Fibromyalgia is the second most common rheumatic disease after osteoarthritis. Although it remains largely misunderstood, it is now considered a lifelong disorder of the central nervous system, responsible for increased, radiating pain in sufferers. Dr. Daniel Clauw, Professor of Anesthesiology at the University of Michigan, analyzed the neurological basis of fibromyalgia in a plenary lecture today at the American Pain Society’s annual meeting.
“Fibromyalgia can be viewed as both a discrete disorder and a common progression of pain centralization and chronification. Most sufferers suffer from lifelong chronic pain throughout the body,” said Clauw. “The disorder can be difficult to diagnose without knowing the classic symptoms, as there is no single cause and no external signs.”
Clauw explained that fibromyalgia pain originates more from the brain and spinal cord than from areas of the body where peripheral pain can occur. The condition is associated with disturbances in the brain’s processing of pain and other sensory information. He said doctors should consider fibromyalgia in patients with multifocal (usually musculoskeletal) pain that cannot be fully explained by injury or inflammation.
“Because pain pathways are enhanced throughout the body in fibromyalgia patients, pain can occur anywhere. Therefore, chronic headaches, visceral pain, and sensory hypersensitivity are common in people with this painful condition,” said Clauw.
“This does not mean that peripheral nociceptive stimuli do not contribute to the pain of fibromyalgia patients, but they experience more severe pain than would normally be expected based on the extent of peripheral stimuli. People with fibromyalgia and other pain conditions characterized by sensitization experience pain from touch that people without the condition would describe as pain,” added Clauw.
Because fibromyalgia pain originates in the central nervous system, treatments with opioids or other narcotic analgesics are generally ineffective because they do not reduce neurotransmitter activity in the brain, Clauw said. “The effectiveness of these medications in fibromyalgia patients has not yet been proven, and there is evidence that opioids may even worsen fibromyalgia and other centralized pain conditions,” he said.
Clauw advises clinicians to combine pharmacological treatments such as gabapentinoids, tricyclics, and serotonin reuptake inhibitors with non-pharmacological approaches such as cognitive behavioral therapy, exercise, and stress reduction.
“Sometimes the magnitude of treatment response with simple and inexpensive non-drug therapies exceeds that of pharmaceuticals,” said Clauw. “The greatest benefit is improved function, which should be the primary treatment goal for chronic pain. The majority of fibromyalgia patients can experience relief from their symptoms and lead a normal life with the right medications and comprehensive use of non-drug therapies.”
