A Cross-Sectional Study on Central Sensitization and Autonomic Changes in Fibromyalgia

Abstract

Fibromyalgia is a multi-symptomatic disorder characterized by generalized pain. The pathophysiology of fibromyalgia is supposedly an interplay between central nervous system hyper-responsiveness, autonomic dysfunction, and peripheral pain. In this cross-sectional study, the objective was to assess central sensitization and autonomic activity in patients with fibromyalgia compared with control. Fifty adults diagnosed with fibromyalgia by the modified American College of Rheumatology 2010 criteria and an equal number of age-and sex-matched controls participated in the study in an urban tertiary care hospital. Central sensitization was assessed by history and by evidence of increased prefrontal cortical activity as measured by cortical oxygenation using functional near-infrared spectroscopy. Autonomic activity was assessed by heart rate variability, electrodermal activity, and deep breathing test in three physiological states: rest, sympathetic stress (cold pressor test), and deep breathing. Mann-Whitney U-test, paired t-test, Wilcoxon test, and Friedman test with Bonferroni a priori were used to analyze the data. Cortical activity was significantly higher in the fibromyalgia group than control. There was no significant difference in autonomic activity between the fibromyalgia and control groups. In the fibromyalgia group, variable degrees of sympathetic hyperactivity and normal parasympathetic activity were observed. Central sensitization may be playing a primary role in the pathophysiology of generalized pain in fibromyalgia.

Is central sensitization an important determinant of functional disability in patients with chronic inflammatory arthritides?

“…6 Nevertheless, fibromyalgia is a disorder characterized by a varying degree of generalized pain and CS contributes to only a portion of the perceived pain, possibly through top-down or bottom-up processes. 9 In 2012 the CS inventory (CSI) was developed for the diagnosis of CS. 10 The CSI consists of 25 Likert-type questions with a score ranging from 0 to 100; 10 the CSI showed to have good clinimetric properties in different populations with chronic pain [11][12][13] and a cut-off of 40 points allowed a correct identification of approximately eight out of 10 patients with CS.…”

Females with Diabetes Mellitus Increased the Incidence of Premenstrual Syndrome

“…Potential reasons for suitable therapy include diagnosis by codes in the claim dataset that are not associated with PMS. Sympathetic overactivity in thyrotoxicosis and fibromyalgia [ 38 , 39 ] was noted to be related to PMS with a lower prevalence in this study.…”

Increased Incidence of Premenstrual Syndrome in Females with Palmar Hyperhidrosis

“…Patients with chronic kidney disease have fluid overload with parasympathetic impairment and higher sympathetic activity [ 29 ], and our study showed chronic kidney disease increases the risk of PMS. Thyrotoxicosis and fibromyalgia presented hypersympathetic activity [ 30 , 31 ], higher parasympathetic activity in asthma, and lower parasympathetic function in chronic obstructive pulmonary disease [ 32 , 33 ] in past studies unrelated to PMS; the potential reasons might be that, in patients with chronic obstructive pulmonary disease retrieved by diagnosis codes, suitable treatments were performed after diagnosis confirmation in claim dataset. The lower prevalence of thyrotoxicosis and fibromyalgia were noted but in the statistical analyses they were not significantly different, and PMS occurred in the late luteal phase of menstrual cycles without season effect.…”