The role of the central nervous system in the generation and maintenance of chronic pain in rheumatoid arthritis,osteoarthritis and fibromyalgia |
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Authors: | Yvonne C Lee Nicholas J Nassikas Daniel J Clauw |
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Institution: | 1Division of Rheumatology, Immunology and Allergy, Brigham and Women''s Hospital, 75 Francis Street, PBB-B3, Boston, MA 02115, USA;2Chronic Pain and Fatigue Center, University of Michigan Medical School, Domino''s Farms, Lobby M, PO Box 385, 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48106, USA |
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Abstract: | Pain is a key component of most rheumatologic diseases. In fibromyalgia, the importance of central nervous system pain mechanisms
(for example, loss of descending analgesic activity and central sensitization) is well documented. A few studies have also
noted alterations in central pain processing in osteoarthritis, and some data, including the observation of widespread pain
sensitivity, suggest that central pain-processing defects may alter the pain response in rheumatoid arthritis patients. When
central pain is identified, different classes of analgesics (for example, serotonin-norepinephrine reuptake inhibitors, α2δ ligands) may be more effective than drugs that treat peripheral or nociceptive pain (for example, nonsteroidal anti-inflammatory
drugs and opioids). |
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