Although some systematic review s have not established an unequivocal benefit of physical training , most authors report a benefit for patients with chronic pain or fatigue .
OBJECTIVE To review the published information on physical training for fibromyalgia ( FM ) and related syndromes .
Ketamine reduces muscle pain, temporal summation, and referred pain in fibromyalgia patients
& NA ; Central mechanisms related to referred muscle pain and temporal summation of muscular nociceptive activity are facilitated in fibromyalgia syndrome ( FMS ) patients . The present study assessed the effects of an NMDA‐antagonist ( ketamine ) on these central mechanisms . FMS patients received either i.v . placebo or ketamine ( 0.3 mg/kg , Ketalar ® ) given over 30 min on two separate occasions . Habitual pain intensity was assessed on a visual analogue scale ( VAS ) . Initially , 29 FMS patients received ketamine or isotonic saline to determine which patients were ketamine responders ( > 50 % decrease in pain intensity at rest by active drug on two consecutive VAS assessment s ) . Fifteen out of 17 ketamine‐responders were included in the second part of the study . Before and after ketamine or placebo , experimental local and referred pain was induced by intramuscular ( i.m . ) infusion of hypertonic saline ( 0.7 ml , 5 % ) into the tibialis anterior ( TA ) muscle . The saline‐induced pain intensity was assessed on an electronic VAS , and the distribution of pain drawn by the subject . In addition , the pain threshold ( PT ) to i.m . electrical stimulation was determined for single stimulus and five repeated ( 2 Hz , temporal summation ) stimuli . The pressure PT of the TA muscle was determined , and the pressure PT and pressure pain tolerance threshold were determined at three bilaterally located tenderpoints ( knee , epicondyle , and mid upper trapezius ) . VAS scores of pain at rest were progressively reduced during ketamine infusion compared with placebo infusion . Pain intensity ( area under the VAS curve ) to the post‐drug infusion of hypertonic saline was reduced by ketamine ( −18.4±0.3 % of pre‐drug VAS area ) compared with placebo ( 29.9±18.8 % , P<0.02 ) . Local and referred pain areas were reduced by ketamine ( −12.0±14.6 % of pre‐drug pain areas ) compared with placebo ( 126.3±83.2 % , P<0.03 ) . Ketamine had no significant effect on the PT to single i.m . electrical stimulation . However , the span between the PT to single and repeated i.m . stimuli was significantly decreased by the ketamine ( −42.3±15.0 % of pre‐drug PT ) compared with placebo ( 50.5±49.2 % , P<0.03 ) indicating a predominant effect on temporal summation . Mean pressure pain tolerance from the three paired tenderpoints was increased by ketamine ( 16.6±6.2 % of pre‐drug thresholds ) compared with placebo ( −2.3±4.9 % , P<0.009 ) . The pressure PT at the TA muscle was increased after ketamine ( 42.4±9.2 % of pre‐drug PT ) compared with placebo ( 7.0±6.6 % , P<0.011 ) . The present study showed that mechanisms involved in referred pain , temporal summation , muscular hyperalgesia , and muscle pain at rest were attenuated by the NMDA‐antagonist in FMS patients . It suggested a link between central hyperexcitability and the mechanisms for facilitated referred pain and temporal summation in a sub‐group of the fibromyalgia syndrome patients . Whether this is specific for FMS patients or a general phenomena in painful musculoskeletal disorders is not known
Although some systematic review s have not established an unequivocal benefit of physical training , most authors report a benefit for patients with chronic pain or fatigue .
OBJECTIVE To review the published information on physical training for fibromyalgia ( FM ) and related syndromes .