Abstract
Central sensitivity syndromes (CSS) include fibromyalgia syndrome (FMS), irritable bowel syndrome, temporomandibular disorder, restless legs syndrome, chronic fatigue syndrome, and other similar chronic painful conditions that are based on central sensitization (CS). CSS are mutually associated. In this paper, prevalence of FMS among other members of CSS has been described. An important recent recognition is an increased prevalence of FMS in other chronic pain conditions with structural pathology, for example, rheumatoid arthritis, systemic lupus, ankylosing spondylitis, osteoarthritis, diabetes mellitus, and inflammatory bowel disease. Diagnosis and proper management of FMS among these diseases are of crucial importance so that unwarranted use of such medications as corticosteroids can be avoided, since FMS often occurs when RA or SLE is relatively mild.
Highlights
The fact that fibromyalgia syndrome (FMS) is associated with several similar conditions without structural pathology was first reported in a controlled study in 1981 [1], following which a conceptual model was proposed with a Venn diagram, showing the mutual overlaps in these syndromes [2]
A large number of studies have confirmed these associations, compared with both healthy controls as well as diseases with structural pathology (DWSP) [3, 4]. ( there are structural changes, e.g., decreased hippocampus and gray matter volume in some CSS conditions, these changes seem to result from prolonged central sensitization (CS) and will be discussed at the end.) These overlapping conditions are collectively known as central sensitivity syndromes (CSS) [5,6,7,8], since CS is the common binding glue between them
This study suggests that peripheral input contributes to CS
Summary
The fact that fibromyalgia syndrome (FMS) is associated with several similar conditions without structural pathology was first reported in a controlled study in 1981 [1], following which a conceptual model was proposed with a Venn diagram, showing the mutual overlaps in these syndromes [2]. A name should be meaningful, tell the gist of the topic, and must not distort the underlying truth, recognizing that scientific truth is not carved in rock and does change over time In this discourse, I shall use the terms syndrome, illness, condition, and disease synonymously. Such nomenclatures as “medically unexplained symptoms” or MUS and “somatization disorder” (SD) are fallacious and detrimental to scientific progress, and statements of bias. Such a bias impedes empathetic and proper patient care. By DSM IV-TR definition, in SD “laboratory tests are remarkable for the absence of findings to support subjective symptoms.” This is obviously not true of CSS diseases as has been adequately discussed [7]. The problem is that MUS represents illness and illness is a second class citizen in the land of medicine
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