Pain in fibromyalgia (FM)

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Just as our caveman forebears were frail in the face of

predatory animals, we are frail in today’s society of

childhood neglect or abuse, bumper-to-bumper traffic,

frustration at work, and multiple daily hassles.

The same

neuroendocrine systems and pain regulatory mechanisms

protected early man during acute stress are still encoded in

our genome, but may be maladaptive in psychologically and

physiologically vulnerable people faced with chronic stress.

Many patients with fibromyalgia become vulnerable because of

the long-lasting psychological and neurophysiological effects

of negative experiences in childhood. Ill-equipped with

positive cognitive, emotional, and behavioral skills as

adults, they display maladaptive coping strategies, low

self-efficacy, and negative mood when confronted with the

inevitable stressors of life.

Psychological distress ensues,

which reduces thresholds for pain perception and tolerance

(already relatively low in women) even further. Converging

lines of psychological and neurobiological evidence strongly

suggest that chronic stress-related blunting of the HPA,

sympathetic, and other axes of the stress response together

with associated alterations in pain regulatory mechanisms may

finally explain the pain and fatigue of fibromyalgia.

Vulnerable people who can be classified by the ACR criteria as

having fibromyalgia do not have a discrete disease. They are

simply the most ill in a continuum of distress, chronic pain,

and painful tender points in the general population.

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