Fibromyalgia is the second most common rheumatic disease behind arthritis and, although poorly known, is today considered a disease of the central nervous system responsible for the amplification of pain that spreads throughout the body. those who are suffering. Daniel Clauw, MD, professor of anesthesiology at the University of Michigan, discussed the neurological bases of fibromyalgia during a plenary session today at the annual scientific meeting of the American Pain Society.
“Fibromyalgia can be considered as a discrete disease and a common evaluation criterion in the centralization and chronification of pain. “Most people with this disease have a history of chronic pain throughout their body,” declared Clauw. “The condition can be difficult to diagnose if you are not familiar with the classic symptoms, because there is no unique cause or external signs.”
Clauw explained that the pain of fibromyalgia comes more from the brain and spinal cord than from areas of the body where a person can feel peripheral pain. It is thought that this condition is associated with disturbances in the way the brain treats pain and other sensory information. He added that clinicians should suspect fibromyalgia in patients suffering from multifocal (principally musculoskeletal) pains that are not entirely explained by an injury or an inflammation.
“Because the pain voids throughout the body are amplified in patients with fibromyalgia, the pain can occur anywhere. Therefore, chronic headaches, visceral pains and sensory hyperreactivity are common among people suffering from this painful affection”, declared Clauw.
“This does not mean that peripheral nociceptive input does not contribute to the pain felt by patients with fibromyalgia, but they do experience more pain than they would normally expect with the degree of peripheral input. People who suffer from fibromyalgia and other painful affections characterized by a sensitivity will feel a pain that those who do not have them would not describe as touching », added Clauw.
Due to the pain that fibromyalgia causes in the central nervous system, Clauw stated that treatments with opioids or other analgesic narcotics are generally not effective because they do not reduce the activity of neurotransmitters in the brain. “These drugs have never been shown to be effective in patients with fibromyalgia and there is evidence that opioids may even aggravate fibromyalgia and other centralized painful conditions,” he said.
Clauw recommends to clinicians to integrate pharmacological treatments, such as gabapentinoids, tripcyclics and serotonin reuptake inhibitors, as well as non-pharmacological approaches, such as cognitive-behavioral therapy, exercise and stress reduction. .
“For example, the magnitude of response to treatment for simple and inexpensive non-drug therapies exceeds that of pharmaceutical products,” said Clauw. « The main advantage is the improvement of function, which should be the main objective of the treatment of all chronic pain. Most patients with fibromyalgia can notice an improvement in their symptoms and lead a normal life with good medications and the intensive use of non-drug treatments. ,
