Fibromyalgia syndrome: a pain modulation disorder related to altered limbic function?

Abstract

publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. Fibromyalgia syndrome: a pain modulation disorder related to altered limbic function?JAY A. GOLDSTEIN As a physician who specializes in the diagnosis and treatment of chronic fatigue syndrome (CFS) and fibromyalgia syndrome (FMS), I see a large number of patients who also have such problems as irritable bowel syndrome, panic disorder, amnestic disorder, allergic rhinitis, blurred vision, muscle fasciculations, myasthenia, interstitial cystitis, sleep disorders, headache, bruxism, irritable bladder, alopecia, thermoregulatory dysfunction, lymphadenalgia, dyspnoea, chemical sensitivity, endometriosis, late luteal phase dysphoric disorder, heart palpitations, photophobia, vertigo, Raynaud phenomenon and dysmenorrhoea. Some patients have immune activation related to 'overlap syndromes' with such disorders as systemic lupus erythematosus and multiple sclerosis. Over half report feeling well until they had 'the worst flu of my life', after which they never felt the same, so that investigation of persistent viral infection or 'hit and run' viral episodes that result in long-term functional impairment of affected and bystander cells is relevant.It is quite common for me to consult with individuals who have many of the above disorders. Initially, most of them seemed unrelated. Looking for a mechanism to produce such a wide range of illnesses led me to the study of neuroimmunoendocrine networks, especially the limbic system and its projections. This myriad of signs and symptoms may be explained by limbic dysfunction.The literature discussing the structure and function of the limbic system and its cortical projections (Figure 1), an example of a neural network which uses a parallel distributed computational strategy, is complex and may be unfamiliar to many readers of this volume. These topics have been well discussed by M. -Marsel Mesulam (1985, and these works form a good foundation for the understanding of limbic physiology and its derangements.One can view the limbic neural network functioning as a computer, processing intero-and exteroceptive stimuli (input), primarily via a bewildering array of chemically transduced messages, integrating them with experiences and attitudes (processing), and selecting responses (output) that should ideally maximize the survival capabilities of the individual (Figure 2).

Chronic fatigue syndrome and fibromyalgia syndrome in childhood.

“…The significance of these lesions was investigated by Cope, Pernet, Kendall, and David (19951, who found a positive correlation between the total number of lesions and premorbid I& and current I& decrements. By analyzing the brain's blood flow using a single-photon emission computed scan, 75% of those with CFS or FMS were found to have a significant reduction in the amount of brain blood flow than healthy control individuals or people who were diagnosed with depression with this hypofusion occurring in the temporal lobes (Goldstein, 1994;Mena & Villanueva-Meyer, 1992). Goldstein also demonstrated that these individuals had trouble forming new memories (encoding) as well as retrieving existing information.…”

“…The symptoms of both syndromes, although commonly associated with adults, are similar to symptoms described for children and adolescents (Bell, 1995). The following symptomatology is reported for CFS and FMS: headaches (98%); fatigue (77%); abdominal symptoms (77%); sleep disorders (74%); myalgia (pain or aching in the muscles; 73%); pharyngitis (inflammation of the pharynx; 72%); memory and concentration difficulties (71%); visual problems including photophobia (sensitivity to light), increased problems with night vision, pain in or around eyes, and focusing difficulty (70%); paresthesia with numbness; prickling or tingling (70%); shortness of breath or hyperventilation (70%); myoclonus (twitching of muscles), 70%; sicca syndrome with dry eyes and mouth; dry vagina (60%); hypoglycemia with low blood sugar and carbohydrate intolerance (60%); acute alcohol intolerance (50%); bladder problems (50%); irritable bowel syndrome (50%); Reynaud's syndrome with cold hands or feet, followed by redness, heat, and tingling (30-40%); and butterfly rash (a reddish lupus-type rash found primarily on the face and chest; 25-30%; Goldstein, 1994;Kulig, 1991). Kulig elucidated additional symptomatology for children: night sweats, dysuria (painful urination), dizziness, paresthesia (abnormal tactile sensations), and depression.…”

“…Those with FMS have reported more cognitive problems (94%) than those with CFS (Fukuda et al, 1994). Thus, the tendency is to view FMS and CFS as a variable presentation of the same pathophysiological process (Goldstein, 1994;Waylonis & Heck, 1992).…”