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Fibromyalgia As A Neuropathic Pain Disorder: The Link To Small Fiber Neuropathy

Thursday 11 June 2020


From Practical Pain Management:


Fibromyalgia syndrome (FM) is widely considered
to be the prototypic, centralized pain disorder, but
emerging evidence is changing this definition.
(Image: iStock)

Fibromyalgia as a Neuropathic Pain Disorder: The Link to Small Fiber Neuropathy

Rather than debating whether fibromyalgia is primarily a central or neuropathic pain disorder, the author argues that clinicians must understand that centralized and peripheral pain intersect and overlap.

By Don L. Goldenberg, MD
Practical Pain Management, Volume 20, Issue #3, Pages 45-49
© 2020 Remedy Health Media, LLC ALL RIGHTS RESERVED.

Fibromyalgia syndrome is a common chronic pain disorder affecting 3% to 8% of the general population. The syndrome also occurs in 20% to 40% of patients with osteoarthritis, rheumatoid arthritis, and systemic immune disorders, such as systemic lupus erythematosus and Sjogren’s syndrome.1 Diagnosis is typically made based on the symptom of chronic widespread pain and associated symptoms, particularly fatigue and sleep disturbances. The widespread pain must be present for at least 3 months and cannot be attributed to any other condition.

The Changing Terminology

Fibromyalgia (FM) is widely considered to be the prototypic, centralized pain disorder, which I have addressed in previous publications.2,3 Centralized pain, also referred to as central pain, central sensitization, or, recently, nociplastic pain, includes any chronic pain disorder with no identifiable mechanism of action outside the central nervous system (CNS). The International Association for the Study of Pain (IASP) has defined nociplastic pain as “pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain.”4,5


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