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Fibromyalgia physiological aspects
Eva Kosek, MD., PhD., Assistant Professor
Department of Clinical Neuroscience, Karolinska
Institute and Stockholm Spine Center, Stockholm,
Sweden. Lausanne 2008-05-22
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Fibromyalgia - ACR 1990 criteria.

• History of widespread pain gt 3 months
• Pain in at least 11 of 18 tender points on
  digital palpation.
  
  

Wolfe et al., 1990
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TP count - a crude screening tool for disturbed
sensory processing?
CWP (10-11) Female/male ratio 1½1
CWP TP FMS (0.5-4) Female/male ratio 101
Clauw and Crofford 2003
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Increased pain sensitivity to all tested
modalities
Pressure pain Heat
pain
Kosek et al 1995, 1996
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Evidence of enhanced transmission/ processing of
painful stimuli
Subjectively similar pain intensity Similar
central nervous system activation in both
groups. Same intensity of pressure
stimulation More pronounced and bilateral CNS
activation in FM patients compared to healthy
controls.
Gracely et al., 2002
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Nucleus accumbens
Lower my-opioidreceptor bindning capacity in
patients with fibromyalgia
Harris et al. 2007
Left amygdala
Abnormal concentrations of pain related
transmittor substances in the cerebrospinal fluid
(i.e., serotonin, SP, glutamate)
Right dorsal ACC
Russell et al. 1992, 2002 Sarchielli et al. 2007
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FMS patients have increased sensitivity to
somatosensory stimuli independently of emotional
factors indicating augmentation of pain
transmission and/or processing.
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Future Challenges

• Develop clinically useful diagnostic tools to
  detect facilitation, central sensitisation/disinhi
  bition in individual patients
• Further development of new treatments targeting
  these CNS-abnormalities
• Investigate the possibilities of secondary
  prevention