Blunted Pain Modulation Response to Induced Stress in Women with Fibromyalgia with and without Posttraumatic Stress Disorder Comorbidity: New Evidence of Hypo-Reactivity to Stress in Fibromyalgia?

Fibromyalgia: one year in review 2022

“…Life traumas are probably related to personality tendencies, as reference is often made to a "fibromyalgic personality" (43) or a form of hyporeactivity to stress (44) that is mirrored by altered vagal activity, in line with Porges' polyvagal theory of the aetiopathogenesis of trauma (45). This has been investigated in more detail by Green et al in a study of male and female rats exposed to the early-life stress of neonatal limited bedding (NLB), who were found to have a significantly lower mechanical nociceptive threshold in skeletal muscle than adult controls previously exposed to neonatal standard bedding.…”

The Biology of Stress Intolerance in Patients with Chronic Pain—State of the Art and Future Directions

“…On the contrary, results were conflicting for primary headache or irritable bowel syndrome (IBS) [ 43 ]. In addition, the sympathetic stress response in patients with chronic pain is blunted, especially in chronic widespread pain (CWP) syndromes such as fibromyalgia [ 45 , 48 , 49 , 50 , 51 , 52 , 53 ]. In other conditions, such as localised chronic muscle pain and chronic whiplash-associated disorder, hypo-reactivity is less pronounced or absent, respectively [ 48 , 54 ].…”

Stress-induced hyperalgesia instead of analgesia in patients with chronic musculoskeletal pain

“…Mixed results were found for wind-up ratio and cold pain thresholds (no change ( Crettaz et al, 2013 ) versus increase ( Ferreira et al, 2018 )). Pressure pain thresholds did not change after cognitive plus social stress ( Ferreira et al, 2018 ), and yielded mixed results (no change ( Crettaz et al, 2013 ) versus decrease ( López-López et al, 2021 )) although the same stressor was used in both tasks. In summary, the current findings indicate that SIA occurs in humans primarily for mechanical and electric pain sensitivity, whereas SIH appears after heat, cold or pressure pain.…”

“…Although acute stress is usually associated with analgesic effects ( Costa et al, 2005 ), it may induce hyperalgesia in healthy humans under specific conditions. For example, cognitive stressors have been linked to hypoalgesia ( Flor et al, 2002 , Flor and Grüsser, 1999 , Yilmaz et al, 2010 ), whereas stressors including social feedback often induce hyperalgesia ( Cathcart et al, 2008 , Cathcart et al, 2010 , Cathcart et al, 2009 , Crettaz et al, 2013 , Ferreira et al, 2018 , López-López et al, 2021 ), with some exceptions ( Ferreira et al, 2021 ).…”

“…signs of SIA, after a stressor that increased windup ratio in controls ( Ferreira et al, 2018 ). Further, patients with fibromyalgia showed absent or delayed decreases of pressure pain thresholds and –tolerance after social stress that elicited SIH in controls ( López-López et al, 2021 ), while another study showed decreases of pressure and cold pain thresholds after social stress in patients with fibromyalgia, but decreased heat pain thresholds in controls ( Crettaz et al, 2013 ). All prior studies in patients with chronic pain have employed stress paradigms typically associated with SIH.…”