Fibromyalgia now considered as a lifelong central nervous system disorderMalik Qasir
Fibromyalgia is the second most common rheumatic disorder behind osteoarthritis and, although still widely misunderstood, is now considered a lifelong central nervous system disorder that is responsible for amplified body pain in those suffering from it. Daniel Clauw, M.D., Professor of Anesthesiology at the University of Michigan, analyzed the neurological basis for fibromyalgia in a plenary speech today at the annual scientific meeting of the American Pain Society.
“Fibromyalgia can be regarded as both a discrete disease and a final common pathway of centralizing and chronizing pain. Most people with this condition have long history of chronic pain throughout their bodies,” Clauw said. “The condition can be difficult to diagnose if one is not familiar with classical symptoms because there is no 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 where peripheral pain may occur to somebody. The condition is thought to be associated with disturbances in how the brain processes pain and other sensory information. He said that physicians should suspect fibromyalgia in patients with multifocal (mostly musculoskeletal) pain that is not fully explained by injury or inflammation.
“Because pain pathways in patients with fibromyalgia are amplified throughout the body, pain can occur anywhere, so chronic headaches, visceral pain and sensory hyper-responsiveness are common in people with this painful condition,” Clauw said.
“This does not imply that peripheral nociceptive input does not contribute to pain experienced by patients with fibromyalgia, but they feel more pain than would normally be expected from the degree of peripheral input. People with fibromyalgia and other sensitized pain conditions will experience pain from what those without the condition would describe as touch,” added Clauw.
Because of the origins of fibromyalgia pain in the central nervous system, Clauw said opioid or other narcotic analgesic treatments are usually not effective because neurotransmitter activity in the brain is not reduced. “The drugs in fibromyalgia patients were never shown to be effective and there is evidence that opia may worsen fibromyalgia and other centralized suffering conditions even,” he said.
Clauw advises clinicians to integrate pharmacological treatments such as gabapentinoids, tricyclics, and inhibitors of serotonoin reuptake with non-pharmacological approaches such as cognitive behavioral therapy, exercise, and stress reduction.
“Sometimes for simple and inexpensive non-drug therapies, the magnitude of treatment response exceeds that for pharmaceuticals,” Clauw said. “Most of the patients with Fibromyalgia can see symptom improvements and live a normal life with appropriate medications, and extensive use of non-drogue therapies,” he adds. “The most benefit is an enhanced treatment goal.”
American Pain Society (APS