS criteria for clinical

practice, they nevertheless seem to capture the most afflicted patients.

Similar to FMS, several other clinically important syndromes also represent

extremes of a continuum of symptoms including hypertension and diabetes. The

particular usefulness of the latter syndromes, however, relies on their ability

to predict significant morbidity and mortality in large numbers of patients.

Although in the past the diagnosis of FMS appeared only predictive for

increased dysfunction and emotional distress, recent epidemiological studies

provided important evidence for excessive mortality in patients with widespread

chronic pain syndromes like FMS.[2,3**] These findings seem to support the

relevance of FMS as a distinct clinical syndrome and provide impetus for the

identification of relevant FMS pain mechanisms that may result in better

diagnosis and treatments.

Infections Associated With

Fibromyalgia Syndrome Fibromyalgia syndrome is a disorder of diffuse pain in

the muscles or joints accompanied by tenderness at specific tender points and a

constellation of related symptoms. These symptoms are reminiscent of those

related to many acute or chronic infections.

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