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Chronic Low Back Pain as a Model of Fibromyalgia

Goal of study: In a study funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases and led by Daniel J. Clauw, MD, investigators compared mechanisms of pain and tenderness in patients with two chronic pain conditions: chronic low back pain and fibromyalgia.

For many people with chronic low back pain, as for people with fibromyalgia, there is no identifiable, physiologic cause of pain. Researchers have used sensory testing and magnetic resonance imaging (MRI) of the brain to identify generalized pain sensitivity and altered brain processing in people with fibromyalgia. These findings suggest that the central nervous system is somehow augmenting pain. Researchers suspect this also may be the case for a subset of people with low back pain. In other words, their back pain has more to do with the way their body’s process pain signals than with their backs.

To test this theory, Dr. Clauw and his research team used MRI and pain testing to study three groups of people:
* One with chronic low back pain that is not explained by MRI or x-ray findings
* One with fibromyalgia
* One without either low back pain or fibromyalgia

They conducted pain tests with a computerized device that applies pressure to the thumbnail. Participants from the three groups rated their pain at various levels of pressure. The researchers then used MRI to measure activity in areas of the brain that process pain. Using MRI provides objective evidence of the pain that study participants report.

At equal pressures, those in the chronic low back pain group and those in the fibromyalgia group reported significantly more pain than people without either condition. Also, the MRI data showed more extensive activity in the areas of the brain that process pain in both these groups. These findings supported previous studies that found people with fibromyalgia report a high amount of pain - and show brain activity that corresponds with their reports - when a low amount or pressure is applied.

The novel finding of Dr. Clauw's team, however, is that people with low back pain experienced just as much tenderness and sensitivity in response to thumbnail pressure as did the people with fibromyalgia. They also showed the same types of brain activation. These results suggest that understanding chronic low back pain better may lead to more effective treatments for it and could discourage the use of surgery and medications that will not help for this particular subset of people with back pain.