EDITORIAL - An elephant among us: the role of dopamine in the pathophysiology of fibromyalgia

[Guest guest]

Journal of Rheumatology

Feb 2009

Editorial

An Elephant Among Us: The Role of Dopamine in the Pathophysiology of

Fibromyalgia

Exploration of the pathophysiology underlying fibromyalgia (FM) has

become an exciting field of inquiry as we strive to improve our

understanding of this enigmatic disorder. While evidence of a

neuro-dysregulatory state mounts and insights are gained as to

potential contribution of specific neurotransmitters, a review of

recent literature demonstrates that not all relevant neurotransmitters

are being considered equally or with disinterest. Specifically, the

potential contribution of serotonin and norepinephrine has been

emphasized, ostensibly due in part to the qualified success of trials

of serotonin-norepinephrine reuptake inhibitors, while a general

awareness of the potential contribution of dopamine-related

dysfunction lags.

Indeed, the text of recent reviews, and even peer-reviewed continuing

medical education test articles, have contained either scant reference

or, in a majority of cases, conspicuous neglect regarding the question

of dopamine’s role in FM. Despite the recent European League Against

Rheumatism consensus recommendation to consider a dopamine agonist for

treatment of FM1, most clinicians and even medical authorities in the

field routinely fail to acknowledge the mounting evidence for a role

for dopamine in the pathogenesis of FM.

The proposition that a disruption of normal dopaminergic

neurotransmission may make a substantial contribution to the

pathophysiology of FM was initially based on 3 key observations: (1)

FM has been characterized as a “stress-related” disorder due to its

frequent onset and apparent exacerbation of symptoms in the context of

stressful events2; (2) the experience of chronic stress results in

disruption of dopaminergic activity in otherwise healthy organisms3;

and (3) dopamine plays a dominant role in natural analgesia within

multiple brain centers4.

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Read the entire editorial here:

http://jrheum.org/content/36/2/221.full

Not an MD