Decreased muscle blood flow in fibromyalgia patients during standardised muscle exercise: A contrast media enhanced colour doppler study

The aim of the study was to investigate if contrast enhanced ultrasound (US) imaging of muscular blood flow during and following exercise could detect alterations in vascularity in fibromyalgia (FM) patients. Ten FM patients and 10 matched controls were examined with US during standardised static and directly following static and dynamic muscular contractions of the infraspinatus muscle. Doppler ultrasound evaluation was performed before and after the administration of ultrasound contrast media. The FM patients had lower magnitude of muscle vascularity following dynamic (p < 0.001) and during (p < 0.002) static exercise compared to controls. The immediate flow response to muscular activity was not only of a lower magnitude, but also of a shorter duration in FM patients following dynamic exercise (p < 0.001) and during static exercise (p < 0.01). There were no statistically significant group differences in blood flow intensity or duration following static contraction. In conclusion, contrast enhanced US was found useful to study real‐time muscle blood flow changes during and following standardised, low‐intensity exercise in FM patients and healthy controls. Our results support the suggestion that muscle ischemia can contribute to pain in FM, possibly by maintaining the central nervous changes such as central sensitisation/disinhibition. US with contrast can be a new valuable approach to assess muscle perfusion in pain patients during standardised exercise.

[1]  J. M. Lash.  Training-induced alterations in contractile function and excitation-contraction coupling in vascular smooth muscle. , 1998, Medicine and science in sports and exercise.

[2]  C. Thomsen,et al.  31P magnetic resonance spectroscopy of skeletal muscle in patients with fibromyalgia. , 1992, The Journal of rheumatology.

[3]  C. Lindh,et al.  Elevated cerebrospinal fluid substance P-like immunoreactivity in patients with painful osteoarthritis, but not in patients with rhizopatic pain from a herniated lumbar disc. , 1997, Scandinavian journal of rheumatology.

[4]  J E Michalek,et al.  Elevated cerebrospinal fluid levels of substance P in patients with the fibromyalgia syndrome. , 1994, Arthritis and rheumatism.

[5]  M. Kotler,et al.  Autonomic nervous system derangement in fibromyalgia syndrome and related disorders. , 2001, The Israel Medical Association journal : IMAJ.

[6]  A. Mark,et al.  Differential control of heart rate and sympathetic nerve activity during dynamic exercise. Insight from intraneural recordings in humans. , 1987, The Journal of clinical investigation.

[7]  D. Cosgrove,et al.  Quantification of blood flow , 2001, European Radiology.

[8]  N. Vøllestad,et al.  Muscle fatigue in early fibromyalgia. , 1995, The Journal of rheumatology.

[9]  D. Cooper,et al.  Oxygen uptake during exercise in patients with primary fibromyalgia syndrome. , 1993, Journal of Rheumatology.

[10]  B. Danneskiold-Samsøe,et al.  Isokinetic and isometric muscle strength combined with transcutaneous electrical muscle stimulation in primary fibromyalgia syndrome. , 1991, The Journal of rheumatology.

[11]  L. Jorfeldt,et al.  Diagnostic epidural opioid blockade in primary fibromyalgia at rest and during exercise , 1989, Pain.

[12]  S. Larsson,et al.  Chronic pain after soft-tissue injury of the cervical spine: trapezius muscle blood flow and electromyography at static loads and fatigue , 1994, Pain.

[13]  A. Bengtsson,et al.  Muscle biopsy in primary fibromyalgia. Light-microscopical and histochemical findings. , 1986, Scandinavian journal of rheumatology.

[14]  R. Victor,et al.  Muscle metaboreflex triggers parallel sympathetic activation in exercising and resting human skeletal muscle. , 1994, The American journal of physiology.

[15]  J. Mitchell,et al.  Substance P release in the spinal cord during the exercise pressor reflex in anaesthetized cats. , 1993, The Journal of physiology.

[16]  L. Terenius,et al.  Elevated CSF levels of substance P and high incidence of Raynaud phenomenon in patients with fibromyalgia: new features for diagnosis , 1988, Pain.

[17]  E. Lund,et al.  Muscle metabolism in fibromyalgia studied by P‐31 magnetic resonance spectroscopy during aerobic and anaerobic exercise , 2003, Scandinavian journal of rheumatology.

[18]  J. Taylor,et al.  Autonomic mediation of the pressor responses to isometric exercise in humans. , 1988, Journal of applied physiology.

[19]  P. Tugwell,et al.  The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. , 1990, Arthritis and rheumatism.

[20]  D. Richardson.  Blood flow response of human calf muscles to static contractions at various percentages of MVC. , 1981, Journal of applied physiology: respiratory, environmental and exercise physiology.

[21]  B. Larsson,et al.  Chronic pain and difficulty in relaxing postural muscles in patients with fibromyalgia and chronic whiplash associated disorders. , 2001, The Journal of rheumatology.

[22]  P. Hansson,et al.  Modulatory influence on somatosensory perception from vibration and heterotopic noxious conditioning stimulation (HNCS) in fibromyalgia patients and healthy subjects , 1997, Pain.

[23]  B. Saltin.  THE INTERPLAY BETWEEN PERIPHERAL AND CENTRAL FACTORS IN THE ADAPTIVE RESPONSE TO EXERCISE AND TRAINING , 1977, Annals of the New York Academy of Sciences.

