Fibromyalgia – physiological aspects Eva Kosek, MD., PhD., Assistant Professor Department of Clinical Neuroscience, Karolinska Institute and Stockholm Spine Center, Stockholm, Sweden. Lausanne 2008-05-22
Jan 03, 2016
Fibromyalgia – physiological aspects
Eva Kosek, MD., PhD., Assistant Professor
Department of Clinical Neuroscience, Karolinska Institute and Stockholm Spine Center, Stockholm, Sweden.
Lausanne 2008-05-22
Fibromyalgia - ACR 1990 criteria.
• History of widespread pain > 3 months
• Pain in at least 11 of 18 tender points on digital palpation.
Wolfe et al., 1990
CWP + TP =FMS (0.5-4%)
Female/male ratio 10:1
CWP (10-11%)Female/male ratio 1½:1
TP count - a crude screening tool for disturbed sensory processing?
Clauw and Crofford 2003
Increased pain sensitivity to all tested modalities
0 35 40 45 50
Temp. (°C)
0
2
4
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10
VA
S r
atin
gs
FM. pat. max. pain FM. pat. contralat. to max pain Controls `max. pain´ Controls contralat. to `max. pain´
Pressure pain Heat pain
Kosek et al 1995, 1996
Subjectively similar pain intensity:Similar central nervous system activation in both groups.
Same intensity of pressure stimulation:More pronounced and bilateral CNS activation in FM patients compared to healthy controls.
Evidence of enhanced transmission/processing of painful stimuli
Gracely et al., 2002
Left amygdala
Nucleus accumbens
Right dorsal ACC
Lower my-opioidreceptor bindning capacity in patients with fibromyalgia
Harris et al. 2007
Abnormal concentrations of pain related transmittor substances in the cerebrospinalfluid (i.e., serotonin, SP, glutamate)
Russell et al. 1992, 2002Sarchielli et al. 2007
FMS patients have increased sensitivity to somatosensory
stimuli independently of emotional factors – indicating
augmentation of pain transmission and/or processing.
Future Challenges
• Develop clinically useful diagnostic tools to detect facilitation, central sensitisation/disinhibition in individual patients
• Further development of new treatments targeting these CNS-abnormalities
• Investigate the possibilities of secondary prevention