Introduction to a Referred Sympathetic Pain Map
by Mathew C. Wallack, MD
| The following article offers several new avenues of thought in identifying specific
pain patterns in fibromyalgia patients as well as a possible new strategy in treatment.
Although Dr. Wallack’s theories need to be studied in a double- blind investigation,
his viewpoints and patient treatment outcomes seem impressive and definitely warrant
further investigation. Pushing scientists to look outside the box is always a little on
the adventurous side but this kind of thinking has historically lead to new diagnostic
protocols and resulted in better treatment options for patients. |
— Rae Marie Gleason,
Fibromyalgia Department Editor |
 This paper presents a description of a unique and previously
unde-scribed map of referred sympathetically-mediated pain. The mapping is based upon pain
relief with selective nerve root procedures, primarily within the thoracic spine. The
mechanism for their efficacy is hypothesized to be via the sympathetic afferents, which
travel through the dorsal root ganglion (DRG).
In a manner similar to a dermatomal map, each spinal cord segmental level from T1 to L2
is described as having a specific region of the body that it innervates, with each level
identified using the newly-coined term “fibromatome.” The map is meant to
supplement the radicular and peripheral nerve maps and to be applied in cases in which
these maps do not apply or when the response to treatments for radicular or peripheral
nerve pain are ineffective. Notably, the fibromatome map is unique in that at certain
levels patients can develop almost hemi-body symptoms, and can account for pain complaints
that are currently described as non-physiological. An understanding of fibromatomes may
allow spine physicians to synergistically treat these conditions both pharmaceutically and
interventionally.
Discovery
This concept was initially discovered after a number of patients who had undergone
thoracic spine epidurals reported unex-pected relief of symptoms such as extremity pain or
headaches. A classic example of this phenomenon is illustrated in Figure 1. The patient is
a 37-year-old disabled gentleman with widespread pain diagnosed as vasculitic arthritis,
who subsequently had significant relief of all of his widespread pain with thoracic nerve
root procedures. The pain drawings, before and after the first two thoracic epidural
steroid injections (TESIs), clearly indicate widespread relief of all left sided pain
(notably, the right-sided pain was initially worse).
Please refer to the March 2010 issue for the complete text. In the event you need to order a back issue, please click here.
— March 2010
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