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Staud R - Most FMS patients present with focal tissue abnormalities including myofascial trigger points, ligamentous trigger points, or osteoarthritis of the joints and spine. Though not predictive for the development of FMS, these changes nevertheless represent important pain generators that may initiate or perpetuate chronic pain. Local chemical mediators, including lactic acid, amino acids, and cytokines could play an important role in sensitizing deep tissue nociceptors of FMS patients. Thus the combination of peripheral impulse input and increased central pain sensitivity may be responsible for widespread chronic pain as reported in FMS.

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