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Pain Sensitization and Descending Pain Inhibition in Fibromyalgia.

Ailyn Garcia-Hernandez¹, Pablo de la Coba², Stephen Bruehl³

¹Department of Psychology, University of Jaén, Jaén.

The Clinical Journal of Pain

|September 22, 2025

Summary

Fibromyalgia patients exhibit reduced descending pain inhibition, contributing to heightened pain sensitivity and potentially explaining clinical symptoms. This impaired pain modulation is linked to greater symptom severity and higher anxiety levels.

Keywords:

central pain sensitization conditioned pain modulation endogenous pain inhibition fibromyalgia pain assessment

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Area of Science:

Neuroscience
Pain Research
Clinical Medicine

Background:

Pain sensitization in fibromyalgia (FM) may involve amplified ascending nociceptive pathways and weakened descending inhibition.
The slowly repeated evoked pain (SREP) protocol shows potential as a diagnostic marker for FM pain sensitization.
Mechanisms of SREP sensitization are not fully understood, but it may relate to ascending facilitation, with the role of descending inhibition unclear.

Purpose of the Study:

To quantify descending pain inhibition in FM patients compared to healthy controls.
To examine the relationship between descending pain inhibition and SREP-induced pain sensitization.
To investigate associations between descending pain inhibition and clinical FM symptoms.

Main Methods:

Descending pain inhibition was assessed using the conditioned pain modulation (CPM) paradigm in 55 women with FM and 45 healthy women.
Pressure stimuli were applied to the nail of the third finger using the SREP protocol.
Clinical symptoms, including anxiety and fatigue, were evaluated via self-report questionnaires.

Main Results:

Fibromyalgia patients demonstrated significantly stronger SREP sensitization and weaker CPM compared to controls.
In FM patients, SREP sensitization was inversely correlated with CPM, with both related to clinical symptom severity.
FM individuals lacking CPM reported more severe FM symptoms, anxiety, and fatigue.

Conclusions:

Impaired endogenous pain inhibition is a key factor in fibromyalgia pain sensitization and may explain SREP findings.
Reduced pain inhibition could underlie the common clinical symptoms observed in fibromyalgia.
Further research is needed to elucidate the balance between ascending and descending pain pathways in FM.