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

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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