Consider CNS Origins When Treating Fibromyalgia
Suspect Fibromyalgia in Multifocal Musculoskeletal Pain
PALM SPRINGS, Calif. — Fibromyalgia pain originates from the central nervous system and amplifies pain pathways throughout the body. So clinicians treating this patient population should focus on integrating pharmacologic and nonpharmacologic pain management approaches to achieve the best outcomes, according to a speaker here.
Fibromyalgia is now the second most common rheumatic disorder after osteoarthritis. Although it's still widely misunderstood, it is now considered to be a lifelong CNS disorder that may be hard to diagnose because there is no known single cause and no outward symptoms.
“Pain can occur anywhere, so chronic headaches, visceral pain and sensory hyper responsiveness are common in people with this painful condition,” Daniel Clauw, MD, professor of anesthesiology at the University of Michigan, said during a plenary session at the 2015 American Pain Society Annual Meeting.
“This does not imply the peripheral nocicipetive input does not contribute to pain experienced by [these] patients, but they do feel more pain than normally would be expected from the degree of peripheral input.”
It is not uncommon for patients with fibromyalgia to experience painful sensitization to stimulus as light as touch, he added.
“Physicians should suspect fibromyalgia in patients with multifocal, mostly musculoskeletal pain that is not fully explained by injury or inflammation,” he said.
Because of the condition's CNS origins, treatments with opioids or other narcotic analgesics are generally ineffective, because they do nothing to reduce the activity of neurotransmitters in the brain, and in fact may even worsen pain in patients with it and other centralized pain states.
“Sometimes the magnitude of treatment response for simple and inexpensive non-drug therapies exceeds that for pharmaceuticals,” said Clauw.
He recommended integrating medications such as gabapentinoids, tricyclics and serotonin repute inhibitors, with approaches including cognitive behavioral therapy, exercise and stress reduction techniques.
“The majority of patients with fibromyalgia can see improvement in their symptoms and lead normal lives with the right medications and extensive use of non-drug therapies,” said Clauw.