Sympathetic nervous system function in fibromyalgia

Petzke, Frank; Clauw, Daniel J.

doi:10.1007/s11926-000-0051-5

Cited by 71 publications

(55 citation statements)

References 56 publications

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“…[4][5][6] Stress response plays an important role in the symptoms, and it is believed that the ANS has a close relationship with the efficiency of the stress response and the hypothalamic-pituitary-adrenal axis (HPA). [7] A simple and reliable neurophysiologic method to evaluate the ANS is the study of the sympathetic skin response (SSR). [8,9] Using an electrical stimulation, the eccrine sweat glands of the skin are activated via a reflex loop which includes large, myelinated sensory fibers, central synapses and efferent sympathetic preand post-ganglionic nerve fibers.…”

Section: Discussionmentioning

confidence: 99%

“…Some of these studies showed elevated function in the sympathetic nervous system. [4][5][6][7] Martinez-Lavin et al [19] suggested that fibromyalgia patients have norepinephrine-evoked pain which may be resolved by sympatholytic maneuvers. They also proposed that sympathetic hyperactivity may explain some of the manifestations of FMS including sleep disorders, irritable bowel syndrome, sicca symptoms and anxiety.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of Sympathetic Skin Response and F Wave in Fibromyalgia Syndrome Patients

et al. 2011

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Evaluation of Sympathetic Skin Response and F Wave in Fibromyalgia Syndrome Patients

et al. 2011

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“…Inappropriate arousal of the sympathetic nervous system has also been demonstrated in fibromyalgia syndrome (28). But, autonomic tone depends on homeostatic balance.…”

Section: Discussionmentioning

confidence: 99%

A randomized, double‐blind, placebo‐controlled trial of pramipexole, a dopamine agonist, in patients with fibromyalgia receiving concomitant medications

Holman¹,

Myers²

2005

Arthritis & Rheumatism

257

120

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Objective. To assess the efficacy and safety of pramipexole, a dopamine 3 receptor agonist, in patients with fibromyalgia.Methods. In this 14-week, single-center, doubleblind, placebo-controlled, parallel-group, escalatingdose trial, 60 patients with fibromyalgia were randomized 2:1 (pramipexole:placebo) to receive 4.5 mg of pramipexole or placebo orally every evening. The primary outcome was improvement in the pain score (10-cm visual analog scale [VAS]) at 14 weeks. Secondary outcome measures were the Fibromyalgia Impact Questionnaire (FIQ), the Multidimensional Health Assessment Questionnaire (MDHAQ), the pain improvement scale, the tender point score, the 17-question Hamilton Depression Inventory (HAM-d), and the Beck Anxiety Index (BAI). Patients with comorbidities and disability were not excluded. Stable dosages of concomitant medications, including analgesics, were allowed.Results. Compared with the placebo group, patients receiving pramipexole experienced gradual and more significant improvement in measures of pain, fatigue, function, and global status. At 14 weeks, the VAS pain score decreased 36% in the pramipexole arm and 9% in the placebo arm (treatment difference -1.77 cm). Forty-two percent of patients receiving pramipexole and 14% of those receiving placebo achieved >50% decrease in pain. Secondary outcomes favoring pramipexole over placebo included the total FIQ score (treatment difference -9.57) and the percentages of improvement in function (22% versus 0%), fatigue (29% versus 7%), and global (38% versus 3%) scores on the MDHAQ. Compared with baseline, some outcomes showed a better trend for pramipexole treatment than for placebo, but failed to reach statistical significance, including improvement in the tender point score (51% versus 36%) and decreases in the MDHAQ psychiatric score (37% versus 28%), the BAI score (39% versus 27%), and the HAM-d score (29% versus 9%). No end points showed a better trend for the placebo arm. The most common adverse events associated with pramipexole were transient anxiety and weight loss. No patient withdrew from the study because of inefficacy or an adverse event related to pramipexole.Conclusion. In a subset of patients with fibromyalgia, ϳ50% of whom required narcotic analgesia and/or were disabled, treatment with pramipexole improved scores on assessments of pain, fatigue, function, and global status, and was safe and well-tolerated.Abnormal autonomic arousal (1-4), altered sleep stage architecture (5), chronic pain, and fatigue characterize fibromyalgia syndrome. The pathogenesis of fibromyalgia is a matter of debate, but centrally mediated abnormalities of sensory processing play an important role (6). Clinicians have tried various pharmacotherapies, including such agents as antidepressants, antiepileptics, muscle relaxants, antiinflammatories, sedative hypnotics, analgesics, and nutriceuticals (7). As a central neurotransmitter, dopamine influences human behavior, autonomic arousal, and sleep (8). Discovery of dopamine receptor subtypes (D 1-5 ) and thei...

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“…The recognition that pain may be present in the absence of measurable clinical abnormality is now fully supported by objective neurophysiological study 19 . Abnormalities have been identified at various levels in the peripheral, central, and sympathetic nervous systems, as well as the hypothalamo-pituitary-adrenal axis stress-response system [20][21][22][23][24][25] .…”

Section: Acceptance Of the Concept Of Fmmentioning

confidence: 99%