Peripheral and central sensitization in fibromyalgia: Pathogenetic role

Staud, Roland; Smitherman, Michael L

doi:10.1007/s11916-002-0046-1

Cited by 151 publications

(104 citation statements)

References 92 publications

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“…The biochemical mediators of inflammation can include cytokines, neuropeptides, growth factors and neurotransmitters, many of which have been reported to be abnormal in patients with FMS [7][8][9]. In addition, research studies over the past 20 years have shown that FMS is a pain amplification disorder with clear evidence for a pathogenesis within the central nervous system [10,11]. For example, in ours and other studies, it has been reported that there were elevated levels of substance P and nerve growth factor in the cerebrospinal fluid (CSF) of patients with FMS [7,12,13].…”

Section: Introductionmentioning

confidence: 99%

A brain-derived neurotrophic factor polymorphism Val66Met identifies fibromyalgia syndrome subgroup with higher body mass index and C-reactive protein

2011

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A common single nucleotide polymorphism (SNP) in the gene of brain-derived neurotrophic factor (BDNF) results from a substitution at position 66 from valine (Val) to methionine (Met) and may predispose to human neuropsychiatric disorders. We proposed to determine whether these BDNF gene SNPs were associated with fibromyalgia syndrome (FMS) and/or any of its typical phenotypes. Patients with FMS (N = 95) and healthy normal controls (HNC, N = 58) were studied. Serum high-sensitivity C-reactive protein (hsCRP) levels were measured using an enzyme-linked immunosorbent assay (ELISA). The BDNF SNPs were determined using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP).The BDNF SNP distribution was 65 (68%) Val/Val, 28 (30%) Val/Met, and 2 (2%) Met/Met for FMS and 40 (69%), 17(29%), and 1 (2%) for HNC, respectively. The serum high-sensitivity C-reactive protein (hsCRP)and body mass index (BMI) in FMS were higher than in HNC. The FMS with BDNF Val66Val had significantly higher mean BMI (P = 0.0001) and hsCRP (P = 0.02) than did FMS carrying the Val66Met genotype. This pattern was not found in HNC. Phenotypic measures of subjective pain, pain threshold, depression, or insomnia did not relate to either of the BDNF SNPs in FMS. The relative distribution BDNF SNPs did not differ between FMS and HNC. The BDNF Val66Met polymorphism is not selective for FMS. The BDNF Val66Val SNP identifies a subgroup of FMS with elevated hsCRP and higher BMI. This is the first study to associate a BDNF polymorphism with a FMS subgroup phenotype.

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Section: Introductionmentioning

confidence: 99%

A brain-derived neurotrophic factor polymorphism Val66Met identifies fibromyalgia syndrome subgroup with higher body mass index and C-reactive protein

2011

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“…Toutefois, il ne semble pas que la substance P fasse partie de ce mécanisme [40]. Il se pourrait que ce soit surtout au niveau des récepteurs (récepteurs vanilloïdes, récepteurs ioniques et récepteurs de purines) que se réalise principalement cette sensibilisation neuronale [164]. D'autres études seront requises pour éclaircir le rôle de l'innervation périphérique dans la genèse de la douleur des fibromyalgiques.…”

Section: Sensibilisation Pé Riphé Rique Par Des Facteurs Impliqué S Dunclassified

“…Certaines études tendent à associer la fibromyalgie beaucoup plus à un trouble anxieux et à une incapacité à gérer le stress qu'à un état dépressif [104]. Il est cependant important de souligner que la grande majorité des études actuelles laisse entrevoir que le problème des fibromyalgiques ne se résume pas qu'à de la somatisation [164].…”

Section: Rôle De La Composante éMotionnelle Et De La Composante Cogniunclassified

