Fibromyalgia--are there different mechanisms in the processing of pain? A double blind crossover comparison of analgesic drugs.
OBJECTIVE
Pain was analyzed in patients with fibromyalgia (FM) in a randomized, double blind, crossover study using intravenous (i.v.) administration of different drugs.


METHODS
In 18 patients with FM muscle pain to i.v. administration of morphine (0.3 mg/kg), lidocaine (5 mg/kg), ketamine (0.3 mg/kg), or saline was studied. Spontaneous pain intensity, muscle strength, static muscle endurance, pressure pain threshold, and pain tolerance at tender points and non-tender point areas were followed. Drug plasma concentrations and effects on physical functioning ability score (FIQ) were recorded. A personality inventory (KSP) was used to related pain response to personality traits.


RESULTS
Thirteen patients responded to one or several of the drugs, but not to placebo. Two patients were placebo responders responding to all 4 infusions. Three were nonresponders responding to no infusions. Seven of the responders had a reduction in pain for 1-5 days. Pressure pain threshold and pain tolerance increased significantly in responders. Plasma concentrations were similar in responders and nonresponders. FIQ values improved significantly after the ketamine infusion. Responders scored higher on KSP scales for somatic anxiety, muscular tension, and psychasthenia compared with healthy controls.


CONCLUSIONS
FM diagnosed according to the American College of Rheumatology criteria seems to include patients with different pain processing mechanisms. A pharmacological pain analysis with subdivision into responders and nonresponders might be considered before instituting therapeutic interventions or research.
Sörensen
J
J
Department of Anaesthesiology, University Hospital, Linköping, Sweden.
Bengtsson
A
A
Ahlner
J
J
Henriksson
K G
KG
Ekselius
L
L
Bengtsson
M
M
D000328:Adult; D000778:Anesthetics, Dissociative / Q000627:therapeutic use*; D019540:Area Under Curve; D018592:Cross-Over Studies; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D005356:Fibromyalgia / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology; D006801:Humans; D007649:Ketamine / Q000627:therapeutic use*; D008012:Lidocaine / Q000627:therapeutic use*; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use*; D009119:Muscle Contraction / Q000187:drug effects; D009294:Narcotics / Q000627:therapeutic use*; D010146:Pain / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology; D010147:Pain Measurement / Q000187:drug effects / Q000523:psychology; D017288:Pain Threshold / Q000187:drug effects / Q000523:psychology; D010807:Physical Endurance / Q000187:drug effects
D000778:Anesthetics, Dissociative; D009294:Narcotics; D007649:Ketamine; D009020:Morphine; D008012:Lidocaine