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Cited by 23Fibromyalgia and Chronic Fatigue Syndrome ResearchPsychosomatic Disorders and Their TreatmentsPain Mechanisms and Treatments

Programmed Symptoms: Disparate Effects United by Purpose

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Gracely, Richard, Schweinhardt, Petra·2015·Current Rheumatology Reviews
DOI 10.2174/1573397111666150619095125PMC PMC4997946
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Abstract

Central sensitivity syndromes (CSS) share features of similar multiple symptoms, virtually unknown mechanisms and lack of effective treatments. The CSS nomenclature was chosen over alternatives because it focused on a putative physiological mechanism of central sensitization common to disorders such as fibromyalgia, irritable bowel syndrome, vulvodynia and temporomandibular disorder. Increasing evidence from multiple biological systems suggests a further development. In this new model central sensitization is part of a ensemble that includes also the symptoms of widespread pain, fatigue, unrefreshing sleep and dyscognition. The main feature is an intrinsic program that produces this ensemble to guide behavior to restore normal function in conditions that threaten survival. The well known "illness response" is a classic example that is triggered in response to the specific threat of viral infection. The major leap for this model in the context of CSS is that the symptom complex is not a reactive result of pathology, but a purposeful feeling state enlisted to combat pathology. Once triggered, this state is produced by potential mechanisms that likely include contributions of the peripheral and central immune systems, as well as stress response systems such as the autonomic system and the hypothalamic-pituitary-adrenal (HPA) axis. These act in concert to alter behavior in a beneficial direction. This concept explains similar symptoms for many triggering conditions, the poorly understood pathology, and the resistance to treatment.

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  • The search for better treatments is ongoing and directed towards multidisciplinary, patient-centred care, ideally focused on identified pathology.

    “The search for better treatments is ongoing and directed towards multidisciplinary, patient-centred care, ideally focused on identified pathology.34”

    From A Review of Movement and Functional Impairments in Fibromyalgia: Implications for Targeted Treatment (2025) · cites this paper as [34]

    The “Epidemiology: Different Diagnoses, Similar Symptoms” section says the search for better treatments is ongoing, describes attention to patient-centered therapy, and says treatment would ideally focus on identified pathology. It does not describe the proposed care as multidisciplinary. (LLM, conf=0.88)

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Cited by

Sorted by citations

Authors
Gracely, R., & Schweinhardt, P.
Affiliations
  • University of North Carolina at Chapel Hill (US)
  • McGill University (CA)
Corresponding author
Gracely, Richard
ORCID
Schweinhardt, Petra
Venue
Current Rheumatology Reviews
Publisher
Bentham Science Publishers Ltd.
Published
2015-07-02
Volume
11
Issue
2
Pages
116-130
ISSN
1573-3971 (ISSN-L)
DOI
10.2174/1573397111666150619095125
PMC
PMC4997946
OpenAlex
W2467618511
Cited by
23
References
18
Citations by year
2025: 2 · 2023: 1 · 2022: 1 · 2021: 2 · 2020: 5 · 2019: 2 · 2018: 3 · 2017: 3 · 2016: 4
FWCI
0.46
Type
journal article
Language
en
Open access
Locations
  • Current Rheumatology Reviews (publishedVersion)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
Funders
Canadian Institutes of Health Research (131673_1)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
  • Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
  • Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
Keywords
central sensitivity syndromes, central sensitization, fibromyalgia, irritable bowel syndrome, vulvodynia, temporomandibular disorders, widespread pain, fatigue, unrefreshing sleep, hypothalamic-pituitary-adrenal axis, autonomic nervous system, immune system, treatment resistance, symptom complex
MeSH terms
Central Nervous System, Central Nervous System Diseases, Diagnosis, Differential, Humans, Hypothalamo-Hypophyseal System, Immune System, Pituitary-Adrenal System, Sympathetic Nervous System, Central Nervous System Sensitization, Chronic Pain

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