Chronic degenerative pain: an update on abdominal pain in comparison to rheumatic diseases

Rheumatic diseases comprise a heterogeneous group of highly prevalent, usually chronic and progressively disabling disorders associated with poor patient quality of life and high healthcare resource utilization. The pain associated with these degenerative or inflammatory conditions represent some of the most important and complex problems of modern medicine, demanding an increasingly attentive, multidisciplinary, and continuous therapeutic approach. Extra-articular syndromes, notably fibromyalgia, can be a lifelong rheumatic condition characterized by widespread musculoskeletal pain and functional impairment, without any known structural or inflammatory cause. Irritable bowel syndrome (IBS) occurs in around half of patients with fibromyalgia raising the possibility of a possible overlapping or underlying pathophysiology. The dysfunction of bidirectional neural pathways and viscerovisceral cross-interactions within the central nervous system has been proposed as a possible central hypersensitization disorder responsible for the extraintestinal manifestations of IBS. Common inflammatory and molecular pathways may also be present in which a dysregulation of the immune system leads to a chronic inflammatory response. Given that the treatment of degenerative chronic pain remains suboptimal, these findings may suggest new treatment strategies.