High Intramuscular pressure was recorded in the trapezius in patients with Fibromyalgia: an identifiable cause of pain and a potential biomarker
Fibromyalgia’s Future is a Biomarker
Frank Leavitt Ph.D.
Fibromyalgia is a painful, multi-symptom disorder that lacks a measurable, biological indicator to differentiate patients with fibromyalgia from other medical patients who present with pain. In the absence of an objective marker, the diagnosis is solely defined by clinical criteria that are symptom based. A major problem inherent in relying upon symptom based self reports as the sole source for diagnosis is that patients with fibromyalgia share so many look alike symptoms with patients with other medical disorders.
Fibromyalgia is a painful, multi-symptom disorder that lacks a measurable, biological indicator to differentiate patients with fibromyalgia from other medical patients who present with pain. In the absence of an objective marker, the diagnosis is solely defined by clinical criteria that are symptom based. A major problem inherent in relying upon symptom based self reports as the sole source for diagnosis is that patients with fibromyalgia share so many look alike symptoms with patients with other medical disorders.
Because symptoms of fibromyalgia are so non-specific and overlapping with other disorders, clinicians often struggle with the diagnosis. The chance that patients with widespread pain have a disorder other than fibromyalgia is high. Equally likely, fibromyalgia fails to be recognized when the diagnosis is appropriate.
Because symptoms of fibromyalgia are so non-specific and overlapping with other disorders, clinicians often struggle with the diagnosis. The chance that patients with widespread pain have a disorder other than fibromyalgia is high. Equally likely, fibromyalgia fails to be recognized when the diagnosis is appropriate.
A biomarker is important in fibromyalgia because of symptom invisibility. For most individuals with fibromyalgia, their symptoms are not expressed overtly. Slurred speech is an example of a highly visible symptom . The widespread pain of fibromyalgia is not. Most people with fibromyalgia pass as healthy in everyday life. Even to the trained clinical eye, they look well .
A biomarker is important in fibromyalgia because of symptom invisibility. For most individuals with fibromyalgia, their symptoms are not expressed overtly. Slurred speech is an example of a highly visible symptom . The widespread pain of fibromyalgia is not. Most people with fibromyalgia pass as healthy in everyday life. Even to the trained clinical eye, they look well .
Symptom invisibility in conjunction with the absence of measurable indicators of disease has made a true condition with high prevalence controversial in the medical field. In fact, doubt and disbelief are rampant in the medical field. Many critics contest the diagnosis of fibromyalgia entirely. They question its legitimacy as if something is amiss among clinicians making the diagnosis and are often active in penning articles that act as barriers to effective clinical care and good insurance coverage.
Symptom invisibility in conjunction with the absence of measurable indicators of disease has made a true condition with high prevalence controversial in the medical field. In fact, doubt and disbelief are rampant in the medical field. Many critics contest the diagnosis of fibromyalgia entirely. They question its legitimacy as if something is amiss among clinicians making the diagnosis and are often active in penning articles that act as barriers to effective clinical care and good insurance coverage.
A peripheral origin for the pain of fibromyalgia has been identified that meets criteria for a biomarker set down by the National Institutes of Health Biomarkers Definitions Working Group. A biomarker refers to “a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention.”[ Clin Pharmacol Therapeutics. 2001;69:89–95].
A peripheral origin for the pain of fibromyalgia has been identified that meets criteria for a biomarker set down by the National Institutes of Health Biomarkers Definitions Working Group. A biomarker refers to “a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention.”[ Clin Pharmacol Therapeutics. 2001;69:89–95].
Borrowing from an old theory of pain in fibromyalgia, we propose that the source of pain is within the site of pain, in the painful tender muscles associated with fibromyalgia. Specifically in the case of fibromyalgia, pain originates from the burden of augmented pressure within the trapezius muscle, a muscle often affected in fibromyalgia. One of the unavoidable consequences of abnormally high pressure in the trapezius muscle is compression of blood flowing through the trapezius muscle. Vascular compression is well known to activate pain by starving muscle tissue of oxygen. This position runs counter to the reigning theory of central sensitization which views pain as arising from abnormalities in central excitability
Borrowing from an old theory of pain in fibromyalgia, we propose that the source of pain is within the site of pain, in the painful tender muscles associated with fibromyalgia. Specifically in the case of fibromyalgia, pain originates from the burden of augmented pressure within the trapezius muscle, a muscle often affected in fibromyalgia. One of the unavoidable consequences of abnormally high pressure in the trapezius muscle is compression of blood flowing through the trapezius muscle. Vascular compression is well known to activate pain by starving muscle tissue of oxygen. This position runs counter to the reigning theory of central sensitization which views pain as arising from abnormalities in central excitability
To test the theory that intramuscular pressure at rest is a potential biomarker for fibromyalgia, we studied a large group of patients who met the clinical criteria for fibromyalgia. In this population, elevated pressure in the trapezius muscle at rest was prominent, with an average pressure of 33.48±5.90 mm Hg. Pressure in the comparison group without fibromyalgia was almost threefold lower. They produced an average pressure of 12.23±3.75 mm Hg (p<.001). The difference in pressure in fibromyalgia at rest was almost 22 mm Hg. Why pressure builds so high in fibromyalgia is unknown, but , in terms of differences, we are not dealing with small innocuous amounts.
