What is the role of depression in the etiology of fibromyalgia?

Updated: Nov 14, 2018
  • Author: Chad S Boomershine, MD, PhD, CPI, CPT; Chief Editor: Herbert S Diamond, MD  more...
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Answer

Depression contributes to the subjective unpleasantness and distress of pain through parallel, somewhat independent neural pain processing networks for purely sensory and affective pain elements. People who are healthy and people who have fibromyalgia but no depression exhibit increased rCBF only in the somatosensory cortices and the anterior insula, whereas people with fibromyalgia and depression also show increased rCBF in the amygdala and contralateral anterior insula, which are involved in affective pain processing. [71]

However, chronic pain is not simply a manifestation of depression. Despite common reports of pain and other somatic symptoms, patients with pure major depression, compared with patients with fibromyalgia, actually have fewer tender points, higher pain thresholds, and more stoic responses to pain stimuli. [72] In addition, negative emotions such as sadness and anger have been shown to be general risk factors for pain amplification independent of a diagnosis of fibromyalgia. [24]


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