Scientific American: Fibromyalgia: Maligned, Misunderstood and (Finally) Treatable

[Firestormm]

Fibromyalgia: Maligned, Misunderstood and (Finally) Treatable

Research suggests it’s a disease of the central nervous system

27 May 2014

...

...Despite the clinical clarity, medicine still lacked a physical explanation for fibromyalgia, leading many experts to implicate the brain.

The next 20 years of research confirmed their suspicion, culminating in today’s understanding of the disorder as a “centralized pain” state, as Dr. Clauw’s review discusses.

“Centralized” refers to the central nervous system — the brain and spinal cord — either originating or amplifying pain.

As Clauw points out, the CNS of patients with fibromyalgia appears to both heighten the response to painful stimuli and perceive normally non-painful stimuli as painful.

A major implication here is that fibromyalgia and possibly related states like chronic fatigue syndrome are drastically different in origin than other conditions common to rheumatology clinics like osteo- and rheumatoid arthritis, both of which result in discernible tissue damage.

Neuroimaging studies support the theory that fibromyalgia-afflicted brains exhibit enhanced sensory response to benign stimuli.

But what leads to this centralized pain state? Fibromyalgia’s strong familial association suggests that genetics plays a major role.

Also any number of environmental influences can trigger fibromyalgia including infection, physical pain and psychological trauma.

Deployment to war is still considered a major risk factor. And it seems there can be a significant psychological or behavioral component to the condition.

Fibromyalgia patients are more likely to suffer from depression, anxiety and post-traumatic stress disorder that in many cases, Clauw speculates, might result from common triggers.

Regardless of the inciting factor, altered levels and activity of neurotransmitters that facilitate pain transmission may ultimately lead to the symptoms of fibromyalgia.

These central disturbances are also likely at the root of the non-pain symptoms of fibromyalgia, as the same neurotransmitters are involved in sleep, memory and mood.

The science of fibromyalgia has clearly progressed. But perhaps most encouraging for patients are advances in the clinic, not the lab.

Using the 1990 ACR diagnostic criteria, nearly all qualifying patients are women, harkening back to an earlier era of misunderstanding. However per newer, seemingly more accurate guidelines — which consider a wide range of symptoms and do away with tender point counts — the female to male ratio is 2:1, similar to that of other chronic pain conditions.

Despite lingering stigma, Clauw reassures that receiving a correct fibromyalgia diagnosis is usually a major relief for patients: fewer doctor visits, fewer tests, fewer bills.

Better still for fibromyalgia sufferers is that it’s now relatively treatable. Several neurotransmitter-modulating drugs and drug classes appear to be effective, including some pain medications and antidepressants. Among these, three treatments are now FDA-approved.

Possibly more effective, according to the current evidence, are exercise, cognitive-behavioral therapy — a form of psychotherapy based in altering negative thoughts and behaviors — and simply patient education.

Clauw stresses that while medications can help alleviate symptoms, patients rarely see significant symptom improvement without also adopting self-management approaches like stress reduction, quality sleep and exercise...

Read more: http://www.scientificamerican.com/article/fibromyalgia-maligned-misunderstood-and-finally-treatable/

 

[Valentijn]

Sounds like a big load of bullshit

 

[Marco]

There's considerable if not overwhelming evidence for central sensitisation playing a key role in fibro and other chronic pain disorders but Dr Clauw fails to mention the high rates of peripheral neuropathy now found in 5 independent studies. Peripheral neuropathy could well be what's driving central pain sensitivity.

What needs to be clarified is whether patients with peripheral neuropathy have been misdiagnosed, whether peripheral neuropathy and fibro occur 'co-morbidly' or whether neuropathy is reflective of the underlying pathology in fibro.

The answers may determine whether fibro needs to be treated peripherally, centrally or both and the role for medication v 'coping' treatments.

 

[alex3619]

Wasn't there a claim that marijuana works better than the standard drugs for FM, based on patient feedback?

FM definitely has peripheral problems. The peripheral influences the central, the central influences the peripheral. Its a big circle. For now we seem to have people who favour the top of the circle over the bottom of the circle, and vice versa, but its still a circle.

Identifying cause in complex dynamic multiple feedback loops is hard. We will get there, but when?

 

[Marco]

Here's an interesting previous discussion involving Dr Clauw regarding the emphasis on central v peripheral mechanisms in fibro :

Dr. Clauw Responds:

To Dr. Caro, I agree with many of your assertions. I suspect we will eventually find that nearly all chronic pain states are “mixed” pain states, with variable degrees of peripheral and central input. In the article in The Rheumatologist, I tried to highlight the central features of fibromyalgia and the fact that these are present to variable degrees across all rheumatic diseases, rather than give an exhaustive review of fibromyalgia.

Daniel J. Clauw, MD

http://www.the-rheumatologist.org/d..._to_the_Editor_Feedback_from_the_Readers.html

 

[Min]

CBT again? Same old drivel...

 

[Snow Leopard]

Sounds like a big load of bullshit

Agreed, it is simply Clauw pushing his speculative ideas again. 'Treatable' is a long way from 'remission'.

 

[alex3619]

It could be argued that CBT treats ME ... treatment only implies success. The trick is to show clear evidence. Sadly this has not been done with either CBT or GET for ME, making such treatment unsubstantiated speculation. I suspect its the same thing with FM, though I have not investigated this side of the literature as well as I would like.

The evidence is growing that sweeping areas in psychiatry, and psychogenic medicine, are pervasively biased. This includes denial of contrary evidence, designing experiments so they cannot produce contrary evidence, gatekeeping on publication, and so on. This is being debated more and more by many academics. Its ironic that for a profession that should know about such things as confirmation bias and cognitive dissonance, they seem singularly unaware that they are trapped in an irrational belief system.

 

[jimells]

My former partner suffers from this disease. Treatment is a joke. It mostly consists of anti-depressants with lots of adverse effects, and lectures on the evils of pain medication.

Given the culture of cruelty that we are subjected to, how can depression caused by poverty, social isolation, and social stigma be separated out from depression possibly caused by the illness itself?

Doctors still call the disease "faker-myalgia"; that really says it all.