Fibromyalgia

DNIC’s efficacy across [the] menstrual cycle in women with fibromyalgia – Source: American Pain Society Annual Scientific Conference, May 2009

[Note: DNIC – diffuse noxious inhibitory controls – is a pain inhibition response originating at the spinal cord level when pain stimuli are communicated from any part of the body.]

Fibromyalgia syndrome (FMS) is a widespread disorder of unknown etiology affecting 2-4% of the general population in which women are about nine times more likely to develop fibromyalgia than men.(1)

Nonetheless, several hypotheses have been advanced to explain the onset of symptoms. One of these supports a reduction of diffuse noxious inhibitory controls (DNIC) in fibromyalgics. (2) Another hypothesis comes from the fact that the higher prevalence of FMS in women should be related to sex hormones (SH).

The goal of this study was to examine DNIC’s efficiency in relation to the menstrual cycle of women with FMS.

We measured DNIC recruitment and blood level of testosterone (T), estrogens (E) and progesterone (P) at three phases (lutheal, ovulation and menstrual) of a regular menstrual cycle in women with FMS. [Note: The lutheal - or luteal – phase involves build-up of the uterus lining after ovulation, to accept an embryo should conception occur.]

DNIC were activated by the persistent pain stimulation (PPS) procedure, which consists in a continuous nociceptive heat stimulation using a constant temperature thermode for two minutes (at the forearm) producing temporal summation of pain.(3)

DNIC activity was then indexed by comparing temporal summation effects recorded before and after a two minutes immersion of the contralateral arm in cold water (12°C).

FMS patients reported similar pain ratings before and after the immersion procedure in menstrual (low E and P) and ovulation phases (high E, low P).

However, they reported less pain after the immersion procedure during the lutheal phase (low E, high P). This pain diminution showed the analgesic effect caused by the activation of the DNIC.

Moreover, SH analysis showed that FMS patients have normal levels of T, E and P.

These results suggest that endogenous pain control mechanisms in FM female patients are modulated by menstrual cycle.

1. Wolfe, J Musculoskelet Pain, 1993;
2. Julien, Pain, 2005;
3. Tousignant-Laflamme, Brain Research, 2008.)

Source: American Pain Society Annual Scientific Conference, May 2009, Poster #165. Paul-Savoie E, Bourgault P, Tousignant-Laflamme Y, Pagé C, Marchand S; University of Sherbrooke, Sherbrooke, Quebec, Canada.