Fibromyalgia and Overlapping Disorders: The Unifying Concept of Central Sensitivity Syndromes

https://doi.org/10.1016/j.semarthrit.2006.12.009Get rights and content

Objectives

To discuss fibromyalgia syndrome (FMS) and overlapping conditions, eg, irritable bowel syndrome, headaches, and chronic fatigue syndrome, within the concept of central sensitivity syndromes (CSS).

Methods

A critical overview of the literature and incorporation of the author’s own views.

Results

The concept of CSS seems viable. It is based on mutual associations among the CSS conditions as well as the evidence for central sensitization (CS) among several CSS members. However, such evidence is weak or not available in other members at this time, requiring further studies. The biology of CSS is based on neuroendocrine aberrations, including CS, that interact with psychosocial factors to cause a number of symptoms.

Conclusions

CSS is an important new concept that embraces the biopsychosocial model of disease. Further critical studies are warranted to fully test this concept. However, it seems to have important significance for new directions for research and patient care involving physician and patient education. Each patient, irrespective of diagnosis, should be treated as an individual considering both the biological and psychosocial contributions to his or her symptoms and suffering.

Section snippets

Methods

This discourse is based on a critical overview of the literature (as of March, 2006) and an incorporation of the author’s own ideas, insights, and opinions.

The Concept of Central Sensitivity Syndromes

To qualify for CSS membership, my conceptual paradigm includes (a) mutual associations between the CSS members; and (b) demonstration of CS to various stimuli among them (1, 2).

Mechanisms of Central Sensitization

This section will provide only a general view of the CS mechanisms. For greater details the readers are referred to several reviews (13, 14, 15). CS is manifested by an abnormal and intense enhancement of pain by central nervous system (CNS) mechanisms.

Pain signaling involves activation of a variety of nociceptors at the

Discussion

Historically, the concept that several CSS disorders are interconnected was first published in 1984 (228) based on the previous demonstration of associations of several CSS members with FMS (22). Fifteen years ago, attention was drawn to the fact that the pathophysiology of FMS involves aberrant central pain mechanisms (229). Now it seems likely that a major component of the central pain mechanism is CS, and it is a major binder for the CSS conditions. At this time, evidence for CS is not

Acknowledgments

The author thanks Drs. Alfonse Masi, John Winfield, and William Maixner for their most helpful critique of the article, and Deeba Yunus for fine help with the references.

References (237)

  • D. Buchwald

    Fibromyalgia and chronic fatigue syndrome: similarities and differences

    Rheum Dis Clin North Am

    (1996)
  • A. Barton et al.

    Increased prevalence of sicca complex and fibromyalgia in patients with irritable bowel syndrome

    Am J Gastroenterol

    (1999)
  • E.F. Wright et al.

    Identifying undiagnosed rheumatic disorders among patients with TMD

    J Am Dent Assoc

    (1997)
  • M. Alagiri et al.

    Interstitial cystitis: unexplained associations with other chronic disease and pain syndromes

    Urology

    (1997)
  • D.J. Clauw et al.

    The relationship between fibromyalgia and interstitial cystitis

    J Psychiat Res

    (1997)
  • J.M. Novi et al.

    Risk of irritable bowel syndrome and depression in women with interstitial cystitis: a case-control study

    J Urol

    (2005)
  • M. Amir et al.

    Posttraumatic stress disorder, tenderness and fibromyalgia

    J Psychosom Res

    (1997)
  • G. Carli et al.

    Reactivity to superficial and deep stimuli in patents with chronic musculoskeletal pain

    Pain

    (2002)
  • S. Lautenbacher et al.

    Multi-method assessment of experimental and clinical pain in patients with fibromyalgia

    Pain

    (1994)
  • A.J. McDermid et al.

    Generalized hypervigilance in fibromyalgia: evidence of perceptual amplification

    Pain

    (1996)
  • E. Kosek et al.

    Sensory dysfunction in fibromyalgia patients with implications for pathogenic mechanisms

    Pain

    (1996)
  • T. Graven-Nielsen et al.

    Ketamine reduces muscle pain, temporal summation, and referred pain in fibromyalgia patients

    Pain

    (2000)
  • M.Y. Agargun et al.

