Fibromyalgia is the second most common rheumatic disease behind osteoarthritis and,
although still widely misunderstood, it is now considered to be a life-long nervous system disorder that is responsible for the amplified pain that shoots through the body in those who suffer from it.
Daniel Clauw, MD, professor of anesthesiology at the University of Michigan, analyzed the neurological basis for fibromyalgia in a plenary address today at the Annual Scientific Meeting of the American Pain Society.

“Fibromyalgia can be considered both as a discrete disease and also as a common final route of centralization pain and chronification.

Most people with this condition have lifelong stories of chronic pain throughout the body, “Clauw said. “The condition can be difficult to diagnose if one is not familiar with classical symptoms because there is not a single cause and there are no external signs.”

Clauw explained that the pain of fibromyalgia comes more from the brain and spinal cord than from areas of the body where someone may experience peripheral pain.
The condition is thought to be associated with alterations in how the brain processes pain and other sensory information.

He said doctors should suspect in patients with multifocal fibromyalgia (mostly musculoskeletal) pain that is not fully explained by injury or inflammation.

“Because pain pathways throughout the body are amplified in patients with fibromyalgia, pain can occur anywhere,

so chronic headaches, visceral pain and sensory hyper-response are common in people with this painful condition, “Clauw said.

“This does not imply that the peripheral nociceptive input does not contribute to the pain experienced by patients with fibromyalgia,
but I feel more pain than would normally be expected from the degree of peripheral input.
People with fibromyalgia and other pain states that are characterized by sensitization will experience pain from what those who do not have the condition would describe as touch, “Clauw added.

Due to the origins of the pain central nervous system of fibromyalgia,
Clauw said opioid treatments or other narcotic analgesics are usually not effective because they do not reduce the activity of neurotransmitters in the brain.
“These medications have not been shown to be effective in patients with fibromyalgia,
and there is evidence that opioids can even worsen fibromyalgia and other centralized pain states,” he said.

Clauw advises physicians to integrate pharmacological treatments, such as gabapentinoids, tricyclics and selective serotonin reuptake inhibitors,
with non-pharmacological approaches such as cognitive behavioral therapy, exercise and stress reduction.

“Sometimes the magnitude of the response to treatment for simple and low-cost non-pharmacological therapies exceeds that of pharmaceuticals,” Clauw said. “The biggest benefit is the function,
which should be the main goal of treatment for any chronic pain condition improved. The majority of patients with fibromyalgia can see an improvement in their symptoms and lead a normal life with the appropriate medications and an extensive use of non-pharmacological therapies. “


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