Fibromyalgia is the second most common rheumatic disorder behind osteoarthritis and, although it is still misunderstood, it is now considered a central nervous system disorder for life, which is responsible for the amplified pain that the body goes through 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 session today at the Annual Scientific Meeting of the American Pain Society.
“Fibromyalgia can be considered as a discrete disease and also as a final common route of centralization and chronicity of pain. Most people with this condition have a history of chronic pain for life throughout the body, ”said Clauw. “The condition can be difficult to diagnose if one is not familiar with the classic symptoms because there is no single cause and there are no external signs.”
Clauw explained that fibromyalgia pain comes more from the brain and spinal cord than from areas of the body where someone may experience peripheral pain. It is believed that the condition is associated with disorders in the way the brain processes pain and other sensory information. He said doctors should suspect fibromyalgia in patients with multifocal pain (mainly musculoskeletal) that is not fully explained by an injury or inflammation.
“Because the pain pathways throughout the body are amplified in patients with fibromyalgia, pain can occur anywhere, so chronic headaches, visceral pain and sensory hypersensitivity are common in people with this painful condition, ”said Clauw.
“This does not imply that peripheral nociceptive entry does not contribute to the pain experienced by fibromyalgia patients, but they feel more pain than would normally be expected due to the degree of peripheral entry. People with fibromyalgia and other pain states characterized by sensitization will experience pain from what those without the condition would describe as touch, ”Clauw added.
Because of the origins of fibromyalgia pain in the central nervous system, Clauw said that treatments with opioids or other narcotic analgesics are generally not effective because they do not reduce the activity of neurotransmitters in the brain. “These medications have never been shown to be effective in patients with fibromyalgia, and there is evidence that opioids may even worsen fibromyalgia and other centralized pain states,” he said.
Clauw advises doctors to integrate pharmacological treatments, such as gabapentinoids, tricyclics and serotonoin reuptake inhibitors, with non-pharmacological approaches such as cognitive behavioral therapy, exercise and stress reduction.
“Sometimes, the magnitude of the response to treatment for simple and inexpensive non-drug therapies exceeds that of pharmaceuticals,” Clauw said. “The biggest benefit is an improved function, which should be the main goal of treatment for any chronic pain condition. Most fibromyalgia patients can see an improvement in their symptoms and lead a normal life with the right medications and the extensive use of non-drug therapies. ”