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Counter irritation test in primary fibromyalgia (FM)

In primary fibromyalgia the main symptom is diffuse pain

predominating at tender points which are sensitive to

palpation. The aim of this study was to compare the effects on

the amplitude of the nociceptive flexion reflex of the lower

limb (RIII reflex) of applying painful pressure to the tender

points with the effects of the same pressure applied to other

points of the body or to the same part of the body in control

subjects. This method was chosen because previous studies have

shown that it was possible to activate the diffuse noxious

inhibitory system using a “counter-irritation” stimulation.

Our study was carried out on 18 fibromyalgic patients and on

12 control subjects. During the counter-irritation procedure,

consisting of applying pressure with a mechanical dolorimeter

to tender points, a clear cut and significant decrease in the

amplitude of the RIII response was observed in 6 patients. In

conclusion, in view of the subjective nature of the criteria

used at present to diagnose primary fibromyalgia, we would

like to suggest that a positive counter-irritation test be

adopted as a further obligatory criterion, since it has been

clearly established that the diffuse noxious inhibitory

control responsible for the decrease in the RIII amplitude can

be activated only when the subjects undergo intense

nociceptive stimulation.

Guieu R, Serratrice G, Pouget J