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An Elephant Among Us: The Role of Dopamine in the Pathophysiology of Fibromyalgia - Source: The Journal of Rheumatology, Feb 2009

  [ 32 votes ]   [ 2 Comments ]
By Patrick B Wood, MD, and Andrew J. Holman, MD • • February 13, 2009

[Note: to read the free full text of this article by the originators of the Dopamine Theory of Fibromyalgia, click here.]

Exploration of the pathophysiology underlying fibromyalgia (FM) has become an exciting field of inquiry as we strive to improve our understanding of this enigmatic disorder.

While evidence of a neuro-dysregulatory state mounts and insights are gained as to potential contribution of specific neurotransmitters, a review of recent literature demonstrates that not all relevant neurotransmitters are being considered equally or with disinterest. Specifically:

• The potential contribution of serotonin and norepinephrine has been emphasized, ostensibly due in part to the qualified success of trials of serotonin-norepinephrine reuptake inhibitors,

• While a general awareness of the potential contribution of dopamine-related dysfunction lags.

Indeed, the text of recent reviews, and even peer-reviewed continuing medical education test articles, have contained either scant reference or, in a majority of cases, conspicuous neglect regarding the question of dopamine’s role in FM.

Despite the recent European League Against Rheumatism consensus recommendation to consider a dopamine agonist for treatment of FM, most clinicians and even medical authorities in the field routinely fail to acknowledge the mounting evidence for a role for dopamine in the pathogenesis of FM.

The proposition that a disruption of normal dopaminergic neurotransmission may make a substantial contribution to the pathophysiology of FM was initially based on 3 key observations:

1. FM has been characterized as a “stress-related” disorder due to its frequent onset and apparent exacerbation of symptoms in the context of stressful events;

2. The experience of chronic stress results in disruption of dopaminergic activity in otherwise healthy organisms; and

3. Dopamine plays a dominant role in natural analgesia within multiple brain centers.

The first hint in the medical literature of a connection between FM and dopamine was provided by Russell, et al, who in 1992 reported lower concentrations of metabolites of dopamine, norepinephrine, and serotonin …

Source: The Journal of Rheumatology, Feb 2009. 36(2). PMID: 19208556, by Wood, PB, Holman AJ. Angler Biomedical Technologies, LLC, Jonestown, Texas; Pacific Rheumatology Research, Inc., Renton, Washington, USA. [E-mail:]

Note: See also Dr. Wood's recent article "Hippocampal Metabolite Abnormalities in Fibromyalgia: Correlation with Clinical Features," published online Sep 2008 in The Journal of Pain.

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Article Comments Post a Comment

Ah HA - dopamine’s role in FM
Posted by: Svette_Palme
Feb 17, 2009
This certainly makes sense to me, as I have been proposing the "Sensory Processing Pain Disorder" theory of chronic pain. Insufficient Dopamine could be either the start of, or a symptom of, pain and/or fatigue. It seems almost obvious that at some point in the Fibro patient's life that dopamine would play a role. Personaly, a family history of problems with dopamine-related dysfunction is a clue; Parkinsons Disease is primarily a dopamine-related disease, right? L-dopa is the first drug for PD patients. As for Sensory Processing, dopamine is a primary neurotransmitter and where the processing of somatic [body] nerve signals takes place in the brain, something goes wrong and pain is created where it is not necessary, or it is to strong. What I am wondering about is MUSCLE CRAMPS - does dopamine dysregulation sometimes produce muscle cramps? My calf muscles are twitching right now, and I had a near-total spasm in the underside of my right foot in the car today, where the toes curl under and the whole foot points down [it is very hard to drive like that!!]. We will continue to unravel this wretched Fibro stuff.
Reply Reply

Posted by: Mishque
Feb 20, 2009
This is a very interesting article. However what non of the research doctors seem to point out or realise is that most of these drugs cannot be taken by people with Fibromyalgia due to severe side effects. I myself cannot take any heavy drugs any more especially those like Amytriptiline etc. In fact some of the medication I have tried have made things far worse. Our allegic tendancies are far higher than most people. In some cases very very low doses much smaller than given to a child actually help whereas adult doses are unbearable.
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