Pain-begets-pain Pattern in Fibromyalgia

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This is a clinical pattern of cycles whereby one pain aggravates the patient’s other diffuse muscular fibromyalgia pains. This could also be dubbed a “pain-begets-pain cycle” (this is not the same as temporal summation or wind-up).

Here is a situation from the author’s clinic in a patient’s pressure pain thresholds in a patient’s tender points were suddenly altered by a fight. The patient was an unusually rough and tumble, single, inner city mother with fibromyalgia. She lived a rough life in a tough neighbourhood. For example, her boyfriend was a convicted murderer that had served his entire sentence in jail. I had seen her many times and I knew her usual levels of tenderness for her fibromyalgia tender points. Generally, they were moderately tender year-round.

One day she was in a fight. She made it to my office only minutes after the fight. She was in pain. Partly it was from the blows to her body. She was also very emotional. A thug in a local restaurant had just punched her. Even though she was only hit in a few areas, all her tender points were extremely tender, well beyond her baseline. My impression was that she was experiencing a combination of direct injury pains where she was hit as well as an exacerbation of her fibromyalgia pains. This suggested to me that a “pain begets pain” pattern may exist in some patients whereby each pain places the brain in situations such that it is inclined to have more pains. This example does not prove the “pain-begets-pain cycle” but it does provide information as to a possible mechanism, should the existence of this hypothetical cycle be proven. More study is needed. It is difficult to say if the pivotal factor was resentment of being hit by an enemy. Or, perhaps the injury pain directly affected the fibromyalgia pain. When enemies attack us physically, we can expect survival mechanisms and evaluative processing to be highly activated.