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/