    Sleep quality and pain threshold in patients with fibromyalgia

    Compr Psychiatry

    (1999)
  • F. Petzke et al.

    Increased pain sensitivity in fibromyalgia: effects of stimulus type and mode of presentation

    Pain

    (2003)
  • M.E. Geisser et al.

    Perception of noxious and innocuous heat stimulation among healthy women and women with fibromyalgia: association with mood, somatic focus, and catastrophizing

    Pain

    (2003)
  • R. Staud et al.

    Abnormal sensitization and temporal summation of second pain (wind-up) in patients with fibromyalgia syndrome

    Pain

    (2001)
  • D.D. Price et al.

    Enhanced temporal summation of second pain and its central modulation in fibromyalgia patients

    Pain

    (2002)
  • R. Staud et al.

    Maintenance of windup of second pain requires less frequent stimulation if fibromyalgia patients compared to normal controls

    Pain

    (2004)
  • B. Banic et al.

    Evidence for spinal cord hypersensitivity in chronic pain after whiplash injury and in fibromyalgia

    Pain

    (2004)
  • L. Vecchiet et al.

    Sensory characterization of somatic parietal tissues in humans with chronic fatigue syndrome

    Neurosci Lett

    (1996)
  • W.E. Whitehead et al.

    Tolerance for rectosigmoid distention in irritable bowel syndrome

    Gastroenterology

    (1990)
  • J. Munakata et al.

    Repetitive sigmoid stimulation induces rectal hyperalgesia in patients with irritable bowel syndrome

    Gastroenterology

    (1997)
  • T. Lembo et al.

    Irritable bowel syndrome patients show altered sensitivity to exogenous opioids

    Pain

    (2000)
  • M. Schmulson et al.

    Correlation of symptom criteria with perception thresholds during rectosigmoid distension in irritable bowel syndrome patients

    Am J Gastroenterol

    (2000)
  • G.N. Verne et al.

    Hypersensitivity to visceral and cutaneous pain in the irritable bowel syndrome

    Pain

    (2001)
  • H. Mertz et al.

    Altered rectal perception is a biologic marker of patients with irritable bowel syndrome

    Gastroenterology

    (1995)
  • M.B. Yunus

    Central sensitivity syndromes: a unified concept for fibromyalgia and other similar maladies

    J Indian Rheumatism Assoc

    (2000)
  • M.B. Yunus

    The concept of central sensitivity syndromes

  • M. Lipkin

    Functional or organic?A pointless question

    Ann Intern Med

    (1969)
  • A.J. Barsky et al.

    Functional somatic syndromes

    Ann Intern Med

    (1999)
  • M. Sharpe

    Medically unexplained symptoms and syndromes

    Clin Med

    (2002)
  • A. Escalante et al.

    Musculoskeletal manifestations, pain, and quality of life in Persian Gulf War veterans referred for rheumatologic evaluation

    J Rheumatol

    (1998)
  • S. Reid et al.

    Multiple chemical sensitivity and chronic fatigue syndrome in British Gulf War veterans

    Am J Epidemiol

    (2001)
  • Gray GC, Reed RJ, Kaiser KS, Smith TC, Gastanaga VM. Self-reported symptoms and medical conditions among 11,868 Gulf...
  • K.C. Trimble et al.

    Heightened visceral sensation in functional gastrointestinal disease is not site-specificEvidence for a generalized disorder of gut sensitivity

    Dig Dis Sci

    (1995)
  • J. Giesecke et al.

    Quantitative sensory testing in vulvodynia patients and increased peripheral pressure pain sensitivity

    Obstet Gynecol

    (2004)
  • R. Staud

    The neurobiology of chronic musculoskeletal pain (including chronic regional pain)

  • S.A. Cohen

    Physiology of Pain

  • A.J. Holman et al.

    A randomized, double-blind, placebo-controlled trial of pramipexole, a dopamine agonist, in patients with fibromyalgia receiving concomitant medications

    Arthritis Rheum

    (2005)
  • L. Arendt-Nielsen et al.

    Effect of N-methyl-D-aspartate antagonist (ketamine) on single and repeated nociceptive stimuli: a placebo controlled experimental human study

    Anesth Analg

    (1995)
  • Cited by (571)

    View all citing articles on Scopus

    There is no conflict of interest.

    View full text