Pain in fibromyalgia and related conditions

Abstract

Pain is the hallmark symptom of fibromyalgia (FM) and other related syndromes, but quite different from that of other rheumatic diseases, which depends on the degree of damage or inflammation in peripheral tissues. Sufferers are often defined as patients with chronic pain without an underlying mechanistic cause, and these syndromes and their symptoms are most appropriately described as "central pain", "neuropathic pain", "nonnociceptive pain" or "central sensitivity syndromes". The pain is particular, regional or widespread, and mainly relates to the musculoskeletal system; hyperalgesia or allodynia are typical. Its origin is currently considered to be distorted pain or sensory processing, rather than a local or regional abnormality. FM is probably the most important and extensively described central pain syndrome, but the characteristics and features of FM-related pain are similar in other disorders of particular interest for rheumatologists, such as myofascial pain syndromes and temporo-mandibular joint disorders, and there is also an intriguing overlap between FM and benign joint hypermobility syndrome. This suggests that the distinctive aspects of pain in these idiopathic or functional conditions is caused by central nervous system hypersensitivity and abnormalities. Pharmacological and non-pharmacological therapies have been suggested for the treatment of these conditions, but a multidisciplinary approach is required in order to reduce the abnormal cycle of pain amplification and the related maladaptive and self-limiting behaviours.

Phenotypic features of central sensitization

“…Those with broader pain distributions demonstrated significantly poorer scores on the other elements of the SPACE symptom cluster (Lai et al, 2017). Similar findings have been reported in the context of TMD (Slade et al, 2013) and FM (Cassisi et al, 2014). …”

Differences in Multidisciplinary and Interdisciplinary Treatment Programs for Fibromyalgia: A Mapping Review

“…The complex features of the syndrome and its various symptoms are partially explained by central sensitization processes that interact with psychological and social factors, leading to a phenomenon where the impact of each component is multiplied and acts in a synergic manner [4, 5]. Given its multifaceted nature and the poor efficacy of standard medical interventions, the integration of different health disciplines for its understanding and for the development of specific treatments has long been advocated [6–10].…”

Clinical and demographic characteristics and functional status of the patients with fibromyalgia syndrome

“…Cassisi et al emphasized the association between FMS, and central nervous system anomalies, MPS, BJHS, and temporomandibular joint disorders, and indicated the necessity of a multidisciplinary approach so as to relieve symptoms of pain, and restricted mobility suffered by these patients [26]. Fitzcharles et al reported that FMS patients with low socioeconomic status experienced worse functional disability, and more severe symptoms compared with other FSM patients despite the same levels of pain, anxiety, and depression due to the differences in the perception of the disease state [27].…”