Fibromyalgia is the second most common rheumatic disorder behind osteoarthritis and, although it is still largely misunderstood, it is now considered a lifelong central nervous system disorder that is responsible for the amplified pain that triggers through the body in those To suffer from it. Daniel Clauw, MD, professor of anesthesiology at the University of Michigan, analyzed the neurological basis of fibromyalgia in a plenary session today addressed to the Annual Scientific Meeting of the American Pain Society.
“Fibromyalgia can be considered as a discrete disease and as a common final path to centralize pain and chronicity. Most people with this condition have stories of chronic pain throughout their lives, ”said Clauw. “The condition can be difficult to diagnose if you are not familiar with the classic symptoms because there is no single cause or an external sign.”
Clauw explained that fibromyalgia pain comes more from the brain and spinal cord than from areas of the body where someone may experience peripheral pain. It is believed that the condition is associated with disorders in the way the brain processes pain and other sensory information. He said doctors should suspect fibromyalgia in patients with multifocal pain (especially musculoskeletal) that is not fully explained by an injury or inflammation.
“Because the pain pathways throughout the body are amplified in patients with fibromyalgia, pain can occur anywhere, so chronic headaches, visceral pain and sensory hyperreactivity are common in people with this painful condition, ”said Clauw.
“This does not imply that peripheral nociceptive entry does not contribute to the pain experienced by fibromyalgia patients, but it feels more pain than would normally be expected from the degree of peripheral entry.” People with fibromyalgia and other sensitizing sensitizing states will experience pain than those without the condition would describe as touch, ”Clauw added.
Due to the origins of the central nervous system of fibromyalgic pain, Clauw said that treatments with opioids or other narcotic analgesics are generally not effective because they do not reduce the activity of neurotransmitters in the brain. “These medications have never been shown to be effective in patients with fibromyalgia, and there is evidence that opioids may even worsen fibromyalgia and other centralized pain states,” he said.
Clauw advises doctors to integrate pharmacological treatments, such as gabapentinoids, triplicals and serotonoin reuptake inhibitors, with non-pharmacological approaches such as cognitive behavioral therapy, exercise and stress reduction.
“Sometimes, the magnitude of the response to treatment for simple and cheap non-drug therapies exceeds that of drugs,” Clauw said. “The biggest advantage is the improvement in function, which should be the main goal of treatment for any chronic pain condition. Most fibromyalgia patients can see an improvement in their symptoms and lead a normal life with the correct medications and extensive use of non-pharmacological therapies.