The Science of Fibromyalgia.
Clauw DJ, Arnold LM, McCarberg BH; for the FibroCollaborative.
Department of Anesthesiology, University of Michigan, 24 Frank Lloyd
Wright Dr, Ann Arbor, MI 48106. dclauw@med.umich.edu.
Abstract
Fibromyalgia (FM) is a common chronic widespread pain disorder. Our
understanding of FM has increased substantially in recent years with
extensive research suggesting a neurogenic origin for the most
prominent symptom of FM, chronic widespread pain.
Neurochemical imbalances in the central nervous system are associated
with central amplification of pain perception characterized by
allodynia (a heightened sensitivity to stimuli that are not normally
painful) and hyperalgesia (an increased response to painful stimuli).
Despite this increased awareness and understanding, FM remains
undiagnosed in an estimated 75% of people with the disorder.
Clinicians could more effectively diagnose and manage FM if they
better understood its underlying mechanisms.
Fibromyalgia is a disorder of pain processing. Evidence suggests that
both the ascending and descending pain pathways operate abnormally,
resulting in central amplification of pain signals, analogous to the
"volume control setting" being turned up too high.
Patients with FM also exhibit changes in the levels of
neurotransmitters that cause augmented central nervous system pain
processing; levels of several neurotransmitters that facilitate pain
transmission are elevated in the cerebrospinal fluid and brain, and
levels of several neurotransmitters known to inhibit pain transmission
are decreased.
Pharmacological agents that act centrally in ascending and/or
descending pain processing pathways, such as medications with approved
indications for FM, are effective in many patients with FM as well as
other conditions involving central pain amplification. Research is
ongoing to determine the role of analogous central nervous system
factors in the other cardinal symptoms of FM, such as fatigue,
nonrestorative sleep, and cognitive dysfunction.
PMID: 21878603 [PubMed - as supplied by publisher]
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