Photo courtesy of (Earthopod, 2009 )depicting pain areas in fibromyalgia.
Fibromyalgia (FMS) comes from three words, the Latin term for fibrous tissue (fibro) and the Greek ones for muscle (myo) and pain (algia). Another way of saying this is muscle knots tied by painful ropes. This condition is not amenable to the medical model so clinicians fell back on the old standby “It’s all in your head” implying the problem is generated by emotional instability rather than specific biological origins.
Fibromyalgia was tagged a syndrome (Fibromyalgia, com, 2008). Patients got mad. They refused to be stonewalled by ignorance or marginalized. Instead they formed strong lobby groups and started campaigning for funding and action (Fibromyalgia network, 2008). This resulted in research getting funded, better treatment options and social change. (CRISP lists 695 NIH funded projects since 2000)
Researchers are finding that FMS could be a disorder of the central processing system resulting in neuroendocrinal and neurotransmitter dysregulation (Bennett, 2008). The FMS patient experiences pain amplification because their pain sensors are slow to recognize pain but the pain they feel spreads across a wider area, lasts longer and is more severe than in a person without FMS ( Staud et al, 2008). Increasingly scientific studies demonstrate physiological abnormalities in the FMS patient including increased levels of substance P in the spinal cord (Helle et al ,1998), low levels of blood flow to the thalamus region of the brain (Kwiatek et, 2000), HPA axis hypo function (McBeth et al, 2007) low levels of serotonin and tryptophan plus abnormalities in cytokine function (Crofford, 1998). Abnormalities like these spell pain. This leads to losses in sleep quality, cognition and coordination, and to increased drug use susceptibility.
New research strengthened by the advent of physical evidence such as SPECT, PET, FMRI and QEEG is confirming fibromyalgia is a biological problem that may cause psychological distress rather than a psychosomatic hysteria pioneered by women as appears to be insinuated by Mcdermid et al, (2008)
New hope may come for some FMS sufferers in the discovery of the brain’s ability to regenerate dendrites a process known as neuroplasticity (Toates, 2006). It is possible that targeted brain and body training may alleviate the severity of chronic pain and cognitive dysfunction associated with FMS (Leurding et al, 2008)
Leurding et al (2008) demonstrates that in fibromyalgia both white and grey brain matter is compromised. Brain imaging studies in FMS patients point to alterations in regional cerebral blood flow (Mountz et al., 1995), in cerebral processing of sensory and nociceptive stimuli (Gracely et al., 2002; Cook et al., 2004) also in dopamine response to pain (Wood et al., 2007). Leurding (ibid) used these imaging studies as a foundation for neuropsychological tests to show that the changed state of brain matter leads to “brain fog” rather than psycho-social maladaption, drug induced confusion, or loss of sleep as primary factors.
Patients offered cognitive rehabilitation tools may improve mental function when these tools are offered before significant white and grey matter dysfunction appears. Neuroplasticity can still be of benefit after damage occurs but progress is slower (Saczynski, 2004)
Brain areas responsible for proprioception damaged in fibromyalgia may be modified by body awareness training according to a pilot study carried out by (Kendall et al, 2000). Targeted body awareness physiotherapy programs led to patient improvement in pain levels and functional capacity even when patients were retested eighteen months after treatment (Kendall et al 2000).
Kendall et al (2000) were dismissive of positive effects realized by stress reduction, hypnosis or neurofeedback training but other researchers such as Meuler et al, 2001 found these treatments were beneficial. FMS is not one size fits all (Bennett, 2006).
A trial of cognitive rehabilitation synergised with neurofeedback and cognitive rehabilitation is underway to determine how combining passive and active therapy can multiply positive effects. Participants will be tested at timely increments and their ongoing level of progress studied.
Another option is to decrease pain to restore function. This is where regenerative medicine can help with therapies like adult stem cell treatment and prolotherapy. Another option is a treatment called IMS where overly sensitized nerve points are reset using a medical system similar to acupuncture.
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