Fibromyalgia - from syndrome to disease. Overview of pathogenetic mechanisms
Karl G. Henriksson
Department of Neuroscience and Locomotion Section of Medical Rehabilitation, Faculty of Health Sciences Linköping University Sweden
According to the classification criteria proposed by the American College of Rheumatology, fibromyalgia is a longstanding multifocal pain condition combined with generalised allodynia/hyperalgesia. It is the generalised allodynia/hyperalgesia that distinguishes fibromyalgia from other conditions with chronic musculoskeletal pain. Central sensitisation of nociceptive neurons in the dorsal horn due to activation of N-methyl-D-aspartic acid receptors and disinhibition of pain due to deficient function of the descending inhibitory system are probable pathogenic factors for allodynia/hyperalgesia. Furthermore, chronic pain is a chronic emotional and physical stressor. Chronic stress and chronic sleep disturbance are not specific for fibromyalgia but could be the causes of symptoms like fatigue, cognitive difficulties and other stress-related symptoms. They may also cause neuroendocrinological and immunological aberrations.
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