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Clinical Journal of Pain:
doi: 10.1097/AJP.0b013e31829e9d2a
Original Articles

Chronic Widespread Pain: Increased Glutamate and Lactate Concentrations in the Trapezius Muscle and Plasma

Gerdle, Björn MD, PhD*,†; Larsson, Britt MD, PhD*,†; Forsberg, Frida MD*,†; Ghafouri, Nazdar MD, PhD*,†; Karlsson, Linn RPT*,†; Stensson, Niclas Chemist*; Ghafouri, Bijar Chemist, PhD*,†,‡,§

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Background: Chronic widespread pain (CWP), including fibromyalgia syndrome (FM), is associated with prominent negative consequences. CWP has been associated with alterations in the central processing of nociception. Whereas some researchers consider CWP/FM as a central hyperexcitability pain condition, others suggest that the central alterations are maintained by peripheral nociceptive input. Microdialysis can be used in vivo to study muscle alterations in chronic myalgia.

Aim: The aim of the study was to investigate the plasma and interstitial concentrations of metabolites and algesics in the trapezius muscle of women with CWP and in pain-free women (CON).

Materials and Methods: Seventeen women with CWP and 24 CON went through a clinical examination and completed a questionnaire; the pressure pain thresholds in the upper and lower extremities were registered. Microdialysis was conducted in the trapezius muscle, and a blood sample was drawn. Muscle blood flow, interstitial muscle concentrations, and plasma concentrations of lactate, pyruvate, glutamate, glucose, and glycerol (not in the plasma) were determined.

Results: CWP patients had significantly increased interstitial muscle (P=0.02 to 0.001) and plasma (P=0.026 to 0.017) concentrations of lactate and glutamate. No significant differences existed in blood flow between CWP and CON. The interstitial concentrations—but not the plasma levels—of glutamate and lactate correlated significantly with aspects of pain such as pressure pain thresholds of the trapezius (R2=0.22) and tibialis anterior (R2=0.18) and the mean pain intensity (R2=0.10) in CWP but not in CON.

Conclusions: The present study supports the suggestion that aspects of pain and central alterations in CWP/FM are influenced by peripheral tissue alterations.

© 2014 by Lippincott Williams & Wilkins

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