This may be due, in part, to the inadequacy of early pain theories, such as the discredited specificity theory, intensity theory and pattern theory ( 21), and to weaknesses in the gate control theory (GCT), which has been been proposed as the basis for some music effects. In TCD, normal thalamocortical resonance is disrupted by changes in the behaviour of neurons in the thalamus.Music and painĪlthough there have been numerous studies investigating music and pain ( 20), few have been adequately theorized in relation to dominant pain theories to explain why music reduces pain. Support for this mechanism was found in a study in which normalization of reduced thalamic activity was observed in response to analgesic treatment (nerve blockade) in patients with peripheral neuropathic pain ( 19). Previous literature suggests that lowered thalamic function in FM patients represents a ceiling effect of descending pain inhibition ( 16) maintained by the persistent excitatory input of pain signals.
There is increasing evidence for altered thalamic function in pain patients with chronic pain ( 14, 15) and FM ( 16– 18). Some forms of chronic pain appear to alter thalamocortical connections, causing a disruption of thalamic feedback and the possibility that chronic pain may be related to thalamocortical dysrhythmia (TCD) ( 13).
Documented abnormalities include evidence of peripheral sensitization and wind-up phenomenon, central sensitization with changes in functional magnetic resonance imaging and single-photon emission computed tomography scans of the brain, increased levels of substance P in the cerebrospinal fluid and impairment of descending noxious inhibitory control ( 11, 12). Ideal management includes both nonpharmacological and pharmacological treatments using a multimodal approach, with active patient participation fostered by a strong patient-centred locus of control ( 10).Ībnormalities in pain processing have been identified at various levels in the peripheral, central and sympathetic nervous systems, as well as the hypothalamo-pituitary-adrenal axis stress-response system. In the United States, the cost for service utilization in an individual FM patient was >$2000 in 1997, with reports in the order of $4000 per year per patient for Canada and Europe ( 6– 9). Due to the nature of FM, many patients experience problems with their activities of daily living (ADL) and poor quality of life, and may end up on disability, which has a significant impact on them and their families.
Mood disorders, including depression and anxiety, are present in up to three-quarters of patients with FM ( 5). Sleep abnormalities result in changes in sleep latency, sleep disturbance and fragmented sleep, leading to impaired daytime function ( 3, 4). Fatigue is the most common associated complaint and is present in >90% of patients ( 1).
Pain is the primary complaint in patients with FM. FM is a common pain disorder estimated to affect 2% to 4 % of the population, of whom 80% are women ( 2) it is most prevalent in the third to fifth decade of life. Fibromyalgia (FM) is a syndrome involving diffuse body pain with associations of fatigue, sleep disturbance, cognitive changes, mood disturbance and other variable somatic symptoms ( 1).
0 kommentar(er)
