Загальне підвищення чутливості: біопсихологічне пояснення хронічного болю у хворих на фіброміалгію і хронічний синдром втоми

 

 

Mira Meeus, Jo Nijs

Department of Human Physiology,

Faculty of Physical Education and Physiotherapy,

Vrijc Universiteit Brüssel (VUB), Brüssel, Belgium

Division of Musculoskeletal Physiotherapy,

Department of Health Sciences, University College Antwerp, Antwerp, Belgium

 

Анотація. Міра Меус, Джо Нейс. Загальне підвищення чутливості: біопсихологічне пояснення хронічного болю у хворих на фіброміалгію і хронічний синдром втоми. У статті приводяться дані щодо фізіологічного механізму централізованого підвищення чутливості при фіброміалгії і хронічній втомі. Висунута гіпотеза про те, що постійне підвищення чутливості є причиною хронічного болю у людей з хронічним синдромом втоми.

Ключові слова: Хронічний синдром втоми, хронічний біль, нервова система.

Аннотация. Мира Меус, Джо Нейс. Общее повышение чувствительности: биопсихологическое объяснение хронической боли у людей с фибромиалгией и хроническим синдромом усталости. В статье имеются данные относительно физиологического механизма централизованного повышения чувствительности при фибромиалгии и хронической усталости. Выдвинута гипотеза о том, что постоянное повышение чувствительности может быть причиной хронической боли у людей с хроническим синдромом усталости.

Ключевые слова: Хронический синдром усталости, хроническая боль, нервная система.

Abstract. Mira Meeus, Jo Nijs. In addition to the debilitating fatigue, the majority of patients with chronic fatigue syndrome (CFS) experience chronic widespread pain. These pain complaints show the greatest overlap between CFS and fibromyalgia (FM). Although the literature provides evidence for central sensitization as cause for the musculoskeletal pain in FM, in CFS this evidence is currently lacking, despite the observed similarities in both diseases. The knowledge concerning the physiological mechanism of central sensitization, the pathophysiology and the pain processing in FM, and the knowledge on the pathophysiology of CFS lead to the hypothesis that central sensitization is also responsible for the sustaining pain complaints in CFS. This hypothesis is based on the hyperalgesia and allodynia reported in CFS, on the elevated concentrations of nitric oxide presented in the blood of CFS patients, on the typical personality styles seen in CFS and on the brain abnormalities shown on brain images. To examine the present hypothesis more research is required. Further investigations could use similar protocols to those already used in studies on pain in FM like, for example, studies on temporal summation, spatial summation, the role of psychosocial aspects in chronic pain, etc.

Keywords Central sensitization, Chronic fatigue syndrome, Chronic pain, Fibromyalgia

 

Chronic fatigue syndrome (CFS), as defined by the Centers for Disease Control and Prevention (CDCP), is a complex illness characterized by prolonged debilitating fatigue and multiple non-specific symptoms including headaches, recurrent sore throats, fever, muscle and joint pain, and neurocognitive complaints [1, 2]. In addition to the chronic fatigue, widespread and persistent pain is common in individuals with CFS [3-5]. A population-based study revealed that 94% of the persons diagnosed with CFS report muscle aches and pain and 84% report joint pain [6]. Nishikai et al. [7] reported muscle pain in 85 CFS patients of 114 patients (74. 6%). Seventy-four patients (64. 9%) complained of arthralgia. In another study, 24 of 44 patients suffered from chronic widespread pain [8]. Chronic fatigue accompanied by chronic musculoskeletal impairments such as myalgias and arthralgias could be considered an important subclass of CFS [9]. Evidence supportive of the clinical importance of widespread pain in CFS has been provided [10]: chronic pain accounts for up to 34% of the CFS patients' self-reported activity limitations and participation restrictions. Chronic pain is more disabling than chronic fatigue [10].

Given these facts, it may be sutprising that the etiology of these pain complaints has not been studied extensively in patients with CFS. The systematic literature review by Meeus et al. [11] shows that only little progress has been made in understanding chronic widespread pain in patients with CFS. A few hypotheses have been proposed, but they have not been studied in depth or relatively little work has been performed to test these hypotheses. In contrast, a large body of scientific literature regarding the etiology of chronic pain complaints in fibromyalgia (FM) is currently available. The diagnosis of FM is based on the 1990. American College of Rheumatology criteria. Following these criteria, FM patients present with 11 of 18 positive tender points and with widespread pain [12]. Validity of both the definition for CFS and FM has been shown [12, 13].

Especially, investigations focusing on the phenomenon «central sensitization» are presented in force in FM. In CFS, the theory of central sensitization has only been suggested, to our knowledge [14]. Given the great overlap between CFS and FM [15] and given the dearth of studies focusing on the explanation for the chronic widespread pain in patients with CFS, it would be