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Skeletal Muscle Abnormalities in Patients With Fibromyalgia

Widespread muscle pain and tender points are the most common complaints of fibromyalgia patients, and the underlying mechanisms responsible for these symptoms have been studied intensively during the past decade. It has been suggested that fatigue and pain may lead to decreased levels of physical activity in many patients. The resulting deconditioned state may itself contribute to muscle abnormalities. Associated symptoms such as disturbed sleep, anxiety, depression, or irritable bowel also may have a negative impact on muscle function and level of daily activities. The important interactions between the central nervous and musculoskeletal systems may involve another element, the neuroendocrine stress-response system. This review will consider both the current state of knowledge and also future studies which might be designed to answer more effectively the outstanding questions regarding the underlying pathogenesis of fibromyalgia.

The most common complaints of fibromyalgia (FM) patients are widespread muscle pain and tender points. These symptoms, along with the fatigue, muscle weakness, and stiffness reported by many, are of great concern to the patients. The underlying mechanisms responsible for these symptoms have been studied intensively during the past decade. Considerable progress has been made in identifying morphologic and biochemical abnormalities in these painful, dysfunctional muscles. Most if not all of the observed anatomical and metabolic defects are consistent with symptoms of weakness, fatigue, and pain.

It has often been suggested that fatigue and pain may lead to decreased levels of physical activity in many patients, and the resulting deconditioned state may itself cause muscle abnormalities. However, deconditioning is not usually associated with generalized pain, indicating that a much more inclusive rationale is required to explain the problems of this multidimensional disease. Associated symptoms such as disturbed sleep, anxiety, depression, or irritable bowel syndrome also may have a negative impact on muscle function or level of daily activities. The important interactions between the central nervous system and the musculoskeletal system may involve yet a third player, the neuroendocrine stress-response system. As an example, growth hormone and somatomedin-C deficits in the sleep-deprived patient may prevent adequate repair of muscle tissue following exertion and exercise.

In this review, we will consider both the current state of knowledge and also future studies which might be designed to answer more effectively the outstanding questions regarding the underlying pathogenesis of FM. Improved approaches to treatment for these patients are ultimately dependent upon unraveling the complex pathophysiology of this disorder.

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Skeletal Muscle Abnormalities in Patients With Fibromyalgia