title: Provocation of hypotension and pain during upright tilt table testing in adults with fibromyalgia.
abstract: OBJECTIVE
  Fibromyalgia is a common but poorly understood problem characterized by widespread pain and chronic fatigue. Because chronic fatigue has been associated with neurally mediated hypotension, we examined the prevalence of abnormal responses to upright tilt table testing in 20 patients with fibromyalgia and 20 healthy controls.
  
  
  METHODS
  Each subject completed a symptom questionnaire and underwent a three stage upright tilt table test (stage 1:45 minutes at 70 degrees tilt; stage 2, 15 minutes at 70 degrees tilt with isoproterenol 1-2 micrograms/min; stage 3, 10 minutes at 70 degrees tilt with isoproterenol 3-4 micrograms/min). An abnormal response to upright tilt was defined by syncope or presyncope in association with a drop in systolic blood pressure of at least 25 mm Hg and no associated increase in heart rate.
  
  
  RESULTS
  During stage 1 of upright tilt, 12 of 20 fibromyalgia patients (60%), but no controls had an abnormal drop in blood pressure (P < 0.001). Among those with fibromyalgia, all 18 who tolerated upright tilt for more than 10 minutes reported worsening or provocation of their typical widespread fibromyalgia pain during stage 1. In contrast, controls were asymptomatic (P < 0.001).
  
  
  CONCLUSIONS
  These results identify a strong association between fibromyalgia and neurally mediated hypotension. Further studies will be needed to determine whether the autonomic response to upright stress plays a primary role in the pathophysiology of pain and other symptoms in fibromyalgia.
authors.affiliation: Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: I
authors.initials: I
authors.lastname: Bou-Holaigah
authors.forename: H
authors.initials: H
authors.lastname: Calkins
authors.forename: J A
authors.initials: JA
authors.lastname: Flynn
authors.forename: C
authors.initials: C
authors.lastname: Tunin
authors.forename: H C
authors.initials: HC
authors.lastname: Chang
authors.forename: J S
authors.initials: JS
authors.lastname: Kan
authors.forename: P C
authors.initials: PC
authors.lastname: Rowe
mesh_terms: D000328:Adult; D005260:Female; D005356:Fibromyalgia / Q000150:complications* / Q000503:physiopathology*; D006801:Humans; D007022:Hypotension / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology*; D012016:Reference Values; D018667:Tilt-Table Test