Abstract
Abnormal activity of the sympathetic nervous system may be involved in the pathogenesis of chronic pain syndromes. This article reviews the animal studies of sympathetically induced pain behavior, the controversy of sympathetically maintained pain in clinical practice, and the dysautonomic nature of fibromyalgia (FM). FM has neuropathic pain features (stimuli-independent pain state accompanied by allodynia and paresthesias). The proposal of FM as a sympathetically maintained pain syndrome is based on the controlled studies showing that patients with FM display signs of relentless sympathetic hyperactivity and that the pain is submissive to sympathetic blockade and is rekindled by norepinephrine injections. Dysautonomia also may explain the multisystem features of FM.
Similar content being viewed by others
References and Recommended Reading
Baron R, Levina JD, Fields HL: Causalgia and reflex sympathetic dystrophy: Does the sympathetic nervous system contribute to the generation of pain? Muscle Nerve 1999, 22:678–695.
Sato J, Perl ER: Adrenergic excitation of cutaneous pain receptors induced by peripheral nerve injury. Science 1991, 251:1608–1610.
McLachlan EM, Jäning W, Devor M, Michaelis M: Peripheral nerve injury triggers noradrenergic sprouting within dorsal root ganglia. Nature 1993, 363:543–546.
Hassantash SA, Maier RV: Sympathectomy for causalgia: experience with military injuries. J Trauma 2000, 49:266–271.
Merskey H, Bogduk N: Classification of chronic pain. In IASP Task Force on Taxonomy. Seattle: IASP Press; 1994.
Baron R, Schattschneider J, Binder A, et al.: Relation between sympathetic vasoconstrictor activity and pain and hyperalgesia in complex regional pain syndrome: a case-control study. Lancet 2002, 359:1655–1660. A physiologic study in which endogenous catecholamine production induced by whole body cooling enhanced pain and hyperlagesia in patients with CRPS.
Ali Z, Raja SN, Wesselmann U, et al.: Intradermal injection of norepinephrine evokes pain in patients with sympathetically maintained pain. Pain 2000, 88:161–168.
Ochoa JL, Verdugo RJ: Reflex sympathetic dystrophy: a common clinical avenue for somatoform expression. Neurol Clin 1995, 13:351–363.
Bengtsson A, Bengtsson M: Regional sympathetic blockade in primary fibromyalgia. Pain 1988, 33:161–167.
Vaeroy H, Qiao Z, Morkrid L, Forre O: Altered sympathetic nervous system response in patients with fibromyalgia. J Rheumatol 1989, 16:1460–1465.
Elam M, Johansson G, Wallin BG: Do patients with primary fibromyalgia have an altered muscle sympathetic nerve activity? Pain 1992, 48:371–375.
Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology: Heart rate variability standards of measurement, physiological interpretation, and clinical use. Circulation 1996, 93:1043–1065.
Martinez-Lavin M, Hermosillo AG, Mendoza C, et al.: Orthostatic sympathetic derangement in subject with fibromyalgia. J Rheumatol 1997, 24:714–718.
Kelemen J, Lang E, Balint G, et al.: Orthostatic sympathetic derangement of baroreflex in patients with fibromyalgia. J Rheumatol 1998, 25:823–825.
Raj RR, Brouillard D, Simpson CS, et al.: Dysautonomia among patients with fibromyalgia: a noninvasive assessment. J Rheumatol 2000, 27:2660–2665.
Bou-Holaigah I, Calkins H, Flynn JA, et al.: Provocation of hypotension and pain during upright tilt table testing in adults with fibromyalgia. Clin Exp Rheumatol 1997, 15:239–246.
Martinez-Lavin M, Hermosillo AG, Rosas M, Soto ME: Circadian studies of autonomic nervous balance in patients with fibromyalgia: a heart rate variability analysis. Arthritis Rheum 1998, 42:1966–1971.
Cohen H, Neumann L, Shore M, et al.: Autonomic dysfunction in patients with fibromyalgia: application of power spectral analysis of heart rate variability. Semin Arthritis Rheum 2000, 29:217–227.
Cohen H, Neumann L, Alhosshle A, et al.: Abnormal sympathovagal balance in men with fibromyalgia. J Rheumatol 2001, 28:581–589.
Wolfe F, Smythe HA, Yunus MB, et al.: The American College of Rheumatology 1990 criteria for the classification of fibromyalgia: report of the Multicenter Criteria Committee. Arthritis Rheum 1999, 33:160–171.
Martinez-Lavin M, Hermosillo AG: Autonomic nervous system dysfunction may explain the multisystem features of fibromyalgia. Semin Arthritis Rheum 2000, 29:197–199.
Kooh M, Martínez-Lavin M, Meza S, et al.: Concurrent heart rate variability and polysomnography analyses in fibromyalgia patients. Clin Exp Rheumatol 2003, 21:529–530.
Otzenberger H, Simon C, Gronfier C, Brandenberger G: Temporal relationship between dynamic heart rate variability and electroencephalographic activity during sleep in man. Neurosci Lett 1997, 229:173–176.
Woolf CJ, Mannion RJ: Neuropathic pain: etiology, symptoms, mechanisms, and management. Lancet 1999, 353:1959–1964.
Simms RW, Goldenberg DL: Symptoms mimicking neurologic disorders in fibromyalgia syndrome. J Rheumatol 1988, 15:1271–1273.
Martinez-Lavin M, Lopez S, Medina M, Nava A: Use of the Leeds assessment of neuropathic symptoms and signs questionnaire in patients with fibromyalgia. Semin Arthritis Rheum 2003, 32:407–411.
Russell J: Advances in fibromyalgia: possible role for central neurochemicals. Am J Med Sci 1998, 315:377–384.
Hansson PT, Lacerenza M, Marchettini P: Aspects of clinical and experimental neuropathic pain: the clinical perspective. In Neuropathic Pain: Pathophysiology and Treatment. Edited by Hansson PT, Fields HL, Hill RG, Marchettini P. Seattle: IASP Press; 2001:1–19.
Woolf CJ: Pain: moving from symptom control toward mechanism-specific pharmacological management. Ann Intern Med 2004, 140:441–451.
Staud R, Cannon RC, Mauderli AP, et al.: Temporal summation of pain from mechanical stimulation of muscle tissue in normal controls and subjects with fibromyalgia syndrome. Pain 2003, 102:87–95.
Martínez-Lavń M, Vidal M, Barbosa RE, et al.: Norepinephrineevoked pain in fibromyalgia: a randomized pilot study ISCRTN 70707830. BMC Musculoskelet Disord 2002, 3:2. Most patients with FM have norepinephrine-evoked pain, which suggests that FM is a sympathetically maintained pain syndrome.
Martinez-Lavin M: Is fibromyalgia a generalized reflex sympathetic dystrophy. Clin Exp Rheumatol 2001, 19:1–3.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Martinez-Lavin, M. Fibromyalgia as a sympathetically maintained pain syndrome. Current Science Inc 8, 385–389 (2004). https://doi.org/10.1007/s11916-996-0012-4
Issue Date:
DOI: https://doi.org/10.1007/s11916-996-0012-4