[24]  J. Zidar,et al.  Quantitative EMG and muscle tension in painful muscles in fibromyalgia , 1990, Pain.

[25]  P. Burns,et al.  Nonlinear imaging. , 2000, Ultrasound in medicine & biology.

[26]  D. Seals,et al.  Regulation of muscle sympathetic nerve activity during exercise in humans. , 1991, Exercise and sport sciences reviews.

[27]  G. Clark,et al.  Function of beta-adrenergic receptors on mononuclear cells in female patients with fibromyalgia. , 2003, The Journal of rheumatology.

[28]  A. Bengtsson,et al.  Muscle tissue oxygen pressure in primary fibromyalgia. , 1986, Scandinavian journal of rheumatology.

[29]  J. Ekholm,et al.  Modulation of pressure pain thresholds during and following isometric contraction in patients with fibromyalgia and in healthy controls , 1996, Pain.

[30]  A. Bengtsson,et al.  Skeletal muscle function in primary fibromyalgia. Effect of regional sympathetic blockade with guanethidine , 1988, Acta neurologica Scandinavica.

[31]  Tadaaki Mano,et al.  Responses in muscle sympathetic nerve activity to sustained hand-grips of different tensions in humans , 2004, European Journal of Applied Physiology and Occupational Physiology.

[32]  A. Bengtsson,et al.  Regional sympathetic blockade in primary fibromyalgia , 1988, Pain.

[33]  Jan Ekholm,et al.  Sensory dysfunction in fibromyalgia patients with implications for pathogenic mechanisms , 1996, Pain.

[34]  M. Delp.  Differential effects of training on the control of skeletal muscle perfusion. , 1998, Medicine and science in sports and exercise.

[35]  A. Hermosillo,et al.  Autonomic nervous system dysfunction may explain the multisystem features of fibromyalgia. , 2000, Seminars in arthritis and rheumatism.

[36]  R. Larsson,et al.  Changes of trapezius muscle blood flow and electromyography in chronic neck pain due to trapezius myalgia , 1999, Pain.

[37]  K. Henriksson.  Is fibromyalgia a distinct clinical entity? Pain mechanisms in fibromyalgia syndrome. A myologist's view. , 1999, Bailliere's best practice & research. Clinical rheumatology.

[38]  F. Ogita,et al.  Vasoconstriction in active calf persists after discontinuation of combined exercise with high-intensity elbow flexion. , 1996, Acta physiologica Scandinavica.

[39]  B. Wallin,et al.  Do patients with primary fibromyalgia have an altered muscle sympathetic nerve activity? , 1992, Pain.

[40]  P. Jehenson,et al.  Exercise-induced muscle modifications: study of healthy subjects and patients with metabolic myopathies with MR imaging and P-31 spectroscopy. , 1991, Radiology.

[41]  T. Mano,et al.  Sympathetic nerve activity related to local fatigue sensation during static contraction. , 1989, Journal of applied physiology.

[42]  Serge H. Roy,et al.  Lack of association between fibromyalgia syndrome and abnormalities in muscle energy metabolism. , 1994, Arthritis and rheumatism.

[43]  G. Sjøgaard,et al.  Intramuscular laser-Doppler flowmetry in the supraspinatus muscle during isometric contractions , 1995, European Journal of Applied Physiology and Occupational Physiology.

[44]  T. Mano,et al.  Changes in muscle sympathetic nerve activity and calf blood flow during static handgrip exercise , 2004, European Journal of Applied Physiology and Occupational Physiology.

[45]  L. Kaijser,et al.  Effect of regional alpha‐ and beta‐adrenergic blockade on blood flow in the resting forearm during contralateral isometric handgrip. , 1976, The Journal of physiology.

[46]  A P Hollander,et al.  Physiological effects of exhaustive physical exercise in primary fibromyalgia syndrome (PFS): is PFS a disorder of neuroendocrine reactivity? , 1992, Scandinavian journal of rheumatology.

[47]  Dynamic muscular endurance in primary fibromyalgia compared with chronic myofascial pain syndrome. , 1992, Archives of physical medicine and rehabilitation.

[48]  A. Bengtsson,et al.  Reduced high-energy phosphate levels in the painful muscles of patients with primary fibromyalgia. , 1986, Arthritis and rheumatism.

[49]  A. Mark,et al.  Microneurographic studies of the mechanisms of sympathetic nerve responses to static exercise in humans. , 1985, Circulation research.

[50]  G. A. Mccain,et al.  A controlled study of the effects of a supervised cardiovascular fitness training program on the manifestations of primary fibromyalgia. , 1988, Arthritis and rheumatism.

[51]  T. Sinkjaer,et al.  31P NMR spectroscopy and electromyography during exercise and recovery in patients with fibromyalgia. , 1995, The Journal of rheumatology.

[52]  R. Bennett,et al.  Emerging concepts in the neurobiology of chronic pain: evidence of abnormal sensory processing in fibromyalgia. , 1999, Mayo Clinic proceedings.

[53]  S. Taylor-Robinson,et al.  Transit-time studies with Levovist in patients with and without hepatic cirrhosis: A promising new diagnostic tool , 1999, European Radiology.

[54]  B. Danneskiold-Samsøe,et al.  Isometric and isokinetic muscle strength in patients with fibrositis syndrome. New characteristics for a difficult definable category of patients. , 1987, Scandinavian journal of rheumatology.