Management of peripheral pain generators in fibromyalgia
Section snippets
What is a peripheral pain generator?
Peripheral pain generators are local musculoskeletal, neurological, or other sources of local pain that contribute to the symptom burden of fibromyalgia [1] (Table 1). A methodical search for nociceptive peripheral pain generators in fibromyalgia patients is essential to decrease the total pain burden as well as to decrease the perpetuation of central sensitization [2]. Moreover, individuals with fibromyalgia are better able to participate in an active exercise program and improve their level
Classification of peripheral pain generators
Peripheral pain generators may be divided into five major categories. Within each category, common examples are provided [2], [5].
Osteoarthritis
Peripheral and axial joint osteoarthritis is common especially in patients over 50 [6], [7], [8]. When patients present with mechanical symptoms referable to the joints, it suggests that osteoarthritis may be a superimposed pain generator. Patients may complain of functional limitations such as difficulty putting on socks and shoes with hip arthritis, difficulty ascending and descending stairs with knee arthritis, pain with walking or running over the first metatarsophalangeal joint in foot
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Cited by (21)
Carpal tunnel syndrome in fibromyalgia patients - a crucial factor for their functional impairment
2013, Egyptian RheumatologistCitation Excerpt :In our patients, there was a statistically significant correlation between the severity of CTS and patients’ BMI. It has been reported that compression neuropathies are frequently observed findings in patients with FM [21]. This finding may be connected with weight gain, musculoskeletal pain, biomechanical factors secondary to hypermobility and increased sensitization appearing as a result of central sensitization [22,4].
Evaluation of Upper Extremity Nerve Conduction Velocities and the Relationship Between Fibromyalgia and Carpal Tunnel Syndrome
2012, Archives of Medical ResearchCitation Excerpt :The rate of undiagnosed CTS in patients with FS was reported to be higher than the general population prevalence rates (14–17). The differentiation of paresthesia and other sensory complaints from other compression neuropathies requiring specific treatment is needed in patients with FS (13). Simms and Goldenberg reported the rate of paresthesia in patients with FS as quite remarkable (2).
The Predetermined Sites of Examination for Tender Points in Fibromyalgia Syndrome Are Frequently Associated With Myofascial Trigger Points
2010, Journal of PainCitation Excerpt :Increasing evidence points towards peripheral tissues as relevant contributors of nociceptive input that might either initiate or maintain central sensitization, or both.14,26,30 Indeed, nociceptive stimuli from painful foci in muscles are increasingly recognized as being relevant to the development of fibromyalgia.2,5,30 Active MTrPs show lower PPT7,10 and higher level of algesic substances21 than latent MTrPs, intramuscular SEA when muscle is at rest,15 sympathetic hyperactivity,8,34 and association of enhanced brain responses of somatosensory and limbic activity with active MTrPs,19 and these characteristics render active MTrPs as one of the peripheral pain generators driving central sensitization in fibromyalgia.
Neurophysiopathogenesis of Fibromyalgia Syndrome: A Unified Hypothesis
2009, Rheumatic Disease Clinics of North AmericaMyofascial Pain Syndrome and Fibromyalgia Syndrome
2008, Raj's Practical Management of PainDifferential diagnosis: Myofascial pain syndrome
2003, Fibromyalgia Syndrome: A Practitioner's Guide to Treatment: Second Edition