To test the theory that intramuscular pressure at rest is a potential biomarker for fibromyalgia, we studied a large group of patients who met the clinical criteria for fibromyalgia. In this population, elevated pressure in the trapezius muscle at rest was prominent, with an average pressure of 33.48±5.90 mm Hg. Pressure in the comparison group without fibromyalgia was almost threefold lower. They produced an average pressure of 12.23±3.75 mm Hg (p<.001). The difference in pressure in fibromyalgia at rest was almost 22 mm Hg. Why pressure builds so high in fibromyalgia is unknown, but , in terms of differences, we are not dealing with small innocuous amounts.
An important task of biomarkers is to distinguish pain patients with and without fibromyalgia. In validating the accuracy of biomarkers in the detection of disease, measurements known as sensitivity and specificity play an important role in determining whether a particular characteristic is an accurate indicator of a disease state. Sensitivity is the percentage of people with fibromyalgia who are correctly identified by intramuscular pressure. The critical intramuscular pressure for identifying fibromyalgia is ≥ 23 mm Hg. Specificity is the percentage of the comparison group without fibromyalgia who are correctly identified. The critical pressure is <23 mm Hg.
An important task of biomarkers is to distinguish pain patients with and without fibromyalgia. In validating the accuracy of biomarkers in the detection of disease, measurements known as sensitivity and specificity play an important role in determining whether a particular characteristic is an accurate indicator of a disease state. Sensitivity is the percentage of people with fibromyalgia who are correctly identified by intramuscular pressure. The critical intramuscular pressure for identifying fibromyalgia is ≥ 23 mm Hg. Specificity is the percentage of the comparison group without fibromyalgia who are correctly identified. The critical pressure is <23 mm Hg.
Intramuscular pressure in the fibromyalgia group ranged from 8 to 58 mm Hg, with only 2 scores less than 23 mm Hg. Scores in the comparison groups showed almost no overlap with fibromyalgia. They ranged from 3-22 mm Hg. Pressures ≥ 23 mm Hg accurately flagged 98% of the fibromyalgia sample. Thus only 2% of individuals with fibromyalgia went undetected. Pressures ≥ 23 were found in 0% of the comparison population. As the value of a measure is defined by these values, intramuscular pressure is close to a perfect biomarker measure.
Intramuscular pressure in the fibromyalgia group ranged from 8 to 58 mm Hg, with only 2 scores less than 23 mm Hg. Scores in the comparison groups showed almost no overlap with fibromyalgia. They ranged from 3-22 mm Hg. Pressures ≥ 23 mm Hg accurately flagged 98% of the fibromyalgia sample. Thus only 2% of individuals with fibromyalgia went undetected. Pressures ≥ 23 were found in 0% of the comparison population. As the value of a measure is defined by these values, intramuscular pressure is close to a perfect biomarker measure.
Sex based differences in intramuscular pressure in the fibromyalgia sample were not in evidence. Women and men recorded similarly high intramuscular pressure in the trapezius muscle on examination. The average muscle pressure of males and females was 34.4 ± 4.8 mm Hg and 33.3 ± 6.1 mm Hg respectively. While fibromyalgia predominantly affects females, biological sex is not an independent risk factor for augmented trapezius pressure.
Sex based differences in intramuscular pressure in the fibromyalgia sample were not in evidence. Women and men recorded similarly high intramuscular pressure in the trapezius muscle on examination. The average muscle pressure of males and females was 34.4 ± 4.8 mm Hg and 33.3 ± 6.1 mm Hg respectively. While fibromyalgia predominantly affects females, biological sex is not an independent risk factor for augmented trapezius pressure.
Elevated intramuscular pressure is a measurable characteristic of fibromyalgia that has been overlooked for decades. Replication in other clinical centers may be a turning point that revolutionizes the manner in which clinicians approach assessment. It provides objective proof of a pain disorder that has been discounted by many and casts questions of diagnostic legitimacy into the wastebasket of history. No longer will clinicians be able to discount the symptoms of fibromyalgia as psychological derivatives because of the lack of supporting evidence. They simply need to look beyond the standard set of laboratory and radiological tests. With the right measuring stick, fibromyalgia is medically real and objectively quantifiable.
Elevated intramuscular pressure is a measurable characteristic of fibromyalgia that has been overlooked for decades. Replication in other clinical centers may be a turning point that revolutionizes the manner in which clinicians approach assessment. It provides objective proof of a pain disorder that has been discounted by many and casts questions of diagnostic legitimacy into the wastebasket of history. No longer will clinicians be able to discount the symptoms of fibromyalgia as psychological derivatives because of the lack of supporting evidence. They simply need to look beyond the standard set of laboratory and radiological tests. With the right measuring stick, fibromyalgia is medically real and objectively quantifiable.
Based on an article published in The Journal of Rheumatology, Sept. 15, 2020. https://doi.org/10.3899/jrheum.191068 April 2021, 48(4), 598-602.
Intramuscular Pressure Is Almost Three Times Higher in Fibromyalgia Patients: A Possible Mechanism for Understanding the Muscle Pain and Tenderness.
DOUBLE EXPOSURE PHOTOGRAPHY
DOUBLE EXPOSURE PHOTOGRAPHY
