Aftersensations and Lingering Pain After Examination in Patients with Fibromyalgia Syndrome

Abstract

Fibromyalgia syndrome (FMS) is a chronic widespread pain condition with mixed peripheral and central contributions. Patients display hypersensitivities to a spectrum of stimuli. Patients’ blunt pressure pain thresholds are typically reduced, and sometimes (∼15%) gentle brushstroke induces allodynia. However, after-sensations following these stimuli have not, to our knowledge, been reported. We examined the perception of blunt pressure and ‘pleasant touch’ in FMS. Patients were first interviewed and completed standard psychometric questionnaires. We then measured their sensitivity to blunt pressure and perception of pleasant touch including after-sensations; patients were followed for five days evaluating lingering pain from blunt pressure. We recruited 51 FMS patients and 16 pain-free controls (HC) at a UK Pain Management Centre. Forty-four patients completed the after-sensation protocol. Most patients reported pain after application of less mechanical pressure than HCs; median arm and leg thresholds were 167 kPa and 233 kPa. Eighty-four percent (31/37) of patients reported ongoing pain at the site of pressure application one day after testing, and 49% (18/37) still perceived pain at five days. After-sensations following brushstroke were common in the FMS group, reported by 77% (34/44) compared to 25% (4/16) of HCs; 34% (15/44) patients, but no HCs, perceived these after-sensations as uncomfortable. For FMS patients who experienced after-sensations, brushstroke-pleasantness ratings were reduced, and skin was often an important site of pain. Pain after blunt pressure assessment typically lingers for several days. After-sensations following brushstroke stimulation is a previously unreported FMS phenomenon. They are associated with tactile anhedonia and may identify a clinically distinct subgroup.

Psychometric testing of the Rheumatoid Arthritis Work Instability Scale in employed people with fibromyalgia

“…Diagnostic delay is likely influenced by low levels of skill and confidence in diagnosing FM among health professionals, especially general practitioners (GPs), leading to referrals for diagnosis (e.g., to rheumatology or pain consultants), as well as reluctance by GPs to label people with this diagnosis (Wilson et al., 2022). Recent diagnostic guidelines for FM from the Royal College of Physicians have been designed to address this diagnostic delay and emphasise providing information and rehabilitation in parallel to investigations (Berwick et al., 2022).…”

Myalgic encephalomyelitis/chronic fatigue syndrome from current evidence to new diagnostic perspectives through skeletal muscle and metabolic disturbances

“…• Non-pharmacological approach (strong recommendation for physical exercise) as first-line therapy [171,172] McArdle disease (glycogen storage disease type V) The detection of altered metabolites in the blood such as NAD+ and tryptophan (TRYP) metabolites, stem cells, or extracellular vesicles from ME/CFS patients may be important for novel diagnostic tools. 182,183 A disturbance in TRYP metabolism, which results in a reduction in NAD+ biosynthesis, was observed in ME/ CFS patients, leading to the etiological hypothesis of indolamine-2,3-dioxygenase (IDO) "metabolic trap."…”

Clinical criteria and diagnostic assessment of fibromyalgia: position statement of the Italian Society of Neurology-Neuropathic Pain Study Group

“…In fibromyalgia, QST findings showed a certain heterogeneity in the sensory threshold abnormalities. However, a common result between different studies is the presence of hypersensitivity or gain of function to a broad of standardized sensory stimuli [ 8 , 10 , 17 , 33 , 47 , 48 ]. In particular, increased mechanical pain sensitivity (MPS) and reduced pressure pain thresholds (PPT) are commonly reported [ 3 , 17 ], that suggest prevalent mechanism of central sensitization [ 46 ].…”

“…In particular, increased mechanical pain sensitivity (MPS) and reduced pressure pain thresholds (PPT) are commonly reported [ 3 , 17 ], that suggest prevalent mechanism of central sensitization [ 46 ]. Moreover, a high rate of aftersensation after mechanical stimuli is also described [ 47 ] while, less commonly, mechanical dynamic allodynia is reported [ 3 , 40 , 47 ]. Additionally, in a subset of patients, also, mechanical detection thresholds (MDT) can be increased, that, unrelated to other evidence of large nerve fiber impairment, probably is supposed to be due to impaired C-tactile afferents in the context of a small-fiber pathology [ 10 ].…”