Thursday, June 27, 2019

What Is Going On In Fibromyalgia?

Hi there! Let’s talk about pathophysiology of fibromyalgia; a chronic disorder where fatigue and widespread pain feature prominently.

Current hypothesis says, it’s caused by aberrant peripheral and central pain processing.
Two key features are allodynia, that is, pain in response to a non-painful stimulus and hyperaesthesia, which is, exaggerated perception of pain in response to mildly painful stimulus.

Modern research says, certain antidepressants- with both serotonergic and noradrenergic activity- such as TCAs and venlafaxine, can relieve pain and other symptoms; suggesting the pathway involvement.

Some evidence says, alternative therapies such as acupuncture and spa therapies alleviate pain, which have been postulated to act via similar spinal pain-modulatory pathways.

CSF studies show increased levels of substance P, with decreased levels of noradrenaline and serotonin metabolites. All three are neurotransmitters involved in descending pain-modulatory pathways in the spinal cord.

PET images show an abnormal central dopamine response to pain.

The critical question here is: what is cause and what is effect?

Small sample size and short periods of study, remain the most cumbersome challenge to our complete understanding of fibromyalgia.  

Thank you for reading.
- Ashish Singh.

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