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Provocation of hypotension & pain during upright tilt table testing in adults with fibromyalgia (FM)

  [ 15 votes ]   [ Discuss This Article ]
By Bou-Holaigah I, Calkins H, Flynn JA, Tunin C, Chang HC, Kan JS, Rowe PC • • May 15, 1997

OBJECTIVE: Fibromyalgia is a common but poorly understood problem
characterized by widespread pain and chronic fatigue. Because
chronic fatigue has been associated with neurally mediated
hypotension, we examined the prevalence of abnormal responses
to upright tilt table testing in 20 patients with fibromyalgia
and 20 healthy controls.
METHODS: Each subject completed a
symptom questionnaire and underwent a three stage upright tilt
table test (stage 1:45 minutes at 70 degrees tilt; stage 2, 15
minutes at 70 degrees tilt with isoproterenol 1-2
micrograms/min; stage 3, 10 minutes at 70 degrees tilt with
isoproterenol 3-4 micrograms/min). An abnormal response to
upright tilt was defined by syncope or presyncope in
association with a drop in systolic blood pressure of at least
25 mm Hg and no associated increase in heart rate.
During stage 1 of upright tilt, 12 of 20 fibromyalgia patients
(60%), but no controls had an abnormal drop in blood pressure
(P < 0.001). Among those with fibromyalgia, all 18 who
tolerated upright tilt for more than 10 minutes reported
worsening or provocation of their typical widespread
fibromyalgia pain during stage 1. In contrast, controls were
asymptomatic (P < 0.001).
CONCLUSION: These results identify a
strong association between fibromyalgia and neurally mediated
hypotension. Further studies will be needed to determine
whether the autonomic response to upright stress plays a
primary role in the pathophysiology of pain and other symptoms
in fibromyalgia.

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