New Insights Into Fibromyalgia May Mean Treatment Adjustments

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Fibromyalgia scores have been associated with poorer responses to peripherally-directed interventions.
Fibromyalgia scores have been associated with poorer responses to peripherally-directed interventions.

PALM SPRINGS, Calif. — New data are emerging that are helping shed new light on the clinicians' current understanding of fibromyalgia.

Richard Harris, PhD, of the University of Michigan's Department of Anesthesiology spoke on some of these recently-published data at the Spring Pain 2015 meeting, which was held just before the American Pain Society Meeting's Annual Meeting, held here.

He noted that latent fibromyalgia symptoms are present across a number of painful conditions, and he said that these symptoms are typically associated with poorer responses to peripherally-directed interventions like hip and knee arthroplasty or hysterectomy.

“We're learning that fibromyalgia really is the tip of the iceberg,” Harris said. “These patients have a number of subclinical characteristics as well.”

Recently published data in Arthritis and Rheumatology by Brummet et al, which looked at 464 patients post-surgery,noted that fibromyalgia survey scores were correlated with poorer arthroplasty outcomes. 

Another study by Janda et al, recently published in Anesthesiology, noted that similar outcomes were true for 208 patients who had undergone a hysterectomy. In that study, researchers used a self-reported questionnaire to assess fibromyalgia survey scores, both before and after surgery.

That study noted that “the fibromyalgia survey score was independently associated with increased postoperative opioid consumption, with an increase of 7-mg oral morphine equivalents for every 1-point increase on the 31-point measure (Estimate, 7.0; Standard Error, 1.7; P<0.0001).”

Referring to "what's going on in the brain," for patients like these, Harris said that his research and others have demonstrated that when patients with chronic pain conditions, like fibromylagia, are imaged, both brain insular glutamate and insular connectivity to the default mode network have been implicated as possible factors.

A study his team published in 2013 noted that if you treated these patients with pregabalin, however, patients showed greater reductions in brain insular glutamate and decreased connectivity to the default mode network (DMN).

These types of studies have important clinical implications for clinicians, he said, clinicians, in the future, may use this data to potentially adjust prescribing behavior.

Concluding his talk, Harris noted that “higher fibromyalgia scores in pelvic pain patients are associated with greater insula and DMN connectivity and lower perigenual ACC-dorsal ACC connectivity."

Reference

  1. Harris R. “Imaging Clinical Pain.” Presented at: Spring Pain Meeting. May 11-13, 2015; Palm Springs, California.
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