Central sensitisation in chronic fatigue syndrome and fibromyalgia; a case control study

[nerd]

Authors: Julius H Bourke, Theresa Wodehouse, Lucy V Clark, Elena Constantinou, Bruce L Kidd, Richard Langford, Vivek Mehta, Peter D White
Published: November 2021
Published in: Journal of Psychosomatic Research
PMID: 34600309
doi: 10.1016/j.jpsychores.2021.110624

Abstract

Introduction: Chronic fatigue syndrome (CFS) and fibromyalgia (FM) are both complex conditions that are challenging to treat. This may be related to an incomplete understanding of their pathophysiology, itself obfuscated by their heterogeneity. The symptomatic overlap between them and their common comorbidity suggests a shared vulnerability, which might be explained by central sensitisation.

Methods: 19 CFS cases, 19 FM cases and 20 age and sex matched healthy controls (HC) were recruited primarily from secondary care clinics in London. Those with other pain disorders, psychiatric diagnoses and those taking centrally acting or opiate medications were excluded. Participants were asked to abstain from alcohol and over the counter analgaesia 48 h prior to assessment by static and dynamic quantitative sensory tests, including measures of temporal summation (TS) and conditioned pain modulation (CPM).

Results: CS, as defined by the presence of both enhanced TS and inefficient CPM, was present in 16 (84%) CFS cases, 18 (95%) FM cases, and none of the HC (p < 0.001). Pressure pain thresholds were lower in CFS (Median222kPaIQR 146-311; p = 0.04) and FM cases (Median 189 kPa; IQR 129-272; p = 0.003) compared to HC (Median 311 kPa; IQR 245-377). FM cases differed from HC in cold-induced (FM = 22.6 °C (15.3-27.7) vs HC = 14.2 °C (9.0-20.5); p = 0.01) and heat-induced (FM = 38.0 °C (35.2-44.0) vs HC = 45.3 °C (40.1-46.8); p = 0.03) pain thresholds, where CFS cases did not.

Conclusion: Central sensitisation may be a common endophenotype in chronic fatigue syndrome and fibromyalgia. Further research should address whether central sensitisation is a cause or effect of these disorders.

 

[Pyrrhus]

Thanks so much for posting @nerd!

But the psychiatrists are trying to revive the psychiatric nonsense known as "central sensitization syndrome".

At least they made an effort to use the correct physiological definition of "sensitization", so I must give them credit for that:

assessment by static and dynamic quantitative sensory tests, including measures of temporal summation (TS) and conditioned pain modulation (CPM).

Related discussion:

Central Sensitization Phenotypes in Post Acute Sequelae of SARS-CoV-2 Infection (PASC) 2021
https://forums.phoenixrising.me/thr...elae-of-sars-cov-2-infection-pasc-2021.85840/

 

[nerd]

Me too.
"Central hyperalgesia" is a scientific term.
"Central sensitization" is pseudo-scientific nonsense.

"Microglial sensitization" is a scientific concept.
"Central sensitization" is pseudo-scientific nonsense.

Nicely written.

They try to establish a semi-psychological construct around a biomedical pathophysiology by pure association.

Nice point.

While these practitioners used to say that the patient needed to simply un-learn their incorrect beliefs by, say, Graded Exercise Therapy, they now say that the patient needs to simply un-sensitize their incorrectly-sensitized nervous pathways by, say, Graded Exposure Therapy.

My sister-in-law was an in-patient in one of these non-psychiatric clinics (that happened to be run by the hospital's psychiatric faculty) in order to treat her chronic trigeminal pain.

They didn't look at her trigeminal nerve function or consider any biomedical causes of trigeminal pain. They simply told her to gradually get used to sucking on an ice-cube, which was one of the worst triggers of her trigeminal pain - in order to gradually "un-sensitize her incorrectly-sensitized trigeminal nerve."

Obviously, the Graded Exposure Therapy didn't work. But later, when she tried a biomedical treatment, her trigeminal pain seemed to clear right up.

I assume that homeostasis is the real issue when they try Graded Exposure Therapy and it actually works occasionally. But the means of overstimulation of the neurons is medieval and burns a whole forest just to eradicate one pest. The risk of damage is much greater than the chance of recovery - the same issue as with GET.