Fibromyalgia: orthostatic intolerance

This is of concern to me due to my low blood pressure issues and dizziness. And it makes me wonder. Especially since my doc mentioned I may have POTS.

So the study is looking at the Baroreflex  response. Without it we would stand up and get dizzy and could faint. It is mechanism in the body that tries to regulate our blood pressure.

The response involves nerves in the blood vessels near, in and around the heart.  Receptors called baroreceptors found on these nerves constantly (fractions of a second) monitor your blood pressure. When your blood pressure gets too high, baroreceptors inhibit the heart rate by turning down sympathetic nervous system activity.  When it dips too low, they send a message to the brain to increase the heart rate.

Studies have suggested this baroreceptor problem could explain the pain in FM.  “A 2010 study asserted that the role baroreceptors play in pain inhibition has been “well-documented.” It concluded that problems with cardiovascular control likely played a role in producing the pain problems FM patients face. Reduced baroreceptor activation in a 2015 study was associated with increased pain intensity in FM as well.”

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So are dizziness, rapid heartbeats, increased pain and such known to be common symptoms of FM? They are of M.E/CFS. And they are with me. Even chest pains, and palpitations. People with FM do get palpitations, that I know.

The study

“Baroreflex dysfunction has been observed in women with FMS. However, it is unknown whether the limited involvement of the baroreflex control during an orthostatic stimulus has some impact on the quality of life of the FMS patient. Therefore, the aim of the study is evaluate the relationship between the quality of life of the FMS patient and indexes of the cardiovascular autonomic control as estimated from spontaneous fluctuations of heart period (HP) and systolic arterial pressure (SAP). ”

They enrolled 35 women (age: 48.8±8.9 years; body mass index: 29.3±4.3 Kg/m2). respiratory activity, blood pressure and electrocardiogram were consistently recorded during a 15 period of rest laying down. (REST). And in Orthostatic position during active standing. (STAND).


Traditional cardiovascular autonomic control markers were assessed along with a Granger causality index assessing the strength of the causal relation from SAP to HP (CRSAP→HP) and measuring the degree of involvement of the cardiac baroreflex. The impact of FMS on quality of life was quantified by the fibromyalgia impact questionnaire (FIQ) and visual analog score for pain (VAS pain). No significant linear association was found between FIQ scores and the traditional cardiovascular indexes both at REST and during STAND (p>0.05). However, a negative relationship between CRSAP→HP during STAND and FIQ score was found (r = -0.56, p<0.01). Similar results were found with VAS pain.

They concluded that the lower degree of cardiac baroreflex involvement during STAND in the subjects the higher the impact of the FM quality of life. In other words, we might have problems doing things while standing.

Worthy to note other studies previously:

Evidence of orthostatic problems, however, showed up early in a 1997 study finding that 60% of FM patients (but no healthy controls) exhibited a significant drop in blood pressure during a tilt-table test.  Martinez-Lavin followed that up with a 1998 study highlighting the autonomic nervous system problems that popped up when FM patients stood.

A 2005 study found a high rate of fainting (44%) during a step-wise TILT test.  I was unable to find any studies evaluating the incidence of postural orthostatic tachycardia syndrome (POTS: >30 heart rate increase upon standing), but Staud, in a 2008 review, claimed that POTS commonly showed up in tilt table tests in FM. 

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