Counter irritation test in primary fibromyalgia

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Abstract
In primary fibromyalgia the main symptom is diffuse pain predominating at tender points which are sensitive to palpation. The aim of this study was to compare the effects on the amplitude of the nociceptive flexion reflex of the lower limb (RIII reflex) of applying painful pressure to the tender points with the effects of the same pressure applied to other points of the body or to the same part of the body in control subjects. This method was chosen because previous studies have shown that it was possible to activate the diffuse noxious inhibitory system using a “counter-irritation” stimulation. Our study was carried out on 18 fibromyalgic patients and on 12 control subjects. During the counter-irritation procedure, consisting of applying pressure with a mechanical dolorimeter to tender points, a clear cut and significant decrease in the amplitude of the RIII response was observed in 6 patients. In conclusion, in view of the subjective nature of the criteria used at present to diagnose primary fibromyalgia, we would like to suggest that a positive counter-irritation test be adopted as a further obligatory criterion, since it has been clearly established that the diffuse noxious inhibitory control responsible for the decrease in the RIII amplitude can be activated only when the subjects undergo intense nociceptive stimulation.