Abstract
Abnormal activity of the sympathetic nervous system is involved in the pathogenesis of protracted pain syndromes. The term sympathetically maintained pain is applied to those neuropathic pain cases that respond to sympatholytic maneuvers. The sympathetically maintained pain concept has strong and ample foundations in the animal model. After nerve injury, sympathetic sprouting at the dorsal root ganglia becomes apparent and form basket-like structures around large-diameter axotomized sensory neurons; sympathetic stimulation can activate such neurons repetitively. This article discusses the relationship between sympathetic dysfunction and chronic pain syndromes, the animal models of sympathetically maintained pain and novel clinical instruments that assess autonomic function. This article also reviews the evidence proposing that fibromyalgia is a sympathetically maintained, neuropathic pain syndrome and finally it discusses therapies that improve resting autonomic tone as well as FM symptoms.
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