Fibromyalgia: Compliance, Reactive Hyperaemia, Veterbral Dysfunction


The clinical signs of hyperalgesia-related phenomena were just described. Other measurable clinical signs are evident and may be useful when assessing the "activity" of FMS and its association with other features or response to therapy.


The compliance or distensibility of the subcutaneous tissues and muscle can be assessed using a compliance meter.39This expensive instrument is a variation on an algometer but a sliding plate, present on the shaft, can measure the amount of penetration of the l-cm2 rubber tip into the tissue at any given predesignated pressure. The reliability of these measures is uncertain55. but appears improved if subjects are examined in the same sitting position, with results expressed in millimeters of depth of penetration by the gauge at 4 kg/cm2 pressure minus the value obtained at 2 kg/cm2 pressure.44. Measurements may be obtained bilaterally at the midpoint of the upper trapezius and the paraspinal muscles 3 cm away from T4 and L3,respectively." In FMS patients, compliance is lower than in control subjects44

Reactive Hyperaemia

Exaggerated wheal and flare response after a mechanical or chemical stimulus to the skin is termed reactive hyperemia, Dermatographia, dermographia lll. This may be assessed in the clinic using a swab stick applied with firm but not painful pressure 10 cm vertically and 3 cm away from both sides of the upper thoracic spine. The maximum width of the induced skin flare can be recorded in millimeters at 2 minutes. A flare of over 5 mm in the thoracic region is seen in 85% of FMS subjects compared to 21'X, of controls.44 This measurement, or variations of it, may be used to assess "activity" or response to therapy in FMS patients. The application of the chemical Capsaicin, which selectively induces release of the neuropeptide substance P from polymodal nociceptor fibers, also induces an exaggerated flare in FMS. 61 and may be used to assess this variable in the research setting.

Vertebral Dysfunctions

Vertebral Dysfunctions are more common in people with FMS,45. particularly in the cervicothoracic and low lumbar-sacroiliac regions. Data on vertebral dysfunction may permit alternate management approaches or may be used as a measure of outcome after treatment.

Vertebral dysfunctions (somatic dysfunction, "subluxation") are commonly diagnosed by manual therapists, but the reliability of the clinical features that contribute to this diagnosis is unclear. Clinical signs defining a vertebral dysfunction are those of impaired motion of the spinal "motion segment," comprising adjacent vertebral bodies, disc and associated ligament, muscles, and facet joints. There also is hyperalgesia on palpation of the associated facet joint or nearby related structures. There is rapid onset and offset of hyperalgesia after pressure stimulus and increased pain on provocation.32 There also is paraspinal subcutaneous edema, allodynia, hyperalgesia, and low compliance of paraspinal muscles. These signs are said to reverse with "adequate" physical therapy.26

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