Fibromyalgia is the second most common rheumatic disorder behind osteoarthritis and although largely unrecognized, is now considered a central nervous system disorder to stimulate life, which is responsible for the pain that runs through the body in those who suffer.
Daniel Clauw, MD, professor of anesthesiology, University of Michigan, analyzed the neurological basis of fibromyalgia at a plenary session today at the annual scientific meeting of the American Pain Society.
“Fibromyalgia can be considered both as a distinct disease and as a final common pathway of centralization and chronology of pain. Most people with this disease have a history of chronic long-term pain in their body, “says Clauw. “The condition can be difficult to diagnose if one does not know the classic symptoms because there is no cause and no external sign.”
Clauw explained that the pain of fibromyalgia is the brain and spinal cord areas of the body in which a person is suffering from peripheral pain. The condition is thought to be associated with disorders of how the brain treats pain and other sensory information. He said doctors should suspect fibromyalgia in patients with multifocal pain (mainly the musculoskeletal system) that can not be fully explained by injury or inflammation.
“Because pain pathways are strengthened by the body in fibromyalgia patients, pain can occur anywhere, causing chronic headaches, visceral pain, and sensory hypersensitivity in people with this painful disease.” says Clauw.
“This does not mean that the peripheral nociceptive input does not contribute to the pain of fibromyalgia patients, but they feel more pain than would normally be expected from the degree of peripheral contribution. People with fibromyalgia and other states of pain characterized by consciousness will feel the pain of those whose condition does not feel like, “says Clauw.
Because of the origin of the central nervous system pain of fibromyalgia, claw that treatment with opioids and other narcotic analgesics in general is not effective because they do not reduce the activity of neurotransmitters in the brain. “These drugs have never been considered effective in patients with fibromyalgia, and there are signs that opioids may worsen fibromyalgia and other central pain conditions,” he said.
Clauw advises physicians to integrate pharmacologic treatments, such as gabapentinoids, to reduce tricyclic and serotonin reuptake inhibitors, with non-pharmacological approaches such as cognitive-behavioral therapy, exercise, and stress.
“Sometimes the breadth of the response to treating simple, inexpensive non-drug therapies is that of drugs,” says Clauw. “The biggest benefit is improved function, which should be the main goal of treating chronic pain. The majority of patients with fibromyalgia can see an improvement in their symptoms and lead a normal life with the right medication and intensive use of non-drug treatments. “