1. Fibromyalgia – physiological aspects
Eva Kosek, MD., PhD., Assistant Professor
Department of Clinical Neuroscience, Karolinska Institute and Stockholm Spine Center, Stockholm, Sweden.
Lausanne

2. Fibromyalgia - ACR 1990 criteria.
History of widespread pain > 3 months
Pain in at least 11 of 18 tender points on digital palpation.
Wolfe et al., 1990

3. TP count - a crude screening tool for disturbed sensory processing?
CWP (10-11%)
Female/male ratio 1½:1
CWP + TP =
FMS (0.5-4%)
Female/male
ratio 10:1
Clauw and Crofford 2003

4. Increased pain sensitivity to all tested modalities
Pressure pain Heat pain
Kosek et al 1995, 1996

5. 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

6. Lower my-opioidreceptor bindning capacity in patients
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

7. FMS patients have increased sensitivity to somatosensory stimuli independently of emotional factors – indicating augmentation of pain transmission and/or processing.

8. Future Challenges
Develop clinically useful diagnostic tools to detect facilitation, central sensitisation/disinhibition in individual patients
Further development of new treatments targeting these CNS-abnormalities
Investigate the possibilities of secondary prevention