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Fibromyalgia has central nervous system origins

Fibromyalgia is the second most common rheumatic disorder behind osteoarthritis and, though still widely misunderstood, is now considered to be a lifelong central nervous system disorder, which is responsible for amplified pain that shoots through the body in those who suffer from it.

Daniel Clauw, a medical doctor and professor of anesthesiology, University of Michigan, analyzed the neurological basis for fibromyalgia in a plenary session address at the recent American Pain Society Annual Scientific Meeting.


May 25, 2015
By Massage Therapy Canada staff

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“Fibromyalgia can be thought of both as a discreet disease and also as a
final common pathway of pain centralization and chronification. Most
people with this condition have lifelong histories of chronic pain
throughout their bodies,” said Clauw. “The condition can be hard to
diagnose if one isn’t familiar with classic symptoms because there isn’t
a single cause and no outward signs.”

Clauw explained that
fibromyalgia pain comes more from the brain and spinal cord than from
areas of the body in which someone may experience peripheral pain. The
condition is believed to be associated with disturbances in how the
brain processes pain and other sensory information. He said physicians
should suspect fibromyalgia in patients with multifocal (mostly
musculoskeletal) pain that is not fully explained by injury or
inflammation.

“Because pain pathways throughout the body are
amplified in fibromyalgia patients, pain can occur anywhere, so chronic
headaches, visceral pain and sensory hyper-responsiveness are common in
people with this painful condition,” said Clauw.

“This does not
imply that peripheral nociceptive input does not contribute to pain
experienced by fibromyalgia patients, but they do feel more pain than
normally would be expected from the degree of peripheral input. Persons
with fibromyalgia and other pain states characterized by sensitization
will experience pain from what those without the condition would
describe as touch,” Clauw added.

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Due to the central nervous
system origins of fibromyalgia pain, Clauw said treatments with opioids
or other narcotic analgesics usually are not effective because they do
not reduce the activity of neurotransmitters in the brain.

“These
drugs have never been shown to be effective in fibromyalgia patients,
and there is evidence that opioids might even worsen fibromyalgia and
other centralized pain states,” he said.

Clauw advises clinicians
to integrate pharmacological treatments, such as gabapentinoids,
trycyclics and serotonoin reuptake inhibitors, with nonpharmacological
approaches like cognitive behavioral therapy, exercise and stress
reduction.

“Sometimes the magnitude of treatment response for
simple and inexpensive non-drug therapies exceeds that for
pharmaceuticals,” said Clauw. “The greatest benefit is improved
function, which should be the main treatment goal for any chronic pain
condition. The majority of patients with fibromyalgia can see
improvement in their symptoms and lead normal lives with the right
medications and extensive use of non-drug therapies.”

Based in
Chicago, the American Pain Society is a multidisciplinary community that
brings together a diverse group of scientists, clinicians and other
professionals to increase the knowledge of pain and transform public
policy and clinical practice to reduce pain-related suffering.


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