Common Functional Pain Syndromes
Highlights
- When a patient presents with pain of no obvious organic origin, they are often labelled as having ‘functional’ pain. The exact diagnosis is derived from the organ system displaying the predominant symptoms e.g. musculoskeletal pain in fibromyalgia (FM) or visceral pain in irritable bowel syndrome (IBS). (View Highlight)
- There has been a paradigm shift in the understanding of FPS. The old model of multiple discrete chronic pain conditions is being replaced by a more overarching, although no less complex, state of central sensitivity syndrome (CSS) (View Highlight)
- Evidence is being accrued that FPS represent the phenotypic output of a complex interplay between genetic susceptibility, gene–environment interactions, and environmental triggers (View Highlight)
- Polymorphisms in catechol-O-methyltransferase (COMT) genes are associated with FM and there is correlation between the polymorphism and the number of tender pressure points that can be elicited clinically in these patients (View Highlight)
- Functional magnetic resonance imaging (fMRI) has consistently demonstrated an increased response to stimuli in the insula and anterior cingulate cortex (ACC) in patients with FM. These areas are involved in the processing and perception of unpleasant pain signals (View Highlight)
- Morphometric analysis of FM patients via MRI shows a three-fold increase in age-associated grey matter reduction.5 The loss is more significant in areas correlating to stress, pain, and cognitive function. That could in part explain the flare-up that these patients can have during periods of emotional stress (View Highlight)
- is important to stress that FM is not ‘in the patient's head’ and that it is ultimately a benign disease while acknowledging that there can be significant personal distress. Moderate, gradually introduced increases in physical activity show significant benefits in quality-of-life measures (View Highlight)