Fibromyalgia is the second most common rheumatic disorder behind osteoarthritis and, although still largely misunderstood, is now considered a lifelong central nervous system disorder, which is responsible for the increased pain that pulls through the body at home. those who suffer from it.
Daniel Clauw, MD, professor of anesthesiology, University of Michigan, analyzed the neurological basis of fibromyalgia at a plenary session today at the American Pain Society’s annual scientific meeting.
“Fibromyalgia can be considered both as a discrete disease and also as a common final pathway of centralization and chronology of pain. Most people with this condition have a long history of chronic pain in their body, “Clauw said. “The condition can be difficult to diagnose if one does not know the classic symptoms because there is not a single cause and no outward sign”.
Clauw explained that the pain of fibromyalgia comes more from the brain and spinal cord than areas of the body in which a person is suffering from peripheral pain. The condition is thought to be associated with disturbances in the way the brain processes pain and other sensory information. He said doctors should suspect fibromyalgia in patients with multifocal (mainly 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 hypersensitivity are common. in people suffering from this painful condition, “said Clauw.
“This does not imply that peripheral nociceptive delivery does not contribute to the pain experienced by patients with fibromyalgia, but they feel more pain than would normally be expected from the degree of peripheral intake. People with fibromyalgia and other pain states characterized by sensitization will feel pain from what those whose condition would not describe as touch, “added Clauw.
Due to the central nervous system origin of fibromyalgia pain, Clauw said that treatments with opioids or other narcotic painkillers are usually not effective because they do not reduce the activity of neurotransmitters in the brain . “These drugs have never been considered effective in patients with fibromyalgia, and there are signs that opioids may even worsen fibromyalgia and other states of centralized pain,” he said.
Clauw advises clinicians to integrate pharmacologic treatments, such as gabapentinoids, tricyclics, and serotonin reuptake inhibitors, with non-pharmacological approaches such as cognitive behavioral therapy, exercise, and stress reduction.
“Sometimes the magnitude of the treatment response for simple, inexpensive non-drug therapies exceeds that of pharmaceuticals,” said Clauw. “The greatest benefit is improved function, which should be the main goal of treatment for any condition of chronic pain. The majority of patients with fibromyalgia can see an improvement in their symptoms and lead a normal life with the right medications and intensive use of non-drug therapies. “