Review of the mechanisms involved in a complex pain syndrome: fibromyalgia

Arsenault¹,

Marchand²

2007

Douleur analg

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La fibromyalgie est un syndrome présentant un tableau clinique complexe dans lequel s'inscrivent des douleurs diffuses, mais aussi des troubles du sommeil, de l'humeur et une panoplie de symptômes accompagnateurs, qui peuvent être présents ou absents selon les patients, dont des troubles gastriques et des problèmes de mémoire pour ne nommer que ceux-ci. Devant une telle complexité, il n'est pas étonnant que des mécanismes impliquant plusieurs systèmes aient été proposés pour tenter d'élucider ce syndrome. Dans cet article de synthèse, nous proposons de diviser en neuf grandes catégories les différents mécanismes proposés pour expliquer les douleurs diffuses dont souffrent les patients fibromyalgiques : 1) un phénomène périphérique qui pourrait impliquer les systèmes musculaires, humoraux, vasculaires, immunitaires, ou endocriniens ; 2) une sensibilisation spinale ; 3) une dysfonction des mécanismes endogènes d'inhibition causée par un déficit des contrôles inhibiteurs diffus nociceptifs ; 4) l'existence d'une facilitation centrale, par augmentation des mécanismes cérébraux pronociceptifs ; 5) une perturbation des mécanismes psychiques (émotionnels et/ou cognitifs) ; 6) une modification des activités thalamiques et limbiques ; 7) des modifications au niveau de certaines activités neurohormonales hypothalamiques et hypophysaires ; 8) une dysfonction au niveau de l'activité autonomique ; 9) et des changements au niveau de l'architecture du sommeil. Il est fort possible que la réponse réside dans plus d'un mécanisme. Il est toutefois intéressant de voir comment chacune de ces théories permet de retrouver certaines pièces du casse-tête et pourrait mener à des modèles intégrateurs pour mieux soutenir la recherche de traitements plus efficaces pour soulager les patients qui souffrent de ce syndrome de douleurs diffuses encore mal compris.Abstract: Fibromyalgia is a complex clinical syndrome involving diffuse pain as well as sleep mood and memory disorders and a wide range of symptoms that can include gastrointestinal disorders, among others, depending on the patient. In light of this complexity, it is not surprising that numerous mechanisms involving several biological systems have been proposed to explain the syndrome. In this review article, we divide these various mechanisms into nine major categories discussing: 1) a peripheral phenomenon that could involve muscular, humoral, vascular, immunological, or endocrine systems; 2) spinal sensitization; 3) dysfunction of endogenous inhibitory mechanisms due to deficient diffuse noxious inhibitory controls; 4) the existence of a central facilitation, through increased activity of nociceptive brain mechanisms; 5) disturbances in psychological mechanisms (emotional and/or cognitive); 6) changes in thalamic and limbic activities; 7) modification of certain neurohormonal activities in the hypothalamus and pituitary gland; 8) dysfunction of the autonomic nervous system; 9) and modification of sleep architecture. Certainly, more than one mechanisms is involved in this pathology a...

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“…Prolonged stimulation of α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPA) changes the resting polarization state of the membrane, and, as a result, the magnesium ions that plug the neighboring N-methyl-D-aspartate receptor (NMDA) are removed. This process primes NMDA for glutamate activation, thus triggering a cascade of events leading to central nervous system hypersensitization ("central windup") 8,9 . A hyperactive state of one segment reacting to a source of irritation that is constantly stimulating the dorsal ganglia translates into pain and hyperalgesia 6 .…”

Section: Introductionmentioning

confidence: 99%

Efficacy of paraspinal anesthetic block in patients with chronic pelvic pain refractory to drug therapy: a randomized clinical trial

Rosa¹,

Amantéa²,

Santos³

et al. 2015

Rev. Bras. Ginecol. Obstet.

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Efficacy of paraspinal anesthetic block in patients with chronic pelvic pain refractory to drug therapy: a randomized clinical trial Abstract PURPOSE: To determine whether paraspinal block reduces pain scores compared to placebo in women with chronic pelvic pain refractory to drug therapy. METHODS: Subjects with chronic pelvic pain due to benign conditions and refractory to drug therapy were invited to participate in a randomized, double blind, superiority trial at a tertiary reference center. Subjects were randomly allocated to receive paraspinal anesthetic block with 1% lidocaine without epinephrine or placebo (control). Lidocaine was injected along the spinal process of the painful segment in the supra-and interspinal ligaments using a 25G X 2" needle. Placebo consisted of introduction of the needle in the same segment without injecting any substance. The main outcome measured was the pain score based on a visual analog scale at T0 (baseline), T1 (within 15 min after the procedure) and T2 (one week after the procedure). Data were statistically analyzed by ANOVA and the 95% confidence interval (95%CI). RESULTS: Mean age was similar for both groups, i.e., 51.2 (paraspinal anesthetic block) and 51.8 years (control). A blind examiner measured the degree of pain according to the visual analog scale from 0 (no pain) to 10 (worst pain imaginable). Based on the visual analog scale, the mean pain scores of the paraspinal anesthetic block group at T0, T1 and T2 were 5.50 (SD=2.92; 95%CI 3.84-7.15), 2.72 (SD=2.10; 95%CI 1.53-3.90), and 4.36 (SD=2.37; 95%CI 1.89-6.82), respectively. The difference between T0 and T1 was statistically significant, with p=0.03. CONCLUSIONS: Paraspinal anesthetic block had a small effect on visual analog scale pain score immediately after the injections, but no sustained benefit after one week. Further studies are needed to determine the efficacy of paraspinal anesthetic block with different lidocaine doses for the treatment of visceral pain of other causes.

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Peripheral and central sensitization in fibromyalgia: Pathogenetic role

Cited by 151 publications

References 92 publications

A brain-derived neurotrophic factor polymorphism Val66Met identifies fibromyalgia syndrome subgroup with higher body mass index and C-reactive protein

A brain-derived neurotrophic factor polymorphism Val66Met identifies fibromyalgia syndrome subgroup with higher body mass index and C-reactive protein

Review of the mechanisms involved in a complex pain syndrome: fibromyalgia

Efficacy of paraspinal anesthetic block in patients with chronic pelvic pain refractory to drug therapy: a randomized clinical trial

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