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Central mechanisms in the maintenance of chronic widespread noninflammatory muscle pain – Source: Current Pain and Headache Reports, Oct 2008

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Chronic widespread pain (CWP) conditions such as fibromyalgia and myofascial syndromes are characterized by generalized pain, tenderness, morning stiffness, disturbed sleep, and pronounced fatigue. However, CWP pathophysiology is still unclear.

 

A number of hypotheses have been proposed as the underlying pathophysiology of CWP: muscular dysfunction/ischemia, central sensitization, and a deficit in endogenous pain-modulating systems.

This article reviews the current and emerging literature about the pathophysiology and neurobiology of chronic widespread musculoskeletal pain.

• Widespread musculoskeletal pain results in changes in the central nervous system in human subjects and animal models.

• These changes likely reflect alterations in supraspinal modulation of nociception [modulation of the nervous system’s signal transmission above the spinal cord – i.e., in the brain], and include increases in excitatory and decreases in inhibitory modulation pathways.

• These alterations in excitation and inhibition likely drive changes observed in the spinal cord to result in central sensitization [sensitization of the entire central nervous system], and the consequent pain and hyperalgesia [increased sensitivity to pain].

Source: Current Pain and Headache Reports, Oct 2008;12(5):338-43. PMID: 18765138, by Desantana JM, Sluka KA. Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, USA. [E-mail: kathleen-sluka@uiowa.edu]

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