Fibromyalgia is the second most common rheumatic disease behind osteoarthritis and,
although it is still largely misunderstood, it is now considered a center of life-long nervous system disorder, which is responsible for the amplified pain that goes through the body in those who suffer from it.
Daniel Clauw, MD, professor of anesthesiology at the University of Michigan, analyzed the neurological basis of fibromyalgia in a plenary address today at the annual scientific meeting of the American Pain Society.
“Fibromyalgia can be considered both as a discrete disease and also as a common final pathway of the pain of centralization and chronification.
Most people with this disease have stories of chronic pain throughout their lives, “said Clauw. “The condition can be difficult to diagnose if one does not know the classic symptoms because there is not a single cause and there are no outward signs.”
Clauw explained that the pain of fibromyalgia comes more from the brain and spinal cord than areas of the body where someone may experience peripheral pain.
The condition is believed to be associated with alterations in the way the brain processes pain and other sensory information.
He said physicians should suspect that patients with multifocal fibromyalgia (mainly musculoskeletal) have pain that is not fully explained by injury or inflammation.
“Because the pain pathways throughout the body are amplified in fibromyalgia patients, the pain can occur anywhere,
Chronic headaches, visceral pain and sensory hyperreaction are common in people with this painful disease, “said Clauw.
“This does not imply that peripheral nociceptive delivery does not contribute to the pain felt by patients with fibromyalgia,
but I feel more pain than would normally be expected from the degree of input devices.
People with fibromyalgia and other painful conditions characterized by sensitization will experience pain because those who do not have the condition will feel the pain, “said Clauw.
Because of the origins of fibromyalgia’s central nervous system pain,
Clauw said that treatments with opioids or other narcotic analgesics are usually not effective because they do not reduce the activity of neurotransmitters in the brain.
“These drugs have not proven effective in patients with fibromyalgia,
and there is evidence that opioids can even worsen fibromyalgia and other centralized pain conditions,” he said.
Clauw advises physicians to integrate pharmacologic treatments, such as gabapentinoids, tricyclics, and selective serotonin reuptake inhibitors,
with non-pharmacological approaches such as cognitive behavioral therapy, exercise, and stress reduction.
“Sometimes the scale of the response to treating simple, inexpensive non-pharmacological therapies exceeds that of drugs,” said Clauw. “The biggest advantage is the function,
this should be the main goal of treatment for any condition of improved chronic pain. The majority of patients with fibromyalgia can see an improvement in their symptoms and lead a normal life with appropriate medications and intensive use of non-pharmacological therapies. “