The Clinical Neurobiology of Fibromyalgia and Myofascial Pain

Therapeutic Implications

Robert M. Bennett

• Publisher: CRC Press
• Year: 2020
• eBook ISBN:
  9781000156782
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

Is chronic fatigue syndrome an early process of muscle aging?
Is fibromyalgia a central pain state?

This book covers the latest developments in pain research as presented at the Fifth World Congress on Myofascial Pain (MYOPAIN 2001). It examines the results of a wide scope of basic and applied research on soft-tissue pain, with a strong focus on therapeutic approaches. Its three main sections explore the neurobiology of central sensitization, regional pain syndromes, and chronic widespread pain. In addition, this well-referenced book presents a fascinating chapter on the complex relationship between muscle pain and aging. Handy graphs, charts, and illustrations make the information easy to assimilate.

The Clinical Neurobiology of Fibromyalgia and Myofascial Pain: Therapeutic Implications contains up-to-date information on:

• the brain?s reactions to states of persistent pain
• the physical aftermath of torture
• ways to define and address the emotional distress that commonly observed in chronic pain patients
• the mechanisms and manifestations of muscle hyperalgesia
• the pathophysiology of inflammatory muscle pain
• regional muscle pain syndromes
• state-of-the-art information on the pathophysiology of visceral pain and visceral-somatic pain representations
• a case study of a physical therapy approach to fibromyalgia using Myofascial trigger points
• the epidemiology of widespread pain and its development after injuries
• syndromes that share overlapping clinical features with fibromyalgia
• the connection between HPA dysfunction, ANS dysfunction, and fibromyalgia
• the plasticity of excitatory synaptic transmission in the spinal dorsal horn and its role in the pathogenesis of pain hypersensitivity
• how the central mechanisms of pain transmission relate to pharmacological systems that are responsible for generating central sensitization states
• what PET and MRI show us about the role that the cerebral cortex plays in the perception and modulation of pain

Introduction:
The Fifth World Congress on Myofascial Pain and Fibromyalgia, MYOPAIN 2001, Portland, Oregon, USA, September 9-13, 2001

Soft tissue pain is the primary symptom that the myofascial pain syndrome [MPS] patient and the fibromyalgia syndrome [FMS] patient have in common. It is apparent, from the accounts of physicians around the world, that these syndromes are very common and, for most physicians, difficult to treat. There is, therefore, an acknowledged need for a more complete understanding of pain generation and processing in these disorders and a desire to provide a more rational approach to their management. Thus, it was appropriate that the theme of this fifth World Congress of MYOPAIN should focus on the neurobiology of pain.

MYOPAIN 2001 was attended by participants from 30 countries, providing about 150 podium and poster presentations relating to soft tissue pain disorders. The fields of endeavor included physicians from a variety of medical and surgical specialties, dental practitioners, basic science investigators, nurses, physical therapists, and a number of other paramedical disciplines. Mealtimes provided opportunities for direct interactions between investigators and clinicians, between doctors in training and experienced therapists, to meet and share vital conversations about problems experienced and potential solutions. A number of relevant exhibitors provided viewpoints and resources that would have been missed without them.

(Haworth co-indexing entry note]: "Introduction: The Fifth World Congress on Myofascial Pain and Fibromyalgia, MYOPAIN 2001, Portland, Oregon, USA, September 9-13, 2001." Bennett, Robert M. Co-published simultaneously in Journal of Musculoskeletal Pain [The Haworth Medical Press, an imprint of The Haworth Press, Inc.] Vol. 10, No. 1/2, 2002, pp. 1-3; and: The Clinical Neurobiology of Fibromyalgia and Myofascial Pain: Therupeutic Implications (ed: Robert M. Bennett) The Haworth Medical Press, an imprint of The Haworth Press, Inc., 2002, pp. 1-3. Single or multiple copies of this article are available for a fee from The Haworth Document Delivery Service [1-800-HAWORTH. 9:00 a.m. - 5:00 p.m. [EST|. E-mail address: [email protected]|.

