Muscle Pain – Mechanisms and Clinical Significance: The Situation Is More Complex in Patients With Chronic Pain

by Prof. Dr. med. Siegfried Mense in volume 12/2008

The author writes that the transfer of results from animal experiments to the human model will have to be undertaken with caution. It should be emphasized that conditions in humans are far more complex, especially in patients with fibromyalgia. Patients with pain represent open dynamic models (1) and not isolated models for the study of nociception. Pain is by definition a phenomenon of perception, which may be associated with nociception but is not identical with it.

The proffered explanations can be transferred to patients with pain, but not in the sense of "either – or" alternatives but rather of "as-well-as" mechanisms. Not only promoting or inhibiting influences of the nociceptive system have a role but many other psychosocial disturbances, as is shown by the high correlation with anxiety disorders, depression, and insomnia (2, 3). In fibromyalgia patients, the importance of chronic stress with dysfunction of the hypothalamic-pituitary-adrenal axis has been shown. In many patients, traumatic events in childhood were reported (2), and appropriate diagnosis and treatment therefore include the patient’s perception, personality, and biography (1).
DOI: 10.3238/arztebl.2008.0510a

PD Dr. med. Roland Wörz
Friedrichstr. 73
76669 Bad Schönborn, Germany
[e-mail]

References

1. Wörz R: Die multidimensionale, non-lineare Schmerzkonzeption. Ein breiter Ansatz für Erklärung und Verständnis komplexer Schmerzsyndrome. Fortschr Med 2001; 119: 129–33.

2. Ecker-Egle ML, Egle UT: Primäre Fibromyalgie. In: Egle UT, Hoffmann SO, Lehmann KA, Nix WA (Hrsg.): Handbuch Chronischer Schmerz. Stuttgart, New York: Schattauer 2003; 571–82.

3. Okifuji A, Turk DC: Fibromyalgia syndrome: prevalent and perplexing. Pain Clinical Updates 2003; 11: 1–4.