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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*,†,‡,§

The Clinical Journal of Pain: May 2014 - Volume 30 - Issue 5 - p 409–420
doi: 10.1097/AJP.0b013e31829e9d2a
Original Articles

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 (R 2=0.22) and tibialis anterior (R 2=0.18) and the mean pain intensity (R 2=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.

*Rehabilitation Medicine, Department of Medicine and Health Sciences (IMH)

Occupational and Environmental Medicine, Department of Clinical and Experimental Medicine (IKE), Faculty of Health Sciences, University of Linköping

Pain and Rehabilitation Centre

§Centre of Occupational and Environmental Medicine, UHL, County Council, Linköping, Sweden

Author contributions: Design of the study: all authors; data collection: L.K., N.G., F.F.; biochemical analyses: B.Gh., N.S.; statistical analyses: B.G., B.Gh.; first draft of the manuscript: B.G., B.Gh.; comments on different and final versions of the manuscript: all authors; approved the final version of the manuscript: all authors.

Funded by the Swedish Research Council (K2011-69X-21874-01-6), Stockholm, Sweden and the Swedish Council for Working Life and Social Research (2010-0913), Stockholm, Sweden. The authors declare no conflicts of interest.

Reprints: Björn Gerdle, MD, PhD, Rehabilitation Medicine, Department of Medicine and Health Sciences (IMH), Faculty of Health Sciences, University of Linköping, SE-581 85 Linköping, Sweden (e-mail:

Received January 14, 2013

Accepted May 30, 2013

© 2014 by Lippincott Williams & Wilkins