A Mechanism-Based Approach to Prevention of and Therapy for Fibromyalgia

Abstract

Fibromyalgia syndrome (FMS) is characterized by pain referred to deep tissues. Diagnosis and treatment of FMS are complicated by a variable coexistence with regional pain, fatigue, sleep disruption, difficulty with mentation, and depression. The widespread, deep pain of FMS can be a consequence of chronic psychological stress with autonomic dysregulation. Stress acts centrally to facilitate pain and acts peripherally, via sympathetic vasoconstriction, to establish painful muscular ischemia. FMS pain, with or without a coexistent regional pain condition, is stressful, setting up a vicious circle of reciprocal interaction. Also, stress interacts reciprocally with systems of control over depression, mentation, and sleep, establishing FMS as a multiple-system disorder. Thus, stress and the ischemic pain it generates are fundamental to the multiple disorders of FMS, and a therapeutic procedure that attenuates stress and peripheral vasoconstriction should be highly beneficial for FMS. Physical exercise has been shown to counteract peripheral vasoconstriction and to attenuate stress, depression, and fatigue and improve mentation and sleep quality. Thus, exercise can interrupt the reciprocal interactions between psychological stress and each of the multiple-system disorders of FMS. The large literature supporting these conclusions indicates that exercise should be considered strongly as a first-line approach to FMS therapy.

Characteristics of Sensitization Associated With Chronic Pain Conditions

“…Chronic stress in association with chronic pain may constitute a mechanism for extrasegmental sensitization 11,12 that is not limited to caudal spinal dermatomes for IBS or trigeminal areas for TMD. An additional consequence of stress with sympathetic activation is that blood flow to muscles is reduced, which can result in widespread input from nociceptors in ischemic muscles 13-15 .…”

Efectos de un programa de entrenamiento funcional en la musculatura core en mujeres con fibromialgia

“…Como resultado de estos cambios, la activación máxima voluntaria de los músculos, el número y el tamaño de contracción de fibras musculares disminuyen con el aumento de la edad y estos pueden afectar la producción de fuerza máxima (58). Es por esto que el mayor beneficio que promueve el EF en esta población, es la reducción de la vasoconstricción simpática y muscular, que resulta en una pérdida o reducción del dolor generalizado e hiperalgesia por el aumento del flujo sanguíneo periférico y en los tejidos, que incide sobre las reducciones en la densidad capilar, la per-meabilidad capilar y flujo sanguíneo, así como la baja oxigenación de los tejidos (60).…”

Duloxetine and Pregabalin for Pain Management in Multiple Rheumatic Diseases Associated with Fibromyalgia

“…The nociceptors localized in deep tissues are usually sensitized in patients with FMS, and they could be activated by local ischemia and its metabolic sequelae, caused by sympathetic vasoconstriction. This activation generates hyperalgesia and muscular pain, which goes beyond the area of pain distribution . This peripheral sensitization can be elicited by deep tissue palpation, through the clinical examination of the standard tender point identifying for FMS.…”

“…This peripheral sensitization can be elicited by deep tissue palpation, through the clinical examination of the standard tender point identifying for FMS. The activation of ergo receptors generates a sense of muscular fatigue, which is overly predominant in most FMS patients …”