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Research ArticleAccepted Article
Open Access

Intramuscular Pressure is Almost Three Times Higher in Fibromyalgia Patients: A Possible Mechanism for Understanding the Muscle Pain and Tenderness

Robert S. Katz, Frank Leavitt, Alexandra Katz Small and Ben J. Small
The Journal of Rheumatology September 2020, jrheum.191068; DOI: https://doi.org/10.3899/jrheum.191068
Robert S. Katz
Robert S. Katz MD, Section of Rheumatology, Department of Internal Medicine, Frank Leavitt PhD, Department of Behavioral Sciences, Rush Medical College, Alexandra Katz Small MD, Rush Medical College, and Ben J. Small MD, Northwestern University’s Feinberg School of Medicine, Chicago, IL. Address correspondence and reprint request to: Dr. Robert S. Katz, 1725 W. Harrison St, Suite 365, Chicago, Illinois 60612. e-mail: rkatzchil@gmail.com
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Frank Leavitt
Robert S. Katz MD, Section of Rheumatology, Department of Internal Medicine, Frank Leavitt PhD, Department of Behavioral Sciences, Rush Medical College, Alexandra Katz Small MD, Rush Medical College, and Ben J. Small MD, Northwestern University’s Feinberg School of Medicine, Chicago, IL. Address correspondence and reprint request to: Dr. Robert S. Katz, 1725 W. Harrison St, Suite 365, Chicago, Illinois 60612. e-mail: rkatzchil@gmail.com
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Alexandra Katz Small
Robert S. Katz MD, Section of Rheumatology, Department of Internal Medicine, Frank Leavitt PhD, Department of Behavioral Sciences, Rush Medical College, Alexandra Katz Small MD, Rush Medical College, and Ben J. Small MD, Northwestern University’s Feinberg School of Medicine, Chicago, IL. Address correspondence and reprint request to: Dr. Robert S. Katz, 1725 W. Harrison St, Suite 365, Chicago, Illinois 60612. e-mail: rkatzchil@gmail.com
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Ben J. Small
Robert S. Katz MD, Section of Rheumatology, Department of Internal Medicine, Frank Leavitt PhD, Department of Behavioral Sciences, Rush Medical College, Alexandra Katz Small MD, Rush Medical College, and Ben J. Small MD, Northwestern University’s Feinberg School of Medicine, Chicago, IL. Address correspondence and reprint request to: Dr. Robert S. Katz, 1725 W. Harrison St, Suite 365, Chicago, Illinois 60612. e-mail: rkatzchil@gmail.com
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This article has a correction. Please see:

  • Errata - June 01, 2021

Abstract

Objective Widespread pain in the fibromyalgia syndrome (FMS) is conventionally viewed as arising from disordered central processing. This study examines intramuscular pressure in the trapezius as an alternative mechanism for understanding FMS pain.

Methods 108 patients who satisfied the ACR criteria for FMS and 30 patients who met the ACR criteria for another rheumatic disease comprised the study groups. Muscle pressure was measured in mmHg using a pressure gauge attached to a No. 22 needle inserted into the mid portion of the trapezius muscle. In addition, FMS patients and rheumatic disease controls had dolorimetry testing, digital palpation, and reported pain scores.

Results Muscle pressure was substantially higher in patients with FMS with a mean value of 33.48± 5.90 mmHg. Only 2 of 108 patients had muscle pressure of <23 mmHg. The mean pressure in rheumatic disease controls was 12.23±3.75 mmHg, with a range from 3-22 mmHg. FMS patients were more tender than controls based on both dolorimetry (p<0.001) and digital palpation (p<0.001). The mean pain score in patients with FMS and controls was 6.68±1.91 and 1.43±1.79 (p<0.001).

Conclusion Pressure in the trapezius muscle of patients with FMS is remarkably elevated and may be an intrinsic feature of FMS that could be monitored as part of the diagnostic evaluation. The burden of the pressure abnormality may help explain the diffuse muscle pain of FMS. Therefore, FMS as a disorder of exclusively central pain processing should be revisited. Therapeutically, the reduction of muscle pressure may change the clinical picture significantly.

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The Journal of Rheumatology
Vol. 49, Issue 7
1 Jul 2022
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Accepted manuscript
Intramuscular Pressure is Almost Three Times Higher in Fibromyalgia Patients: A Possible Mechanism for Understanding the Muscle Pain and Tenderness
Robert S. Katz, Frank Leavitt, Alexandra Katz Small, Ben J. Small
The Journal of Rheumatology Sep 2020, jrheum.191068; DOI: 10.3899/jrheum.191068

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Accepted manuscript
Intramuscular Pressure is Almost Three Times Higher in Fibromyalgia Patients: A Possible Mechanism for Understanding the Muscle Pain and Tenderness
Robert S. Katz, Frank Leavitt, Alexandra Katz Small, Ben J. Small
The Journal of Rheumatology Sep 2020, jrheum.191068; DOI: 10.3899/jrheum.191068
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