title: The role of the central nervous system in the generation and maintenance of chronic pain in rheumatoid arthritis, osteoarthritis and fibromyalgia.
abstract: Pain is a key component of most rheumatologic diseases. In fibromyalgia, the importance of central nervous system pain mechanisms (for example, loss of descending analgesic activity and central sensitization) is well documented. A few studies have also noted alterations in central pain processing in osteoarthritis, and some data, including the observation of widespread pain sensitivity, suggest that central pain-processing defects may alter the pain response in rheumatoid arthritis patients. When central pain is identified, different classes of analgesics (for example, serotonin-norepinephrine reuptake inhibitors, α2δ ligands) may be more effective than drugs that treat peripheral or nociceptive pain (for example, nonsteroidal anti-inflammatory drugs and opioids).
authors.affiliation: Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, 75 Francis Street, PBB-B3, Boston, MA 02115, USA. ylee9@partners.org
authors.forename: Yvonne C
authors.initials: YC
authors.lastname: Lee
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Nassikas
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Clauw
mesh_terms: D000818:Animals; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000503:physiopathology*; D002490:Central Nervous System / Q000503:physiopathology*; D059350:Chronic Pain / Q000150:complications / Q000503:physiopathology*; D005356:Fibromyalgia / Q000150:complications / Q000503:physiopathology*; D006801:Humans; D010003:Osteoarthritis / Q000150:complications / Q000503:physiopathology*