Biology and therapy of fibromyalgia: pain in fibromyalgia syndrome |
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Authors: | Roland Staud |
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Institution: | (1) Division of Rheumatology and Clinical Immunology, McKnight Brain Institute, University of Florida, 32610 Gainesville, Florida, USA |
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Abstract: | Fibromyalgia (FM) pain is frequent in the general population but its pathogenesis is only poorly understood. Many recent studies
have emphasized the role of central nervous system pain processing abnormalities in FM, including central sensitization and
inadequate pain inhibition. However, increasing evidence points towards peripheral tissues as relevant contributors of painful
impulse input that might either initiate or maintain central sensitization, or both. It is well known that persistent or intense
nociception can lead to neuroplastic changes in the spinal cord and brain, resulting in central sensitization and pain. This
mechanism represents a hallmark of FM and many other chronic pain syndromes, including irritable bowel syndrome, temporomandibular
disorder, migraine, and low back pain. Importantly, after central sensitization has been established only minimal nociceptive
input is required for the maintenance of the chronic pain state. Additional factors, including pain related negative affect
and poor sleep have been shown to significantly contribute to clinical FM pain. Better understanding of these mechanisms and
their relationship to central sensitization and clinical pain will provide new approaches for the prevention and treatment
of FM and other chronic pain syndromes. |
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