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Muscle Physiology and Cold Reactivity in the Fibromyalgia Syndrome

1989; Elsevier BV; Volume: 15; Issue: 1 Linguagem: Inglês

10.1016/s0889-857x(21)00038-7

1558-3163

Robert M. Bennett,

Sports injuries and prevention

The weight of evidence implicates skeletal muscle as the end organ responsible for the pain in FMS. However, given the fact that FMS patients are aerobically unfit, it may be that the histologic, metabolic, local oxygenation, and blood flow abnormalities in the muscles are a secondary result of the “detraining effect” rather than a primary abnormality. There are many similarities between the muscle changes caused by exercise-induced microtrauma and the findings in FMS, and this needs further study. For example, unfit muscle is more likely to microtrauma; this causes pain and may condition some individuals to avoid further exertion, thus setting up a positive feedback loop of progressive unfitness and susceptibility to musculoskeletal pain. In normal individuals muscle microtrauma usually resolves in 2 to 3 weeks. It can be hypothesized that the slow wave sleep disturbance of FMS may delay this healing process by reducing the pulsatile secretion of growth hormone that is normally associated with delta sleep. Furthermore, muscle microtrauma will allow an influx of calcium into individual myofibrils, causing persistent (electrically silent) contraction with depletion of ATP; this could account for the observed decrease in high energy phosphates in FMS over tender points. Local areas of myofibrillar contraction would distort the architecture of the local capillaries; this may explain the wide variations in oxygen pressure readings over tender areas. If this hypothesis was correct, FMS would not be a “disease” in the classical sense of the word, but a continuum of a normal response, namely the exaggerated reaction of skeletal muscle to microtrauma and the ensuing secondary effects. Several other hypotheses could be generated to explain the objective data presented in this article. Thoughtful scrutiny of these ideas should permit the design of novel studies which will enhance our understanding of the fibromyalgia enigma.