By Amy Price PhD
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.
Bennett, R. (2006) Understanding Chronic Pain and Fibromyalgia: A Review of Recent Discoveries Oregon Health Sciences University, National Fibromyalgia Association. A non-profit 501 (C)(3) organization 2121 S. Towne Centre, Suite 300, Anaheim, CA 92806 714.921.0150 Copyright ©1997-2008 National Fibromyalgia Association (NFA) http://www.fmaware.org/site/PageServer?pagename=fibromyalgia_science (accessed 12/01/2008
Buckelew S, Conway R, Parker J, Deuser W, Read J,
Witty T,. Hewett J, Minor M, Johnson J, Van Male L, McIntosh M, Nigh M, and Kay D, Biofeedback/Relaxation Training and Exercise Interventions for Fibromyalgia:A Prospective Trial Department of Physical Medicine and Rehabilitation, Missouri Arthritis Rehabilitation Research and Training Center, School of Medicine, University of Missouri-Columbia. Submitted for publication June 16, 1997; accepted in revised form October 13, 1997.
1998 by the American College of Rheumatology.
Cook DB, Lange G, Ciccone DS, Liu WC, Steffener J, Natelson BH.Functional imaging of pain in patients with primary fibromyalgia.J Rheumatol 2004; 31: 364–78.
CRISP http://crisp.cit.nih.gov/crisp/crisp_lib.query (accessed dec 04, 2008)
CROFFORD LJ. Neuroendocrine abnormalities in fibromyalgia and related disorders.American Journal of the Medical Sciences 1998;315(6):359-66. Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109-0680, USA
Fibromyalgia.com http://www.fibromyalgia.com/ (accessed Dec 01,2008)
Fibromyalgia Network, P.O. Box 31750, Tucson, AZ 85751 (800) 853-2929. http://www.fmnetnews.com/about-philosophy.php (accessed Dec 04,2008)
Gracely RH, Petzke F, Wolf JM, Clauw DJ. Functional magnetic resonance imaging evidence of augmented pain processing in fibromyalgia. Arthritis Rheum 2002; 46: 1333–43.
Helle H,, Førre R , Kåss E, Terenius L (Jan 1988). "Elevated CSF levels of substance P and high incidence of Raynaud phenomenon in patients with fibromyalgia: new features for diagnosis". Pain 32 (1): 21–6. doi:10.1016/0304-3959(88)90019-X
Kendall S, Sog¨ ren, B Gerdle B, and Gustav K, Henriksson, Department of Rehabilitation Medicine,
Faculty of Health Sciences, Linko¨ping, and Pain and Rehabilitation Centre, University Hospital Linko¨ping, Sweden; and Kerstin
Brolin-Magnusson, Fysioteket, Billdal, Sweden.Submitted for publication January 20, 2000; accepted in revised form June 17, 2000.
© 2000 by the American College of Rheumatology.
KWIATEK R, BARNDEN L, TEDMAN R, JARRETT R, CHEW J, ROWE C, and PILE K REGIONAL CEREBRAL BLOOD FLOW IN FIBROMYALGIA,Single-Photon–Emission Computed Tomography Evidence of Reduction in the Pontine Tegmentum and Thalami ARTHRITIS & RHEUMATISM, Vol. 43, No. 12, December 2000, pp 2823–2833© 2000, American College of Rheumatology
McBeth J, Silman AJ, Gupta A, Chiu YH, Ray D, Morriss R, Dickens C, King Y, Macfarlane GJ. (2007). "Moderation of psychosocial risk factors through dysfunction of the hypothalamic-pituitary-adrenal stress axis in the onset of chronic widespread musculoskeletal pain: findings of a population-based prospective cohort study.". Arthritis Rheum. 2007 Jan;56(1):360-71.. 56 (1): 360-71
MCDERMID A. J. (1) ; ROLLMAN G. B. (1) ; MCCAIN G. A. (2) ; Author(s) Affiliation(s) (2008) Generalized hypervigilance in fibromyalgia : evidence of perceptual amplificationAuthor(s) (1) Department of Psychology, University of Western Ontario, London, Ontario N6A 5C2, CANADA(2) Division of Rheumatology, University Hospital, London, Ontario, N6A 5A5, CANADA, Publisher, Elsevier, Amsterdam, PAYS-BAS (1975) (Revue) Published 2008 http://cat.inist.fr/?aModele=afficheN&cpsidt=3210987 (accessed 12/01/2008)
Mountz JM, Bradley LA, Modell JG, Alexander RW, Triana-Alexander M,Aaron LA, et al. Fibromyalgia in women. Abnormalities of regional cerebral blood flow in the thalamus and the caudate nucleus are associated with low pain threshold levels. Arthritis Rheum 1995; 38: 926–38.
