Page 23 - JCBP-3-3

Journal of Clinical and
Basic Psychosomatics Utilizing hypnosis to cope with fibromyalgia

The diagnosis and management of FMS present a processing and stress response mechanisms. Therefore, a
1
challenge for both patients and health-care professionals biopsychosocial model provides a better way to understand
due to the absence of reliable clinical criteria. There have fibromyalgia compared to a purely biomedical approach. 17
been different criteria for diagnosing FMS over time. The There is increasing evidence linking adverse childhood
modified American College of Rheumatology diagnostic events (ACE) with FMS. 1,2,6,13 Studies have found that
criteria of 2011 and 2016 criteria are the ones that have physical and sexual abuse are more common in FMS
9,10
been used in recent clinical studies: 1,6,13,18-23
1. The pain is generalized, meaning it affects at least four patients than in healthy controls.
out of five regions of the body, except the jaw, chest, Previous studies have found conflicting results
and abdomen regarding the prevalence of victimization in FMS patients.
2. The symptoms have been at a similar level for at least Some studies reported no difference between FMS
3 months patients and healthy controls, whereas others found
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3. The WPI (a measure of how many body regions are significantly higher rates of abuse in FMS patients. Meta-
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painful) is ≥7 and the SSS score (a measure of how analyses by Paras et al., Häuser et al., and Coppens
21
19
severe the symptoms are) is ≥5, or the WPI is 4 – 6 and et al., consistently found a high prevalence of ACE in
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the SSS score is ≥9. FMS patients. Varinen et al. established a link between
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2. Etiopathogenesis childhood bullying victimization and adult fibromyalgia.
A recent meta-analysis by Kaleycheva et al. further
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The pathogenesis of FMS remains elusive, although solidified the association between adult FMS and exposure
several factors have been implicated in its development. to various stressors. Individuals with a history of ACE are
These include central sensitization, impaired stress three times more likely to develop FMS compared to the
response, neuroinflammation, autoimmune dysfunction, general population. 25
neurotransmitter abnormalities, and small fiber
neuropathy. 6,11,12 Childhood abuse can significantly impact the key
symptoms of fibromyalgia. Jiao et al. found that a history
20
Despite the presence of widespread symptoms such as of abuse was associated with more severe symptoms
pain and multiple trigger points, there is limited evidence and reduced QoL in FMS patients. Ortiz et al. found a
26
of peripheral dysfunction, such as musculoskeletal significant association between childhood physical abuse
abnormalities. However, there is growing evidence that and increased tenderness in women with fibromyalgia.
13
FMS is a complex central pain syndrome characterized
by increased pain sensitivity due to hyperexcitability and There is increasing evidence that FMS and post-
decreased inhibition within the central nervous system. 1,2,13 traumatic stress disorder (PTSD) share similar
biological, physiological, and neuroanatomical patterns.
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Neuropsychologic studies have shown that memory Neuroimaging studies have identified overlapping brain
impairment is more common in FMS patients than in activation patterns between PTSD and FMS patients,
those with non-specific chronic low back pain (NS-CLBP), particularly in regions such as the medial prefrontal and
and this impairment is often associated with attention ventromedial cortex, and the amygdala, suggesting the
control disorders. 14 existence of shared neural pathways in both conditions. 28
Neuroimaging studies have found that patients with Häuser et al. found that 45.3% of 395 consecutive FMS
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FMS experience a faster loss of brain gray matter than patients also had PTSD, compared to only 3% of healthy
healthy individuals, suggesting potential premature brain controls. In over two-thirds of cases, adverse events
aging. In addition, studies have shown that FMS patients preceded the onset of FMS, whereas in <1/3 of cases these
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experience amplified brain activation in pain-related
regions when exposed to painful stimuli compared to events followed the onset of FMS. In 4% of cases, adverse
healthy individuals. This suggests that their pain detection events occurred in the same year as the FMS onset. Nardi
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and processing mechanisms may be overly sensitive. 16 et al. confirmed a high prevalence of PTSD among FMS
patients, reporting it at approximately 56%.
3. Psychosocial correlates While trauma and significant stress might not directly
The development, worsening, and chronicity of FMS are cause fibromyalgia or PTSD, they can influence the brain’s
influenced by psychosocial factors, which are acknowledged pain and emotional processing systems, particularly in
as etiopathogenetic factors. Trauma is a well-known trigger genetically predisposed individuals. This influence can
for FMS, with the trauma hypothesis proposing that lead to heightened pain sensitivity and co-occurrence of
experiences of abuse and neglect can alter the body’s pain symptoms that are characteristic of both FMS and PTSD. 6

Volume 3 Issue 3 (2025) 17 doi: 10.36922/jcbp.4796