Pathophysiological

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Once more there are few data on the pathophysiology of childhood chronic pain. It has been widely postulated that, in childhood CRPS, there is either overactivity of the sympathetic nervous system or under-responsiveness of the alpha adrenergic pathways. Despite a lot of studies in adults with fibromyalgia there has been no convincing evidence to suggest a definitive pathophysiological pathway.

There is some interest in related proteomes found in adult fibromyalgia, but this is very early pilot data (40).

Pain sensitivity varies substantially among humans. A significant part of the human population develops chronic pain conditions that are characterized by heightened pain sensitivity. A group in North Carolina recently showed that catecholamine-O-methyltransferase (COMT) activity substantially influences pain sensitivity, and the three major haplotypes determine COMT activity in humans that inversely correlates with pain sensitivity and the risk of developing a chronic pain condition. This again is early work, but it underlines the need to continue research in this area (41). There has also been interest in the preliminary findings that pain sensitivity may be higher in adolescents who were born prematurely (42).

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