Can aberrant spinal nociception be a marker of chronicity of pain in fibromyalgia syndrome?

Tanwar, Suman; Mattoo, Bhawna; Kumar, Uma; Bhatia, Riti

doi:10.1016/j.jocn.2019.04.029

Cited by 9 publications

(13 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This is consistent with other reports of a large heterogeneity in fibromyalgia [53][54][55]. Previous studies have reported reduced NWR thresholds in fibromyalgia [7,8,33], but increased thresholds have also been reported [34]. Two of these studies have small sample sizes [8,34], which limits the interpretation of the results.…”

Section: Discussionsupporting

confidence: 90%

“…The pathophysiology is associated with the sensitization of the nociceptive input at both central and peripheral levels [31,32]. In some studies, the NWR threshold is reduced in fibromyalgia, which is consistent with spinal sensitization [7,8,33]. However, other studies show no difference or even a higher threshold for eliciting the NWR in fibromyalgia compared to healthy controls [9,34].…”

Section: Introductionmentioning

confidence: 75%

See 1 more Smart Citation

Automated Nociceptive Withdrawal Reflex Measurements Reveal Normal Reflex Thresholds and Augmented Pain Ratings in Patients with Fibromyalgia

Ydrefors

Karlsson

Olausson

et al. 2020

JCM

View full text Add to dashboard Cite

The nociceptive withdrawal reflex (NWR) is used to probe spinal cord excitability in chronic pain states. Here, we used an automated and unbiased procedure for determining the NWR threshold and compared the reflex thresholds and corresponding pain ratings in a well-characterized cohort of fibromyalgia (n = 29) and matched healthy controls (n = 21). Surface electrical stimuli were delivered to the foot in a stepwise incremental and decremental manner. The surface electromyographic activity was recorded from the ipsilateral tibialis anterior muscle. Fibromyalgia patients reported significantly higher scores for psychological distress and pain-related disability and a significantly lower score for perceived state of health compared to the matched controls. The subjective pain ratings were significantly higher in patients. The NWR thresholds were similar to the controls. In the patients, but not in controls, the NWR thresholds and subjective pain ratings were significantly correlated. Our results showed an increased subjective pain sensitivity in fibromyalgia, but we found no evidence for spinal sensitization based on the reflex measures.

show abstract

Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 75%

Automated Nociceptive Withdrawal Reflex Measurements Reveal Normal Reflex Thresholds and Augmented Pain Ratings in Patients with Fibromyalgia

Ydrefors

Karlsson

Olausson

et al. 2020

JCM

View full text Add to dashboard Cite

show abstract

“…NFR was recorded at baseline and post rTMS to assess the pain objectively. In our FMS patients NFR thresholds were significantly lower indicating an exaggerated response to painful stimuli or hyperalgesia [22]. However, at the end of real-rTMS treatment, there was an increase in NFR threshold which was maintained during follow-up i.e.…”

Section: Effect Of Rtms On Objective Pain Measures and Pain Modulationmentioning

confidence: 56%

“…In the present study, NFR was recorded according the method described by Willer and colleagues [21]. Further details of the NFR are mentioned in our research article [22] (Fig. S3).…”

Section: Secondary Outcomesmentioning

confidence: 99%

Repetitive transcranial magnetic stimulation of the prefrontal cortex for fibromyalgia syndrome: a randomised controlled trial with 6-months follow up

Tanwar

Mattoo²,

Kumar

et al. 2020

Adv Rheumatol

Self Cite

View full text Add to dashboard Cite

Objectives: Fibromyalgia Syndrome (FMS), is a chronic pain disorder with poorly understood pathophysiology. In recent years, repetitive transcranial magnetic stimulation (rTMS) has been recommended for pain relief in various chronic pain disorders. The objective of the present research was to study the effect of low frequency rTMS over the right dorsolateral prefrontal cortex (DLPFC) on pain status in FMS. Methods: Ninety diagnosed cases of FMS were randomized into Sham-rTMS and Real-rTMS groups. Real rTMS (1 Hz/ 1200 pulses/8 trains/90% resting motor threshold) was delivered over the right DLPFC for 5 consecutive days/week for 4 weeks. Pain was assessed by subjective and objective methods along with oxidative stress markers. Patients were followed up for 6 months (post-rTMS;15 days, 3 months and 6 months). Results: In Real-rTMS group, average pain ratings and associated symptoms showed significant improvement post rTMS. The beneficial effects of rTMS lasted up to 6 months in the follow-up phase. In Sham-rTMS group, no significant change in pain ratings was observed. Conclusion: Right DLPFC rTMS can significantly reduce pain and associated symptoms of FMS probably through targeting spinal pain circuits and top-down pain modulation. Trial registration: Ref No: CTRI/2013/12/004228.

