Heat Allodynia and Hyperalgesia in Fibromyalgia Patients

There are pain conditions that, unlike CRPS described above, are characterized by diffuse pains and hyperalgesia over large areas of body. The ability to use the same patients as their own control in establishing hyperalgesia and allodynia is therefore more challenging in these patient populations. An alternative approach is to compare their ratings of experimental heat stimuli to groups of age- and sex-matched control subjects.

For example, heat hyperalgesia has been shown to be a prevalent characteristic of fibro-myalgia (22-25). Fibromyalgia is a common disease, prevalent in approximately 2% to 10% of the general population and it occurs predominately in females (26). The pathogenesis of fibromyalgia is unknown, although abnormal concentration of central nervous system (CNS) neuropeptides and alterations of the hypothalamic-pituitary-adrenal axis have been described (27,28). Fibromyalgia is a chronic pain syndrome, characterized by generalized pain, tender points, disturbed sleep, and pronounced fatigue. Pain in fibromyalgia is consistently felt in the musculature and may be related to sensitization of CNS pain pathways. Fibromyalgia patients also have heat allodynia/hyperalgesia when tested with ramp-and-hold skin temperatures, as shown in Figure 2 (3). However, unlike CRPS patients, fibromyalgia and IBS patients are more likely to have diffuse pain within many body areas. Thus, their heat hyperalgesia/ allodynia has been established by comparing their pain ratings to those of age- and sex-matched control subjects (Fig. 2).

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