Mueller H, Donaldson C, Nelson N, Layman M, Treatment of Fibromyalgia Incorporating EEG-Driven Stimulation: A Clinical Outcomes Study JOURNAL OF CLINICAL PSYCHOLOGY, Vol. 57(7), 933–952 (2001) © 2001 John Wiley & Sons, Inc.
Saczynski, J., Margrett, J., Willis, S. “Older Adults' Strategic Behavior: Effects of Individual versus Collaborative Cognitive Training.” Educational Gerontology. 2004 Aug; 30(7): 587-610.
Staud R, Craggs J, Perlstein W, Robinson M, Price D, Brain activity associated with slow temporal summation of C-fiber evoked pain in fibromyalgia patients and healthy controls a Department of Medicine, McKnight Brain Institute, University of Florida, Gainesville, FL 32610, United States Department of Clinical and Health Psychology, McKnight Brain Institute, University of Florida, Gainesville, FL 32610, United States Department of Oral and Maxillofacial Surgery, McKnight Brain Institute, University of Florida, Gainesville, FL 32610, United States Received 22 May 2007; received in revised form 13 December 2007; accepted 2 February 2008
Available online 25 March 2008
Toates, F. (2006) Biological Psychology, Pearson Education, Harlow. UK
Wood PB, Schweinhardt P, Jaeger E, Dagher A, Hakyemez H, Rabiner EA, et al. Fibromyalgia patients show an abnormal dopamine response to pain. Eur J Neurosci 2007; 25: 3576–82.
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.
Bennett, R. (2006) Understanding Chronic Pain and Fibromyalgia: A Review of Recent Discoveries Oregon Health Sciences University, National Fibromyalgia Association. A non-profit 501 (C)(3) organization 2121 S. Towne Centre, Suite 300, Anaheim, CA 92806 714.921.0150 Copyright ©1997-2008 National Fibromyalgia Association (NFA) http://www.fmaware.org/site/PageServer?pagename=fibromyalgia_science (accessed 12/01/2008
Buckelew S, Conway R, Parker J, Deuser W, Read J,
Witty T,. Hewett J, Minor M, Johnson J, Van Male L, McIntosh M, Nigh M, and Kay D, Biofeedback/Relaxation Training and Exercise Interventions for Fibromyalgia:A Prospective Trial Department of Physical Medicine and Rehabilitation, Missouri Arthritis Rehabilitation Research and Training Center, School of Medicine, University of Missouri-Columbia. Submitted for publication June 16, 1997; accepted in revised form October 13, 1997.
1998 by the American College of Rheumatology.
Cook DB, Lange G, Ciccone DS, Liu WC, Steffener J, Natelson BH.Functional imaging of pain in patients with primary fibromyalgia.J Rheumatol 2004; 31: 364–78.
CRISP http://crisp.cit.nih.gov/crisp/crisp_lib.query (accessed dec 04, 2008)
CROFFORD LJ. Neuroendocrine abnormalities in fibromyalgia and related disorders.American Journal of the Medical Sciences 1998;315(6):359-66. Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109-0680, USA
Fibromyalgia.com http://www.fibromyalgia.com/ (accessed Dec 01,2008)
Fibromyalgia Network, P.O. Box 31750, Tucson, AZ 85751 (800) 853-2929. http://www.fmnetnews.com/about-philosophy.php (accessed Dec 04,2008)
Gracely RH, Petzke F, Wolf JM, Clauw DJ. Functional magnetic resonance imaging evidence of augmented pain processing in fibromyalgia. Arthritis Rheum 2002; 46: 1333–43.
Helle H,, Førre R , Kåss E, Terenius L (Jan 1988). "Elevated CSF levels of substance P and high incidence of Raynaud phenomenon in patients with fibromyalgia: new features for diagnosis". Pain 32 (1): 21–6. doi:10.1016/0304-3959(88)90019-X
Kendall S, Sog¨ ren, B Gerdle B, and Gustav K, Henriksson, Department of Rehabilitation Medicine,
Faculty of Health Sciences, Linko¨ping, and Pain and Rehabilitation Centre, University Hospital Linko¨ping, Sweden; and Kerstin
Brolin-Magnusson, Fysioteket, Billdal, Sweden.Submitted for publication January 20, 2000; accepted in revised form June 17, 2000.
