Patients Often Have Lifelong Histories of Chronic Pain
Presentation by Daniel Clauw, MD
Much has changed about our understanding of the etiology of fibromyalgia (FM) since the beginning of this century. Although still widely misunderstood, FM is now considered to be a lifelong central nervous system disorder, which is responsible for amplified pain that shoots through the body in those who suffer from it.
“Fibromyalgia can be thought of both as a discreet disease and also as a final common pathway of pain centralization and chronification,”reported Daniel Clauw, MD, professor of anesthesiology, University of Michigan.¹ “Most people with this condition have lifelong histories of chronic pain throughout their bodies. The condition can be hard to diagnose if one isn’t familiar with classic symptoms because there isn’t a single cause and no outward signs.”
The disorder now is considered a central sensitivity syndrome (CSS) because of its basic neurophysiological etiology, Dr. Clauw explained. This makes FM a neurosensory disorder associated with difficulties with pain processing by the central nervous system (CNS).²˒³ This also ties FM, which is estimated to effect 2% to 5% of the population, to other similar, if not overlapping, conditions, including chronic fatigue syndrome, interstitial cystitis, irritable bowel syndrome, vulvodynia, post-traumatic stress disorder, and others.⁴
Physicians should suspect fibromyalgia in patients with multifocal (mostly musculoskeletal) pain that is not fully explained by injury or inflammation. “Because pain pathways throughout the body are amplified in fibromyalgia patients, pain can occur anywhere, so chronic headaches, visceral pain and sensory hyper-responsiveness are common in people with this painful condition,” Dr. Clauw said.
“This does not imply that peripheral nociceptive input does not contribute to pain experienced by fibromyalgia patients, but they do feel more pain than normally would be expected from the degree of peripheral input. Persons with fibromyalgia and other pain states characterized by sensitization will experience pain from what those without the condition would describe as touch,” Dr. Clauw added.
Due to the central nervous system origins of fibromyalgia pain, Dr. Clauw said treatments with opioids or other narcotic analgesics usually are not effective because they do not reduce the activity of neurotransmitters in the brain. “These drugs have never been shown to be effective in fibromyalgia patients, and there is evidence that opioids might even worsen fibromyalgia and other centralized pain states,” he said.
A better treatment option is integrate pharmacological treatments, such as gabapentinoids, trycyclics and serotonoin reuptake inhibitors, with nonpharmacological approaches like cognitive behavioral therapy, exercise and stress reduction, he said.
“Sometimes the magnitude of treatment response for simple and inexpensive non-drug therapies exceeds that for pharmaceuticals,” Dr. Clauw said. “The greatest benefit is improved function, which should be the main treatment goal for any chronic pain condition. The majority of patients with fibromyalgia can see improvement in their symptoms and lead normal lives with the right medications and extensive use of non-drug therapies.”
References
- Clauw D. Fibromyalgia: A Disease, Common Pathway, or Rubbish? Plenary paper presented at: Annual Meeting of the American Pain Society; May 13-16, 2015; Palm Springs, CA.
- Burgmer M, Pogatzki-Zahn E, Gaubitz M, Wessoleck E, Heuft G, Pfeiderer B. Altered brain activity during pain processing in fibromyalgia. Neuroimage. 2009;44(2):502-508.
