Hyperalgesia Amplified Pain in Fibromyalgia & ME/CFS

A hand turns the volume knob on a stereo.

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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.

High-tech brain scans demonstrate this over-response to pain, with the pain centers of the brain lighting up far more for people with illnesses featuring hyperalgesia than in those without. That shows a difference in the physiological--not psychological--experience of pain.

For example, if the average person would rate a particular sensation at a five on the pain scale, someone with hyperalgesia may rate it at a seven or an eight.

The increase in pain due to hyperalgesia can be confined to certain areas of the body or it can be widespread.

An odd feature of hyperalgesia is that it doesn't directly cause pain, it simply intensifies it. A person must have pain from another source before hyperalgesia can have any effect.

The increased pain due to this symptom is sometimes what makes the difference between a person being functional and being debilitated by their illness(es).

While it seems to be contradictory, opioid (narcotic) pain relievers such as Vicodin (hydrocodone-acetaminophen) and OxyContin (oxycodone) can sometimes, with long-term use, lead to hyperalgesia. This is called opioid-induced hyperalgesia. In these cases, the medications people rely on to feel better are actually making them feel worse. The solution is to stop taking these types of medications.

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 syndromerestless legs syndrome, and several other conditions. It's also associated with some inflammatory conditions and damage to certain types of nerves.

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 extreme sensitivity to pressure or movement against the skin.

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