In the introduction article about Fibromyalgia (FMS) last week I covered symptoms, causes, how it’s diagnosed and the difficulties about it. In this article I want to outline some topics you were interested in. I know there is lots of information about FMS out there (e.g. other Fibromyalgia apps) so there is no point in trying to cover it all and I have limited space here. One problem with researching FMS is that you run into the problem of “insufficient” or “conflicting” research data. I know it’s frustrating, but since we speak about a syndrome with different causes and not an entity of disease, the research data will always be conflicting. This is the nature of a syndrome. We have to live with what is known and decide individually if it makes sense to us.
Causes - Central Sensitivity (CS)
The problem with FMS is that it cannot be explained in the classic medical model based on specific tissue pathology with distinctive symptoms. There is no peripheral damage in the tissue, no autoimmunity and no inflammation. It’s regarded a disorder of pain processing in the spinal cord and brain. This means there is an increased responsiveness (“sensitizantion” or “centralized pain”) to sensory information like pain, touch, hearing or light. One reason is that the body’s own pain inhibiting system (e.g.opioids, endocannabinoids) is weakened, mostly because of stress. This hyperresponsiveness causes widespread pain across body parts and is independent of nerve roots. For that reason anti-inflammatory agents (NSAIDs), cortison injections, physiotherapy, massage and of course operations don’t work as treatments. So your rheumatologist or neurologist isn’t going to get you very far.
Accordingly, brain scans (functional MRI) show a higher pattern of activation in the pain processing areas (“pain matrix”) and decreased activity of the descending pain-modulating networks in FMS compared to healthy controls. So there is objective proof of pain in the brain. Now the concept of CS is very complex and serves as a paradigm for explaining the overlap of syndromes we couldn’t explain before. For patients I find it of limited use so I don’t go into it further. You can find much more in depth information about this process here: http://www.fmcpaware.org/fibromyalgia/science-of-fm.html
Pain is a constant balance of ascending perception, descending inhibition and appreciation. It’s a complex interaction of different areas is the brain of which emotions and awareness play a big role. You might notice this when pain is increased during times of stress, anxiety or depression. On the other side, the feeling of success or happiness can fade out pain. For that reason chronic pain is often treated with antidepressants and psychotherapy and psychologists speak of “unlearning pain” (this video explains more about it https://www.youtube.com/watch?v=5KrUL8tOaQs). Because stress and pain are so closely interlinked, everything that affects stress in a positive way is suggested as a treatment for chronic pain as well, e.g. relaxation, exercise, good sleep and psychotherapy. If the underlying cause for stress is emotional trauma, this should be addressed in treatment as well.
The assessment at our clinic usually includes the current social and psychological life situation as well the biography. This often reveals extremely high stress loads in the past. It’s an obvious and distinct pattern but it is difficult to identify in research studies.
But not all people with emotional trauma develop chronic pain and not all people with FMS have a history of trauma. There are other risk factors which leads me to the next topic:
Risk factors for FMS
- Genetics: Current knowledge indicates a genetic underpinning for FMS because of familial aggregation. Since pain sensitivity depends on many different genes and because FMS is a syndrome, there’s a wide variety of genes that play a role. Interestingly studies have found a lower enzymatic activity for the breakdown of catecholamines (e.g. adrenaline) in some FMS patients, based on the gene coding for the enzyme COMT. This leads to higher levels of stress hormones in the blood and fits into the framework of a stress-related disorder. Although significant progress has been made in studying the genetic basis of fibromyalgia, no clinical prediction can be made with current evidence .
- Hypermobility Syndrome: Joint hypermobility is a common and frequently overlooked genetic disorder and is a multisystem disorder, strongly associated with chronic widespread pain .
- Sleep: Sleeping difficulties generally lead to increased pain sensitivity. Anecdotal reports of FMS patients often reveal sleep disturbances long before the onset of pain. A long term observational study has even found anassociation between sleep problems, their severity and the risk of FMS. Also here, sleeping problems generally indicate a stress related problem.
- Stress and Early Life Adversities: High levels of psychological distress increase the likelihood of developing chronic widespread pain. The earlier this happens in life, the bigger the impact is. But also non-remembered painful events, such as stressors during early infancy (hospitalization, maternal deprivation, physical or substance abuse in the neonatal period) and even premature birth can cause long-lasting changes in pain processing systems and increases pain sensitivity later on. So these are events you might not remember but had a lasting impact on pain sensitivity.
So much for this second part. I hope this is useful and I answered some of your questions. Otherwise just leave a comment on what you want to know more about or what your experiences you have made. We can also go into treatment options, personally I favor mind body techniques.