Posted by MERM on 6/22/2008, 7:52 am
Fibromyalgia syndrome’s new paradigm: neural sensitization and its implications for treatment.
Podell RN
When first defined by the American College of Rheumatology (ACR), fibromyalgia syndrome (FMS) was viewed as a rheumatological illness—a matter of sore muscles. The current "neural sensitization" model focuses on abnormal sensitivity within the central nervous system’s pain signaling pathways. Current thinking emphasizes the likelihood that there are several subtypes of FMS with over-lapping but not identical clinical presentations, mechanisms, and treatments. The ACR’s criteria for FMS require:
1) a history of widespread chronic pain, and
2) abnormal tenderness at 11 of 18 designated pain-sensitive anatomic sites, called tender points (TePs).
Several lines of research now provide objective evidence of physical abnormalities in the FMS patient’s pain signaling pathways. Fibromyalgia syndrome patients had increased regional blood flow in multiple areas of the brain at relatively low intensities of pressure.
Changes in blood flow coincided with the patient’s report of pain. Others have described regional cerebral blood flow and cerebrospinal fluid (CSF) neurochemical abnormalities in FMS, including increased CSF levels of Substance P and decreased CSF levels of serotonin. For mild cases, medication for pain together with lifestyle advice may be all that is needed.
When pain is severe or accompanied by other symptoms, the treatment plan should cover at least the following main problem areas:
pain, sleep quality, how patient and family are coping with the distress of chronic illness, exercise, and whether depression and/or anxiety have developed.
Additional problems that may have to be addressed include: low blood pressure, tachycardia, neurocognitive problems such as concentration or
memory problems,
fatigue and poor stamina,
local or regional peripheral sources of musculoskeletal pain,
irritable bowel syndrome,
or post-prandial syndrome.
For each area, patient education and support are important in addition to physical, psychological, and pharmacological attention.
Clinical experience suggests that FMS patients may be atypically more "sensitive" to medicine side effects, particularly those who display chronic fatigue, neurocognitive difficulties, irritable bowel syndrome, etc.
A substantial proportion of patients are unable to tolerate any given medicine, especially at higher doses.Journal: J Musculoskel Pain 15(2):45-54, 2007. 60 References**wellnesstrainresearch!M!
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