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Pressure Abstract II
Provocation of Hypotension and Pain During Upright Tilt Table Testing
in Adults with Fibromyalgia
I. Bou-Holaigah, H. Calkins, J.A. Flynn, C. Tunin, H.-C. Chang, J.S. Kan,
P.C. Rowe
OBJECTIVE: Fibromyalgia is a common but poorly
understood problem characterized by widespread pain and chronic fatigue.
Because chronic fatigue has been associated with neurally mediated hypotension,
we examined the prevalence of abnormal responses to upright tilt table
testing in 20 patients with fibromyalgia and 20 healthy controls.
METHODS: Each subject completed a symptom questionnaire
and underwent a three stage upright tilt table test (stage 1: 45 minutes
at 70° tilt; stage 2, 15 minutes at 70° tilt with isoproterenol
1 – 2 g/min; stage 3, 10 minutes at 70° tilt with isoproterenol
3 – 4 g/min). An abnormal response to upright tilt was defined by
syncope or presyncope in association with a drop in systolic blood pressure
of at least 25 mm Hg and no associated increase in heart rate.
RESULTS: During stage 1 of upright tilt, 12 of
20 fibromyalgia patients (60%), but no controls had an abnormal drop in
blood pressure (P<0.001). Among those with fibromyalgia, all 18 who
tolerated upright tilt for more than 10 minutes reported worsening or
provocation of their typical widespread fibromyalgia pain during stage
1. In contrast, controls were asymptomatic (P<0.001).
CONCLUSION: These results identify a strong association
between fibromyalgia and neurally mediated hypotension. Further studies
will be needed to determine whether the autonomic response to upright
stress plays a primary role in the pathophysiology of pain and other symptoms
in fibromyalgia.
KEY WORDS: fibromyalgia, chronic fatigue syndrome,
hypotension, syncope, tilt-table test.
Clinical and Experimental Rheumatology 15:239-246, 1997
National Fibromyalgia Research Association
PO Box 500, Salem, OR 97308
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