Neurophysiologic evidence for a central sensitization in patients with fibromyalgia

Abstract

Objective. To determine whether abnormalities of peripheral and central nociceptive sensory input processing exist outside areas of spontaneous pain in patients with fibromyalgia (FM) as compared with controls, by using quantitative sensory testing (QST) and a neurophysiologic paradigm independent from subjective reports.Methods. A total of 164 outpatients with FM who were attending a self-management program were invited to participate in the study. Data for 85 patients were available and were compared with those for 40 non-FM controls matched for age and sex. QST was performed using thermal, mechanical, and electrical stimuli at locations of nonspontaneous pain. Pain assessment was 2-fold and included use of subjective scales and the spinal nociceptive flexion reflex (NFR), a specific physiologic correlate for the objective evaluation of central nociceptive pathways. Questionnaires regarding quality of life and the impact of FM were available.Results. Participants were mainly middle-aged women, with a mean disease duration of 8 years. Between-group differences were significant for neurophysiologic, clinical, and quality of life measures. In patients with FM, peripheral QST showed significantly altered cold and heat pain thresholds, and tolerance to cold pain was radically reduced.

Fibromyalgia patients and controls are equally accurate in detecting tactile stimuli while observing another in pain: an experimental study

“…The results are also not in line with those of Brown et al (2010), who suggested that there might be an interrelation between illusory tactile perceptions and the degree of pseudoneurological symptoms, nor with Katzer et al (2011) who suggested medically unexplained symptoms might be related to touch illusions, because both groups in the present study reported a comparable number of vicarious somatosensory experiences. Some previous studies have demonstrated that patients with FM have a hypersensitivity for mechanical, cold and heat pain perception (Kosek et al, 1996;Smith et al, 2008) and mixed results exist for non-painful sensations such as cold, warm and touch (Desmeules et al, 2003;Klauenberg et al, 2008). The results of the present study show that threshold intensities for vibrotactile stimuli, although individually determined, were not significantly different for both groups.…”

Quantitative sensory testing somatosensory profiles in patients with cervical radiculopathy are distinct from those in patients with nonspecific neck–arm pain

“…These differing observations may be indicative of the heterogeneity of FM and the possible existence of various sub-groups [34,29,55]. In the absence of evidence of tissue damage in FM, aberrations in pain inhibitory [39,35,45] and pain facilitatory mechanisms [45] as well as central sensitisation/augmentation of sensory input [19,2,62] have been associated with enhanced pain sensitivity in FM.…”

Hypnosis for Chronic Pain Management

“…CM generates a recurrent type of pain which can come and go over a life time, while FM is considered a disorder of the central nervous system with augmented peripheral facilitation and decreased inhibition [64][65][66]. In addition, FM is often accompanied by other somatic symptoms like fatigue, stiffness, sleep disorders, and mood disturbance [67].…”