show abstract

“…The plot revealed interesting results. First, among the included studies four trials (44%) reported significantly lower NFRthr among FM patients, 9 , 21 , 36 , 37 one study (11%) found significantly higher NFRthr, 39 and four trials (44%) reported non-significant differences between the FM patients and the healthy controls. 20 , 22 , 26 , 28 Secondly, there was a large heterogeneity between the studies (I 2 =91%;τ 2 =25.04;χ; 2 =91.22, df=8; P<0.00001).…”

Section: Resultsmentioning

confidence: 96%

Fibromyalgia and Nociceptive Flexion Reflex (NFR) Threshold: A Systematic Review, Meta-Analysis, and Identification of a Possible Source of Heterogeneity

Amiri¹,

Rhudy²,

Masani³

et al. 2021

JPR

View full text Add to dashboard Cite

Background The nociceptive flexion reflex is a physiological, polysynaptic reflex and refers to the level that an appropriate withdrawal response activates when a painful stimulus is detected. The nociceptive flexion reflex threshold (NFRthr) is defined as the lowest noxious stimulation intensity required to trigger a reflex motor response. Despite wide utilization and reports of the NFRthr, there has been no consensus on a standard and/or best method in assessment of the NFRthr. Objective To systematically review the literature that compared the NFRthr between individuals with fibromyalgia (FM) and healthy controls; and to identify a source of heterogeneity in these trials. Methods Employing the Cochrane methodology, we systematically searched Ovid MEDLINE, Embase, Cochrane Clinical Answers, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and PsycINFO for clinical case-controlled trials assessing the NFRthr in individuals with and without fibromyalgia from inception to July 2019. Selected articles were passed for data extraction and meta-analyses. We utilized the random-effects model for meta-analysis assuming the true effect size may vary between studies. The sample sizes as a possible source of heterogeneity in multiple meta-regressions were investigated. This systematic review and meta-analysis were registered in PROSPERO before data extraction. Results Nine studies met our criteria and were included in the meta-analysis. Methodologies and settings varied between studies, eg, stimulation intensity, duration, and the current increments. Only two articles comprehensively described and reported details about electromyogram amplification, latency, and sampling rate. Evidence from 423 patients with fibromyalgia and 326 healthy individuals suggested that there may not be a meaningful decreased NFRthr in patients (overall mean difference = –3.16; 95% CI:–6.82 to 0.50; Z = 1.69; P=0.09). Published effect sizes were not homogenous (I 2 = 0.91, τ 2 = 25.04, χ 2 = 91.22, df = 8, P < 0.00001). The multiple meta-regression analyses indicated that total and female sample sizes might be the main sources of heterogeneity for the effect sizes SS total = –0.0570, P = 0.040; SS female = –0.0569; P = 0.047. Conclusion Evidence suggests that the nociceptive flexion reflex threshold may not be different between patients with fibromyalgia and healthy controls. A unified and rigorous methodology and sample size calculation (probably sex specific investigation) is required for the assessment of nociceptive flexion reflex threshold in patients with fibromyalgia.

show abstract

Can aberrant spinal nociception be a marker of chronicity of pain in fibromyalgia syndrome?

Cited by 9 publications

References 38 publications

Automated Nociceptive Withdrawal Reflex Measurements Reveal Normal Reflex Thresholds and Augmented Pain Ratings in Patients with Fibromyalgia

Automated Nociceptive Withdrawal Reflex Measurements Reveal Normal Reflex Thresholds and Augmented Pain Ratings in Patients with Fibromyalgia

Repetitive transcranial magnetic stimulation of the prefrontal cortex for fibromyalgia syndrome: a randomised controlled trial with 6-months follow up

Fibromyalgia and Nociceptive Flexion Reflex (NFR) Threshold: A Systematic Review, Meta-Analysis, and Identification of a Possible Source of Heterogeneity

Contact Info

Product

Resources

About