Fibromyalgia is the second most common rheumatic disorder behind osteoarthritis and, but still widely misunderstood, it is now considered a lifelong disorder of the central nervous system that is responsible for the increase in pain that is triggered by the body. who suffer Daniel Clauw, M.D., Professor of Anesthesiology at the University of Michigan, analyzed the neurological basis for fibromyalgia at the plenary conference today at the Annual Scientific Meeting of the American Pain So
Clauw explained that the pain of fibromyalgia comes more from the brain and spinal cord than from areas of the body where anyone can experience peripheral pain. The condition is thought to be associated with alterations in how the brain processes pain and other sensory information. He said doctors should suspect patients with fibromyalgia with multifocal (mostly musculoskeletal) pain that is not fully explained by an injury or inflammation.
“Because pain pathways throughout the body are amplified in patients with fibromyalgia, pain can occur anywhere, so chronic headaches, visceral pain and sensory hyperresponsiveness are common in people with this condition. painful condition, “said Clauw.
“This does not mean that peripheral nociceptive input does not contribute to the pain experienced by patients with fibromyalgia, but they feel more pain than they would normally expect from the degree of peripheral input. People with fibromyalgia and other pain conditions, characterized by a hypersensitivity to experience pain of what those who do not have the condition would describe as touch, “added Clauw.
Due to the origin of the central nervous system pain of fibromyalgia, Clauw said therapies with opioids and other narcotic analgesics are usually not effective, since they do not reduce the activity of neurotransmitters in the brain. “These medications have not been shown to be effective in patients with fibromyalgia, and there is evidence that opioids may even worsen fibromyalgia and other centralized pain conditions,” he said.
Clauw advises physicians to integrate pharmacological treatments, such gabapentinoids, tricyclics and selective serotonin reuptake inhibitors, non-pharmacological approaches such as cognitive behavioral therapy, exercise and stress reduction.
“Sometimes the size of the response to treatment for simple, cheap non-medical treatment outweighs the drugs,” Clauw said. “The greatest benefit is a better performance, which should be the main objective of the treatment of any chronic pain condition. Most patients with fibromyalgia can see an improvement in their symptoms and lead a normal life with proper medication and extensive use of non-pharmacological therapies. “
“Fibromyalgia can be seen both as a discrete disease, and also as a common end route of pain centralization and becomes chronic. Most people with this condition have lifelong stories of chronic pain throughout the body, “said Clauw. “The condition can be difficult to diagnose, if you are not familiar with classical symptoms because there is no single cause and there are no external signs.”