To the Editor
I read with great interest Chandan et al. enlightening article describing the association of childhood maltreatment with the subsequent development of fibromyalgia and other similar maladies. Using a large UK primary care database, they found that, when compared to an unexposed cohort, maltreated children have significantly higher risk for fibromyalgia development later in life (aIRR = 2.06; 95%CI = 1.71–2.48). Fifty-eight percent of maltreated children were female. [1] We are not told what percentage of abused children developing fibromyalgia were women. This seems to be an important point considering fibromyalgia a female-predominant illness. Around 90% of fibromyalgia patients seeking medical care are women.
Fibromyalgia is clearly a stress-related disorder. The key issue in fibromyalgia research is to define how different stressful circumstances including childhood abuse could lead to chronic pain, and why females are predominantely affected [2].
Our research proposes fibromyalgia as a stress-related sympathetically-maintained neuropathic pain syndrome [2]. The recently recognized link between fibromyalgia and small fiber neuropathy reinforces this pathogenetic model [3]. We propose dorsal root ganglia as the key site where different afferent stress-derived signals are converted into neuropathic pain [2,3]. There is marked sexual dimorphism in stress-evoked dorsal root ganglia phenotypic changes and also in stress-evoked painful neuropathy [4], [5]. Chandan et al. excellent research could advance our knowledge on the gender differences in stress-evoked fibromyalgia and similar syndromes. Would be important to know if maltreated children developing fibromyalgia were mostly women.
Declaration of Competing Interest
I declare no conflict of interest.
Footnotes
Supplementary material associated with this article can be found, in the online version, at doi:10.1016/j.eclinm.2020.100468.
Appendix. Supplementary materials
References
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