Central Sensitivity Syndromes: Mounting Pathophysiologic Evidence to Link Fibromyalgia with Other Common Chronic Pain Disorders

Abstract

Objective-To review emerging data from the fields of nursing, rheumatology, dentistry, gastroenterology, gynecology, neurology, and orthopedics that supports or disputes pathophysiologic similarities in pain syndromes studied by each specialty.Methods-A literature search was performed through PubMed and Ovid using the terms fibromyalgia, temporomandibular joint disorder, irritable bowel syndrome, irritable bladder/ interstitial cystitis, headache, chronic low back pain, chronic neck pain, functional syndromes and somatization. Each term was linked with pathophysiology and/or central sensitization. This paper presents a review of relevant articles with a specific goal of identifying pathophysiological findings related to nociceptive processing.Results-The extant literature presents considerable overlap in the pathophysiology of these diagnoses. Given the psychosomatic lens through which many of these disorders are viewed, demonstration of evidence based links supporting shared pathophysiology between these disorders could provide direction to clinicians and researchers working to treat these diagnoses.Conclusions-Central sensitivity syndromes denotes an emerging nomenclature that could be embraced by researchers investigating each of these disorders. Moreover, a shared paradigm would be useful in promoting cross-fertilization between researchers. Scientists and clinicians could most effectively forward the understanding and treatment of fibromyalgia and other common chronic pain disorders through an appreciation of their shared pathophysiology.

A Collaborative Approach Between Chiropractic and Dentistry to Address Temporomandibular Dysfunction: A Case Report

“…8,23 This may explain the resolution of the patient's numerous complaints in the head and neck region in addition to the TMD. The secondary referred pain from orofacial pathology and chronic painful stimuli in TMD alters the normal physiological processing in the brain and sensitizes the central nervous system.…”

“…5 Another article discusses this central sensitization in patients with TMD, stating that they exhibit enhanced temporal summation to noxious stimuli and impaired central inhibitory mechanisms and this allows for enhanced sensitivity to pain at the TMD and sites distant from the head and neck region. 8,23 Sensitization could be the mechanism by which widespread pain in TMD occurs. 8,23 The trigeminal nerve gives the main afferent conduction in the pathophysiology and the transmission of headache in humans.…”

“…8,23 Sensitization could be the mechanism by which widespread pain in TMD occurs. 8,23 The trigeminal nerve gives the main afferent conduction in the pathophysiology and the transmission of headache in humans. 5 This connection shows how patients with TMD can also have headaches and patients with headaches should also be screened for TMD.…”

Orofacial pain and temporomandibular disorders: the impact on oral health and quality of life

“…Given the psychosomatic lens through which many of these disorders are viewed, demonstration of evidence-based links supporting shared pathophysiology between these disorders could provide direction to clinicians and researchers working to treat these diagnoses. 18 As explained above, although the onset of several of these disorders is triggered by peripheral painproducing mechanisms, persistent nociceptive inputs lead to changes in the central nociceptive system. 18 Central sensitization is common to these central sensitivity syndromes, and is clinically and physiologically characterized by hyperalgesia (excessive sensitivity to a normally painful stimulus), allodynia (painful sensation to a normally nonpainful stimulus), expansion of the receptive field (pain beyond the area of peripheral nerve supply), prolonged electrophysiological discharge, and unpleasant afterstimulus quality of the pain (e.g., burning, throbbing, tingling or numbness).…”

“…18 As explained above, although the onset of several of these disorders is triggered by peripheral painproducing mechanisms, persistent nociceptive inputs lead to changes in the central nociceptive system. 18 Central sensitization is common to these central sensitivity syndromes, and is clinically and physiologically characterized by hyperalgesia (excessive sensitivity to a normally painful stimulus), allodynia (painful sensation to a normally nonpainful stimulus), expansion of the receptive field (pain beyond the area of peripheral nerve supply), prolonged electrophysiological discharge, and unpleasant afterstimulus quality of the pain (e.g., burning, throbbing, tingling or numbness). 19 The rehabilitation of patients with chronic musculoskeletal pain like that of chronic TMDs should target, or at least take into account, the process of central sensitization.…”