© 2000 by the American College of Rheumatology.
KWIATEK R, BARNDEN L, TEDMAN R, JARRETT R, CHEW J, ROWE C, and PILE K REGIONAL CEREBRAL BLOOD FLOW IN FIBROMYALGIA,Single-Photon–Emission Computed Tomography Evidence of Reduction in the Pontine Tegmentum and Thalami ARTHRITIS & RHEUMATISM, Vol. 43, No. 12, December 2000, pp 2823–2833© 2000, American College of Rheumatology
McBeth J, Silman AJ, Gupta A, Chiu YH, Ray D, Morriss R, Dickens C, King Y, Macfarlane GJ. (2007). "Moderation of psychosocial risk factors through dysfunction of the hypothalamic-pituitary-adrenal stress axis in the onset of chronic widespread musculoskeletal pain: findings of a population-based prospective cohort study.". Arthritis Rheum. 2007 Jan;56(1):360-71.. 56 (1): 360-71
MCDERMID A. J. (1) ; ROLLMAN G. B. (1) ; MCCAIN G. A. (2) ; Author(s) Affiliation(s) (2008) Generalized hypervigilance in fibromyalgia : evidence of perceptual amplificationAuthor(s) (1) Department of Psychology, University of Western Ontario, London, Ontario N6A 5C2, CANADA(2) Division of Rheumatology, University Hospital, London, Ontario, N6A 5A5, CANADA, Publisher, Elsevier, Amsterdam, PAYS-BAS (1975) (Revue) Published 2008 http://cat.inist.fr/?aModele=afficheN&cpsidt=3210987 (accessed 12/01/2008)
Mountz JM, Bradley LA, Modell JG, Alexander RW, Triana-Alexander M,Aaron LA, et al. Fibromyalgia in women. Abnormalities of regional cerebral blood flow in the thalamus and the caudate nucleus are associated with low pain threshold levels. Arthritis Rheum 1995; 38: 926–38.
Mueller H, Donaldson C, Nelson N, Layman M, Treatment of Fibromyalgia Incorporating EEG-Driven Stimulation: A Clinical Outcomes Study JOURNAL OF CLINICAL PSYCHOLOGY, Vol. 57(7), 933–952 (2001) © 2001 John Wiley & Sons, Inc.
Saczynski, J., Margrett, J., Willis, S. “Older Adults' Strategic Behavior: Effects of Individual versus Collaborative Cognitive Training.” Educational Gerontology. 2004 Aug; 30(7): 587-610.
Staud R, Craggs J, Perlstein W, Robinson M, Price D, Brain activity associated with slow temporal summation of C-fiber evoked pain in fibromyalgia patients and healthy controls a Department of Medicine, McKnight Brain Institute, University of Florida, Gainesville, FL 32610, United States Department of Clinical and Health Psychology, McKnight Brain Institute, University of Florida, Gainesville, FL 32610, United States Department of Oral and Maxillofacial Surgery, McKnight Brain Institute, University of Florida, Gainesville, FL 32610, United States Received 22 May 2007; received in revised form 13 December 2007; accepted 2 February 2008
Available online 25 March 2008
Toates, F. (2006) Biological Psychology, Pearson Education, Harlow. UK
Wood PB, Schweinhardt P, Jaeger E, Dagher A, Hakyemez H, Rabiner EA, et al. Fibromyalgia patients show an abnormal dopamine response to pain. Eur J Neurosci 2007; 25: 3576–82.
A comment from J Kildare The opioids narcotics are effective for diseases such as chronic pain partially solved, medicines like Vicodin, Lortab, hydrocodone, Lorcet are widely used in USA and Europe for medical specialists according to findrxonline the percentage of use of these drugs is very high in this part of the continent
ReplyDeleteOpiods do nothing to fix the underlying problem and regrettably drug tolerance is built up requiring ever higher dosages to get pain relief. In addition patients are likely to over do activity because the pain/cognition responses are blunted by drugs and so bring immediate greater harm to themselves and increase effects of longterm issues inclusive of kidney /liver damage, dependency and personality changes.Opiods are short term at best and we need to develop more competent options. This is in no way a condemnation of those who need the drugs to survive the day it is just they are not a great longterm solution
ReplyDeleteAmy Price PhD