A pilot study investigating whether quantitative sensory testing alters after treatment in patients with fibromyalgia

Abstract

Background: Fibromyalgia is a chronic musculoskeletal pain condition that is often associated with sleep disturbances and fatigue. The pathophysiology of fibromyalgia is not understood, but indirect evidence suggests a central dysfunction of the nociceptive modulating system. The aim of this study was to evaluate whether quantitative sensory testing detects a change in pain thresholds in fibromyalgia patient receiving pregabalin treatment. Methods: A total of 25 patients were recruited for the study and received routine pregabalin, but only 14 patients completed the treatment. Assessment of pressure pain thresholds and changes in conditioned pain modulation using ischaemic pain as a conditioning stimulus were measured at baseline and every 4 weeks for 12 weeks. Fibromyalgia impact questionnaire, PainDETECT and SF-12 were also completed. Results: Patients with fibromyalgia demonstrated a less-efficient conditioned pain modulation at baseline. An efficient conditioned pain modulation was observed at 1 month and this was maintained until the final visit. Pressure pain thresholds (PPTs) showed a significant improvement from baseline. Patients also reported a similar magnitude of improvements in PainDETECT, fibromyalgia impact questionnaire (FIQ) and its impact on daily life and change in outcome for SF-12. Conclusion: This pilot study reports an increase in PPTs and improved conditioned pain modulation response after commencing pregabalin, which was maintained at 12 weeks, and this was supported by positive pain scores. Pregabalin is a licenced treatment for fibromyalgia in Europe, and its response to central sensitisation, particularly 'dynamic responses', has not been reported. We conclude that pregabalin has the potential to reduce peripheral and central sensitisation in patients with fibromyalgia, as measured using quantitative sensory testing.

Pain burden, sensory profile and inflammatory cytokines of dogs with naturally-occurring neuropathic pain treated with gabapentin alone or with meloxicam

“…On the other hand, the percentage of dogs with facilitatory profile after gabapentin was comparable with healthy controls. A similar effect has been found with pregabalin in human patients with fibromyalgia [21]. This finding is consistent with recent research showing an activation of the inhibitory system by increased activity of noradrenergic neurons located in the locus coeruleus after the administration of gabapentin [22].…”

Tactile Detection in Fibromyalgia: A Systematic Review and a Meta-Analysis

“…Participants with fibromyalgia were instructed to stop taking their medication prior to their participation in less than half of the studies of the review [47%; ( 27 , 30 , 32 , 33 , 57 , 59 , 61 – 63 )] and of the meta-analysis [42%; ( 32 , 57 , 59 , 61 , 62 )]. Medication commonly used to alleviate fibromyalgia symptoms have been shown to reduce sensitivity to somatosensory stimuli ( 89 – 91 ) and to have an effect on cerebral activation of pain processes ( 91 ). However, for ethical reasons and to prevent a recruitment bias, the interruption of medication is not always the solution.…”

Walking the Tightrope: A Proposed Model of Chronic Pain and Stress

“…Quantitative sensory testing has been used to measure sensory functioning and pain perception in several chronic pain populations. Groups of individuals with fibromyalgia (Crettaz et al, 2013;Coppieters et al, 2016;Wodehouse et al, 2018), chronic type headache (Cathcart et al, 2008;Cathcart et al, 2012;Defrin, 2014), whiplash disorders (Scott et al, 2005;Häggman-Henrikson et al, 2013), musculoskeletal pain Clark et al, 2017), menstrual pain (Slater et al, 2015;Payne et al, 2019), and irritable bowel syndrome (Murray et al, 2004) have previously undergone QST after exposure to acute psychological stress. A majority of these studies examined the relationship between acute stress and pain perception in individuals with chronic pain versus healthy controls.…”