Central Processes Underlying Fibromyalgia

Abstract

Fibromyalgia is a common chronic pain disorder characterised by a robust clinical phenotype with principal features that include widespread pain and tenderness, as well as high levels of sleep disturbance, fatigue, cognitive dysfunction, and emotional distress. Fibromyalgia symptoms occur along a spectrum ranging from mild to severe. The impact on the patient can be very high, with significant effects on personal, recreational, and work activities. The pathophysiology of fibromyalgia is complex and involves abnormal processing of pain and other sensory inputs from the periphery to the brain. In turn, central processes, which modulate this input, are the critical elements that initiate the sequence of events that lead to the clinical phenotype. The functioning of the stress response through its links to pain and other sensory neural processing is a key upstream component of the fibromyalgia cascade. Furthermore, emotional distress appears as a common everyday driver of this process. The mechanisms contributing to the clinical phenotype of fibromyalgia are driven by a top-down process. The aim of this review is to discuss the key central processes that underlie the fibromyalgia clinical phenotype and discuss how these should be the focus of both current management strategies and future research.