Blunted Pain Modulation Response to Induced Stress in Women with Fibromyalgia with and without Posttraumatic Stress Disorder Comorbidity: New Evidence of Hypo-Reactivity to Stress in Fibromyalgia?

The Challenge of Fibromyalgia Efficacy of Hypnosis in Alleviating the Invisible Pain: A Narrative Review

Fibromyalgia syndrome (FMS) is a multifaceted and incapacitating functional pain syndrome characterized by continuous, severe, widespread musculoskeletal pain. FMS is associated with other symptoms such as fatigue, nonrestorative sleep, cognitive/emotional dysfunction, and diminished health-related quality of life. The pathogenesis of FMS is still not fully understood, but an increasing amount of evidence supports the link between childhood/adulthood emotional, physical, sexual abuse or neglect and the development of FMS. Managing and treating FMS patients can be challenging because the syndrome is refractory to most treatments. However, psychological interventions, particularly hypnotherapy, have been shown to be effective in the cognitive modulation of fibromyalgic pain. FMS patients may benefit from hypnotherapy alone or in combination with standard medical therapy. Symptom-oriented hypnosis aims to reduce pain, fatigue, sleep problems, anxiety, and depression, while hypnotherapy focuses on resolving emotional conflicts and unresolved traumas associated with FMS. In conclusion, hypnosis may be a useful and safe adjunct tool for managing chronic pain and dysfunctional symptoms in challenging fibromyalgic patients.

The Biology of Stress Intolerance in Patients with Chronic Pain—State of the Art and Future Directions

Stress has been consistently linked to negative impacts on physical and mental health. More specifically, patients with chronic pain experience stress intolerance, which is an exacerbation or occurrence of symptoms in response to any type of stress. The pathophysiological mechanisms underlying this phenomenon remain unsolved. In this state-of-the-art paper, we summarised the role of the autonomic nervous system (ANS) and hypothalamus-pituitary-adrenal (HPA) axis, the two major stress response systems in stress intolerance. We provided insights into such mechanisms based on evidence from clinical studies in both patients with chronic pain, showing dysregulated stress systems, and healthy controls supported by preclinical studies, highlighting the link between these systems and symptoms of stress intolerance. Furthermore, we explored the possible regulating role for (epi)genetic mechanisms influencing the ANS and HPA axis. The link between stress and chronic pain has become an important area of research as it has the potential to inform the development of interventions to improve the quality of life for individuals living with chronic pain. As stress has become a prevalent concern in modern society, understanding the connection between stress, HPA axis, ANS, and chronic health conditions such as chronic pain is crucial to improve public health and well-being.

Stress-induced hyperalgesia instead of analgesia in patients with chronic musculoskeletal pain

Many individuals with chronic musculoskeletal pain (CMP) show impairments in their pain-modulatory capacity. Although stress plays an important role in chronic pain, it is not known if stress-induced analgesia (SIA) is affected in patients with CMP. We investigated SIA in 22 patients with CMP and 18 pain-free participants. Pain thresholds, pain tolerance and suprathreshold pain ratings were examined before and after a cognitive stressor that typically induces pain reduction (SIA). Whereas the controls displayed a significant increase in pain threshold in response to the stressor, the patients with CMP showed no analgesia. In addition, increased pain intensity ratings after the stressor indicated hyperalgesia (SIH) in the patients with CMP compared to controls. An exploratory analysis showed no significant association of SIA or SIH with spatial pain extent. We did not observe significant changes in pain tolerance or pain unpleasantness ratings after the stressor in patients with CMP or controls. Our data suggest that altered stress-induced pain modulation is an important mechanism involved in CMP. Future studies need to clarify the psychobiological mechanisms of these stress-induced alterations in pain processing and determine the role of contributing factors such as early childhood trauma, catastrophizing, comorbidity with mental disorders and genetic predisposition.