In this age of increasingly large meetings, with their multiple concurrent sessions, the challenge for the avid learner is to decide which sessions to attend and which to write off. It often represents an impossible quandary. The MYOPAIN series of meetings takes a different approach. It assumes that the attendees are better served by providing high quality material on a wide range of topics, in an all plenary program. In this style of meeting, it is possible to take in everything that is provided and miss nothing over an intensive three and one half day period. The three morning sessions were composed of didactic presentations of the basic sciences relevant to the neurobiology of pain, followed by clinical and therapeutic descriptions of regional pain syndromes, and concluding with the diagnosis and management of chronic widespread pain. During the noon hours and early evenings, time was specifically allocated to the viewing original new research presented by the investigators at their posters. The afternoon sessions provided opportunity for podium presentations of the best of the poster abstracts from that day. These sessions allowed review of what was learned from the poster presentations and an opportunity to see how the larger audience related to the new information. Finally, on the last day of the meeting, special workshops were provided on selected key topics to help new clinicians and investigators to get up to speed on fibromyalgia, myofascial pain syndrome, and on how to write for the medical literature. A new feature of this meeting was the provision of thematic symposia on two important topics: 1. Novel Approaches to the Management of Fibromyalgia, and 2. Torture and Myofascial Pain Syndrome.

A full listing of the scheduled topics was made available to Congress attendees in the form of a program booklet. For those not in attendance, the manuscripts of the invited morning session speakers are provided. These proceedings will also be available from the publisher [see below] to nonsubscribers in bookform. The abstracts, presented during the poster sessions, have already been published (1) and are available to Journal subscribers and others from The Haworth Press at 1-800-HAWORTH or on line at <http://www.haworthpressinc.com>.

It is my hope that this volume of the proceedings will provide a comprehensive update on the latest developments in soft tissue pain and a valuable point of reference for both clinicians and scientists in the field.

Robert M. Bennett, MD, FRCP, FACP
Professor of Medicine
Division of Arthritis and Rheumatic Diseases
Oregon Health and Science University
Portland, Oregon, USA

REFERENCE

• 1. Russell IJ, editor: Abstracts from the 5th World Congress on Myofascial Pain and Fibromyalgia, Portland, Oregon, USA, September 9-September 13, 2001. J Musculoske Pain 9(Suppl #5):1-113, 2001.

PRESIDENTIAL ADDRESS

Muscle Pain and Aging

Leonardo Vecchiet

SUMMARY. Objectives: Pain complaints at the musculoskeletal level, especially in their chronic manifestations, increase with age. The objectives of this review article are to discuss the physiologic and pathologic factors that may contribute to changes in sensitivity towards muscle pain with aging.

Findings: Very few psychophysical studies have explored the physiologic changes in muscle sensitivity with age. The largest population study so far conducted would indicate a decrease in pain threshold [pressure and electrical stimuli], particularly in elderly men. The profile of this hypersensitivity runs parallel to that of an increased oxidative damage to muscle fibers documented with the aging process. The global prevalence of pathologic events potentially painful for the muscle increases with age. The increase, however, mostly regards primary muscle pain, e.g., myofascial pain due to trigger points from microtraumatic events, or muscle pain secondary to deep somatic structure involvement, e.g., referred muscle pain/hyperalgesia from osteoarthrilic joints. In contrast, the same phenomenon is not observed for muscle pain secondary to visceral pathology-especially in its acute form-which, instead decreases with age. The extent of the pain symptom due to pathologic conditions does not increase proportionally to that of the underlying pathologic process, probably due to reduced reactivity of the elderly tissues towards inflammatory events [lesser capacity of producing algogenic substances].

Leonardo Vecchiet, MD, is affiliated with the Department of Medicine and Science of Aging, "G. D'Annunzio" University of Chieti. Italy.

