Spinal fluid evacuation may provide temporary relief for patients with unexplained widespread pain and fibromyalgia

Med Hypotheses. 2018 Sep:118:55-58. doi: 10.1016/j.mehy.2018.06.017. Epub 2018 Jun 20.

Abstract

Fibromyalgia (FM) exhibits characteristics of a neurological disorder, and similarities have been identified between FM and idiopathic intracranial hypertension (IICH). When intracranial pressure rises, the drainage of excess cerebrospinal fluid (CSF) through the subarachnoid space of the cranial and spinal nerves increases. Higher CSF pressure irritates nerve fibers inside nerve root sheaths and may consequently cause radicular pain, as was reported in patients with IICH. Moreover, the cut-off of 20-25 cm H20 used to define IICH may be too high, as has been suggested in patients with chronic fatigue syndrome. We hypothesize that the neurological symptoms of FM are caused by the dysregulation of cerebrospinal pressure (CSP) and that spinal fluid drainage can relieve this pain. Exploring the processes underlying increased CSP may provide an alternative explanation for the generation of unexplained widespread pain (WSP) and FM as opposed to central sensitization. Additionally, when performing a lumbar puncture for diagnostic reasons, it is useful to measure opening pressure in patients with chronic WSP.

MeSH terms

  • Adult
  • Cerebrospinal Fluid
  • Ehlers-Danlos Syndrome / cerebrospinal fluid
  • Ehlers-Danlos Syndrome / therapy
  • Fatigue Syndrome, Chronic / cerebrospinal fluid
  • Fatigue Syndrome, Chronic / physiopathology*
  • Female
  • Fibromyalgia / cerebrospinal fluid
  • Fibromyalgia / therapy*
  • Humans
  • Intracranial Pressure
  • Male
  • Middle Aged
  • Models, Theoretical
  • Pain / etiology*
  • Pain Management / methods*
  • Pseudotumor Cerebri / therapy
  • Spinal Cord / physiopathology
  • Spinal Puncture
  • Subarachnoid Space
  • Young Adult