Fibromyalgia has been diagnosed more as a collection of pain symptoms vs a disease. It is a diagnosis of exclusion which means it is diagnosed only when all other causes for a person’s symptoms have been ruled out. Symptoms can be deep muscle pain, flulike symptoms, body aches and fatigue. The cause has been a medical mystery until recently. In the past rheumatologists were looking for signs of inflammation or injury in the joints, but tests would come up negative.
Most recently, neurologists have suggested that this unexplained pain may arise at least in part from damaged nerves. Experts also suspect that fibromyalgia occurs when individuals with an inherited or genetic risk experience a trigger such as an illness, injury or psychological crisis.
Using brain imaging, researchers have found that people with fibromyalgia process pain differently. It’s like the brain’s “volume control” is magnified. Part of this is due to the recent information showing impairment (or withering away) of nerve endings serving muscles and tendons. When an injury effects these nerves, they fire excessively and become over-sensitized. This can explain the aches and pains on the periphery that sends signals up to the brain which is the basis of ongoing pain.
Medications such as certain antidepressants and anticonvulsant medications are effective treatments in that they dampen pain signals in the brain and spinal cord. These drugs may provide modest pain relief for some patients, but they don’t improve sleep or overall quality of life. What is unclear is whether fibromyalgia changes the brain or whether some patients’ brains are prewired for chronic pain. Patterns seen in the brains of fibromyalgia patients have also turned out to be common among other chronic pain conditions.
If fibromyalgia can be caused by injury such as diabetes, autoimmune disease or other illnesses, then by treating the underlying condition, doctors could alleviate or in some cases cure fibromyalgia. Researchers now suspect that the experience of chronic pain reshapes the brains architecture and activity patterns much like learning to ride a bike. Therefore the best strategy for treatment involves both the mind and body. These patients need to learn how to cope with their pain. Avoiding weather and temperature extremes (a common trigger), exercise, improving seep habits and cognitive-behavioral therapy have been very successful for many people.
These clues surrounding the experience of pain may finally allow researchers to start unraveling the mysteries surrounding fibromyalgia and bring relief to millions of people.
Reference: Sutherland, S. “An Unnerving Enigma: New Clues to Fibromyalgia’s Origins Could Crack the Case of Chronic Pain”. Scientific American Mind, Sept/Oct 2014. pp. 55-59.