Novel Paradigms of Centralized Pain in Fibromyalgia (Pain Signatures)

Daniel Clauw
University of Michigan, USA

The term centralized pain is used to refer to chronic pain states that are caused or maintained by the central nervous system.  This new mechanism of pain has been much better understood over the past few decades and is now officially recognized by the IASP as nocicplastic pain.  The centralized pain phenotype is now understood to include widespread or multifocal pain accompanied by other CNS symptoms such as fatigue, sleep, memory and mood problems, as well as by hypersensitivity to multiple types of sensory stimuli.  Objective evidence of this centralized pain phenotype can be identified on quantitative sensory testing and functional, chemical and structural neuroimaging.   Changes in functional connectivity patterns are emerging which seem to be biomarkers for this type of pain.  There is also emerging evidence that these centralized pain states are accompanied by a primed inflammatory response that might contribute to symptomatology.