A Short Guide to Fibromyalgia

By Daniel J. Wallace; Janice Brock Wallace | Go to book overview

The Basic Science of
Fibromyalgia

In this chapter, we'll explore what makes fibromyalgia a pain amplifi⁃ cation syndrome. Why does the patient hurt in places where there was often no injury and all laboratory tests are normal? What creates what doctors call allodynia, or a clinical situation that results in pain from a stimulus (such as light touch) that normally should not be painful? Fibromyalgia is a form of chronic, widespread allodynia, as well as sustained hyperalgesia, or greater sensitivity than would be expected to an adverse stimulus.


NORMAL PAIN PATHWAYS

The nervous system consists of several components. The brain and spinal cord comprise the central nervous system. Nerves leaving the spinal cord that tell us to move our arms or legs are part of the [motor] aspects of the peripheral nervous system. Additionally, all sorts of in⁃ formation about touch, taste, chemicals, and pressure are relayed through [sensory] pathways back to the spinal cord, where they are processed and sent up to the brain for a response. The autonomic ner⁃ vous system consists of specialized peripheral nerves. Fibromyalgia is characterized by an inappropriate neuromuscular reaction that leads to chronic pain. Patients with fibromyalgia usually react normally to acute pain.

To elaborate upon this, nerve wires from the skin, muscles, or joints send sensory signals (e.g., touch, pressure) to the spinal cord. Several separate sensory pathways have been described. The particular sen⁃ sory trail important in fibromyalgia is one termed nociception. A noci⁃ ceptor is a receptor that is sensitive to a noxious stimulus. Nociceptors are present in blood vessel walls, muscle, fascia, tendons, joint capsules, fat pads, and on body surfaces. A noxious stimulus can be thermal (heat,

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