Address correspondence to: Leonardo Vecchiet, MD, Semeiotica Medica, Policlinico "SS. Annunziata," via dei Vestini s.n., 66013 Chieti Scalo [CH], Italy [E-mail: [email protected]].

(Haworth co-indexing entry note): "Muscle Pain and Aging." Vecchiel. Leonardo. Co-published simultaneously in Journal of Musculoskeletal Pain (The Haworth Medical Press, an imprint of The Haworth Press. Inc.] Vol. 10, No. 1/2.2002. pp. 5-22; and: The Clinical Neurobiology of Fibromyalgia and Myofascial Pain: Therapeutic Implications [ed: Robert M. Bennett] The Haworth Medical Press, an imprint of The Haworth Press, Inc., 2002, pp. 5-22. Single or multiple copies of this article are available for a fee from The Haworth Document Delivery Service [1-800-HAWORTH, 9:00 a.m. - 5:00 p.m. [EST]. E-mail address: geiinfo@ haworthpressinc.com].

Conclusions: The increased complaints of musculoskeletal pain with aging appear the result of a complex interaction between the physiologic process of aging, which seems to promote muscle damage and muscle hypersensitivity especially in the male sex, and the increased prevalence with age of most potentially painful pathologic conditions of the muscle itself or of other deep somatic structures. Future clinical and research efforts should aim at better understanding the pathophysiology of the increased pain in muscles in the elderly to help prevent not only the suffering to the patient but also the disabling consequences of the pain symptom at this level. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-HAWORTH. E-mail address: <getinfo@ haworthpressinc.com> Website: <http://www.HaworthPress.com> © 2002 by The Haworth Press, Inc. All rights reserved.]

KEYWORDS. Muscle pain threshold,oxidative damage,elderly,pri- mary and secondary muscle pain/hyperalgesia

INTRODUCTION

Pain in the musculoskeletal domain is one of the most frequent forms of pain in humans, in relation to a high number of conditions that may cause the symptom, both physiologic-such as physical exercise-and pathologic (1-3). Though muscle pain is dominant in every stage of life, it has been shown to increase with the aging process, so that complaints of the symptom-especially forms of chronic musculoskeletal pain-are more frequent in the elderly than in the younger population (4,5).

The aim of the present report is to discuss the factors that may contribute to changes in sensitivity towards muscle pain with aging. An indispensable premise to this discussion is an analysis of the general elements that may alter pain perception in relation to senescence.

PAIN IN THE ELDERLY

In the past few decades, there has been an exponential rise in the average individual life expectancy, which has led to a significant percentage increase in the elderly population. Pain in the elderly has therefore become a topical subject, destined to play an increasingly important role in the field of pain research and management in the forthcoming years (6).

When analyzing the problem of pain manifestations in older people, two fundamental elements need to be considered: 1. the impact of the physiologic process of aging on the system involved in perception, transmission, and elaboration of the painful signal; 2. the prevalence and incidence of potentially painful pathologies in old age.

While numerous epidemiologic investigations have been carried out to explore the frequency of the pathologic algogenic conditions of various body districts in the elderly (4), very few studies have so far examined the possible changes in pain perception as a function of age perse, i.e., in the absence of any pathology (5). In addition, the design and results of these studies are often controversial (4). It therefore seemed important to pay particular attention to the problem of the relationship between the physiologic aging process and the transmission/elaboration of the painful signal.

Physiologic Changes in Pain Perception in the Elderly

The progression of age, even in excellent health, in itself implies a decline in the functionality of the various body systems, which appears to be more marked the higher the level of "specialization" of the systems. Typical examples are the progressive reduction of visual and auditory capacities-producing the classic situations termed "presbyopia" and "presbycus...

Table of contents

• Cover
• Half Title
• Series Page
• Title Page
• Copyright Page
• Contents
• Preface: MYOPAIN 2001
• Introduction: The Fifth World Congress on Myofascial Pain and Fibromyalgia, MYOPAIN 2001, Portland, Oregon, USA, September 9-13, 2001
• Index