Hyperalgesia Amplified Pain in Fibromyalgia and ME/CFS

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Hyperalgesia is an increased pain response that’s common in fibromyalgia (FMS) and chronic fatigue syndrome (ME/CFS). In fibromyalgia, it’s such a significant feature that it essentially defines the condition. Put simply, when you have hyperalgesia, your body makes sensations more painful than they should be.

This is often referred to as “turning up the volume” on pain. It is a real, physiological phenomenon and not due to mental illness such as hypochondria. Nor is it the result of a person “making a big deal out of nothing,” as some people may believe.

Facts about Hyperalgesia

  • >Hyperalgesia is also recognized as “Medication Overuse Pain”.
  • >Hyperalgesia caused by opioid medications is generally observed when a medical condition like chronic headache or pain is treated with high doses of opioids.
  • >Recent evidence points to the fact that use of chronic opioids is solely responsible for activating pain receptor-IV of the glial cells,which leads to pain receptors getting into an inflammatory state resulting in amplification of pain impulse resulting in hyperalgesia.
  • >The opioids have been proved to cause chronic hyperalgesia after chronic opioid treatment.
  • >Acute hyperalgesia is seen during postoperative pain management with opioids in patients following surgery performed under general anesthesia.
  • >Fibromyalgia causes chronic neuropathic pain, which results in increased sensitivity to pain known as hyperalgesia.

Hyperalgesia and Central Sensitivity Syndromes

Hyperalgesia is a common underlying feature of a category of illnesses called central sensitivity syndromes, which includes FMS, ME/CFS, irritable bowel syndrome, restless legs syndrome, and several other conditions. It’s also associated with some inflammatory conditions and damage to certain types of nerves.


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Additionally, hyperalgesia can be a response to immune-system cells called pro-inflammatory cytokines, which your body releases in response to infection. Pro-inflammatory cytokines are theorized to be present in some cases of ME/CFS. (It’s not yet known whether that’s because of an on-going infection or due to a chronically activated immune system.) Many of the treatments for FMS and ME/CFS are aimed, at least in part, at reducing hyperalgesia.

These include anti-depressant medications (such as Cymbalta, Savella, and amitriptyline) and anti-seizure medications (including Lyrica and gabapentin.) This pain type is different from allodynia, which is also typical in FMS and present in some cases of ME/CFS.

Allodynia is a pain response to something that’s not normally painful, such as a light touch. Allodynia is often referred to as “skin pain,” as it commonly manifests as an extreme sensitivity to pressure or movement against the skin.

Hyperalgesia in Fibromyalgia: Neuropathic Pain

  • >If one is to describe neuropathic pain, it can be done so as both hyperalgesia as well as allodynia.
  • >Fibromyalgia causes neuropathic pain.
  • >Hyperalgesia is totally different from allodynia. Hyperalgesia is heightened sense of pain after painful stimuli where as allodynia is heightened sense of pain induced by non-painful stimuli like simple palpation on skin.
  • >Hyperalgesia induced by opioids is different than hyperalgesia caused by of fibromyalgia.
  • >Hyperalgesia caused by fibromyalgia is significantly heightened sense of pain to noxious as well as non-noxious stimuli.

Additionally, hyperalgesia can be a response to immune-system cells called pro-inflammatory cytokines, which your body releases in response to infection. Pro-inflammatory cytokines are theorized to be present in some cases of ME/CFS. (It’s not yet known whether that’s because of an on-going infection or due to a chronically activated immune system.)

Scientific study performed by Burgmer M et al.

Patient with chronic diseases like fibromyalgia occasional suffer with hyper responsiveness of central nervous system causing hyperalgesia. One of the study involving 34 patients were divided into two groups of seventeen patients, group consisted of seventeen fibromyalgia patients and seventeen normal control groups.

Scientific study was performed by Burgmer M et al. and published in 2012. Each patient in both groups had experimental incision in the right volar forearm. Primary and secondary hyperalgesia were assessed and recorded. Changes in hyperalgesia were correlated to brain activation (functional magnetic resonance imaging).

Test results suggest alteration of pain transmission at the central level (brain) in patients suffering with fibromyalgia. Similar changes in MRI were not observed in normal patients. These findings were related to changes in cerebral-midbrain-spinal mechanisms of pain inhibition.

Hyperalgesia is a common symptom in-patient suffering with fibromyalgia. Symptom of fibromyalgia often triggers the diagnosis of opioid addiction, tolerance or dependence. Hyperalgesia is a predominant symptom in large population of fibromyalgia patients who are not taking opioids for chronic pain.

Using a new therapy

Your medical history will always be important when using a new therapy. Ask a lot of questions and research what is available to you to help with your fibromyalgia pain. Everyone is different, and it’s okay if certain therapies don’t work right away. Should you get the diagnosis of fibromyalgia, your doctor may diagnose you with a specific type of fibromyalgia. It is important to pay attention to the diagnosis you receive.

The diagnosis of “hyperalgesia” means excessive pain, or it could mean that your pain has been amplified. Those who suffer from this type of fibromyalgia may experience pain that seems to be amplified. One example is a person who bumps into a corner. They may feel as though they have been stabbed and it brings tears to their eyes, but in the past they probably didn’t react like this.

Treatment of Hyperalgesia

  • >Patients who have hyperalgesia symptoms are treated by rotating opioids.
  • >Change of opioids helps to prevent hyperalgesia.

Hyperalgesia may not respond to opioid rotation. In such cases following medication are prescriibed with opioids.

Prevention of Hyperalgesia:

Hyperalgesia can be prevented by rotation of different opioids in approximately six month interval. Addition of NMDA receptor antagonists like dextromethorphan, methadone or ketamine with opioids also helps to prevent hyperalgesis.


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Reference: fight fibromyalgia.

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