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Hyperexcitability in fibromyalgia (FM)

  [ 48 votes ]   [ Discuss This Article ]
By Sorensen J, Graven-Nielsen T, Henriksson KG, Bengtsson M, Arendt-Nielsen L • • January 15, 1998

OBJECTIVE: Spontaneous chronic widespread pain in combination with
hyperalgesia to pressure stimuli is the hallmark of
fibromyalgia (FM). We tested whether muscular hyperalgesia can
exist in a muscle without spontaneous pain, which could
indicate a generalized hyperexcitability of the nociceptive
system in patients with FM.

METHODS: Twelve women with FM and
12 age matched female controls participated in this blind
study. Patients had no spontaneous pain in the anterior tibial
(AT) muscle. The pressure pain threshold was tested on the AT
muscle. The pain threshold to electrical single and repeated
stimulations of the skin and of the right AT muscle was
assessed. Pain was evoked in the left AT muscle by infusion of
sterile hypertonic saline (5.7%, 2.8 ml over 480 s). The
saline induced muscle pain intensity and duration were
assessed by continuous recordings on an electronic visual
analog scale (VAS), and the distribution of pain was assessed
on drawings. The sequence of electrical sensibility tests and
the infusion of hypertonic saline was randomized.

Pressure pain thresholds were lower (p < 0.02) in patients
with FM compared to controls. Thresholds for pain evoked by
electrical stimulation at the skin were not significantly
different in the 2 groups. The pain threshold to repeated
intramuscular stimulation was significantly (p = 0.02) lower
for the patients with FM compared to the control group,
indicating that the temporal nociceptive summation was more
pronounced in patients with FM. This is an indication of
central sensitization (hyperexcitability). Infusion of
hypertonic saline evoked muscle pain with a longer duration (p
= 0.01) in patients with FM, and referred pain that spread to
a larger area (p = 0.002) than in controls. This is an
indication of central hyperexcitability.

a state of central hyperexcitability in the nociceptive system
in FM. This hyperexcitability can be revealed by excitation of
intramuscular nociceptors in a muscle with no spontaneous

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