Fibromyalgia
The FAQs and More
Fibromyalgia - The Pain
The one common factor in all diagnosed or suspected cases of fibromyalgia is chronic widespread pain, a pain that lasts longer than 3 months and is in all four quadrants of the body. The question is, why is this pain happening?
Pain is a normal response signaled from the brain. Everyone has pain at one time or another. This is how our body helps protect us from danger by creating the unpleasant sensation we cannot ignore to get us to react in an appropriate manner. The way pain normally works:
- The body experiences an abnormal interaction (a burn, bump, cut... something happened that is not normally there or was not there before)
- The area which experiences that abnormal interaction sends a signal through the nervous system
- The nervous system picks up that signal causing the body to react (fight or flight - ie: if you touched fire, you immediately react by getting your hand away from the fire)
- The signal sent to the site registers the sensation of pain to the brain
- The brain reacts by sending hormones, white blood cells, and other elements to heal the site
- The site is usually inflamed as a result of the healing process
- The brain eventually gets sensitized to the sensation of pain during the healing process and the pain goes away
Pain can be acute (meaning it lasts a short time) or chronic (meaning it lasts a long time). Pain can be somatogenic (arising from the body) or psychogenic (arising from the mind). The source of somatogenic pain can be nociceptive (caused by nociceptors - a sensory receptor which responds to stimuli by sending signals to the brain) or neuropathic (caused by damage or malfunction of the nervous system).
Inflammation is often present with pain, but not always. If you have a burn or a broken bone or a disease such as rheumatoid arthritis or gout, you will experience inflammation. Some painful conditions not associated with inflammation include osteoarthritis, muscular back and neck pain. What is inflammation? It is a process which protects us from infection and foreign substances by releasing chemicals from white blood cells which are released into the blood to the affected areas in an attempt to eliminate and heal the infection or foreign substances. This release of chemicals increases blood flow to the affected area causine redness and warmth from the leakage of this protective fluid into the tissues and results in swelling.
Two of the common tests given are Erythrocyte Sedimentation Rate (ESR) test and C-Reactive Protein (CRP) test both of which give an idea of how much inflammation is going on in your body. In many people with fibromyalgia, these tests will come back normal meaning there is no (or very little) inflammation associated with the pain. With inflammation, one can usually point to a cause of the pain. Without inflammation present, it is harder to determine the cause or nature of the pain, but that does not mean the pain is imagined.
The confusion in explaining this type of pain to those who have no experience in fibromyalgia is it does not behave in a normal pain pattern. Because of this, some people, doctors included, assume this is all in one's head (psychogenic/somatoform disorders formerly known as psychosomatic, the mind causes the body to respond to non-existent stimuli) and discount anyone as having "real pain" (somatogenic) especially given there are no tests which can prove it. In fact, most tests come back normal on FMS patients.
Fibromyalgia results in chronic, hypersensitive pain response without a known cause. There may be a cause found in the future, but as of now, no one knows what really causes it.
Some people with fibromyalgia also suffer from diseases such as rheumatoid arthritis or another auto-immune disease where they have a different pain experience concurrent (along with) with FMS pain that is characterized by inflammation, but for the most part the pain associated with FMS does not induce inflammation.
The pain is indeed real, it just is not well understood. There are many theories on FMS pain, but nothing is conclusive. The general thinking is that this pain is a result of central sensitization where the entire central nervous system becomes sensitized to an unknown stimulus. This results in a hypersensitivity to pain; what a normal person might perceive as non-painful or minimally painful, a fibromyalgia person will perceive it as extremely more painful.
It may be comforting to know that this pain is not fatal and will not result in degeneration of the joints, muscles or bones in and of itself, but if one has fibromyalgia and fails to be active because of the pain it will result in degeneration because of inactivity.
The hardest thing for most people to understand is the cycle of the pain. While it cannot be determined how FMS pain starts, what is known is if you experience long-term pain, it affects your brain with depression and anxiety and this affects your sleep; both of which can make the pain worse. To deal with the FMS pain alone, one has to address the issues of relieving the pain, anxiety, depression and sleep. That being said, FMS pain is no different than any other type of chronic pain: if you had cancer, MS, a broken bone, etc, and the pain was not relieved, you would also experience anxiety, depression and lack of sleep which would make the pain worse, yet you would never say that depression, anxiety, and lack of sleep would cause those conditions.
It is thought if the pain, anxiety, depression and sleep can be managed, the rest of the fibromyalgia symptoms become easier to deal with or eliminated. However, it is also thought that the longer one continues without getting the pain, anxiety, depression and sleep under control, the harder it will be to treat. Delaying treatment of FMS may actually lead to moderate to severe FMS that won't ever go away.
Certain drugs such as SSIs, anti-depressants, and anti-seizure medications are thought to be effective ways to treat the pain of FMS by allowing receptors in the brain to respond normally to pain signals. In many cases, these drugs work, but there are some people who feel no relief who must try alternative methods to deal with the pain such as acupuncture, chiropractors, heat/cold packs, NSAIDS, or herbal remedies.
Different approaches may include dealing with what may be an underlying sleep disorder or a depressive or other psychiatric disorder. Sometimes these treatments run along with the prescription approach or if the traditional medical solutions have all failed. When it gets to that point, a patient may feel insulted, humiliated, or not believed and refuse to participate in treatment opting to suffer in silence. They may perceive psychiatric doctors and psychiatric drugs as the doctor's way of telling him/her they are crazy and not experiencing something real or of a psychiatric nature.
For those who have reached that point, don't give up just because your doctors have given up. You know your body and your mind better than someone who is not experiencing your life. It could also be that your doctor may just have a lousy way of communicating with you or is completely ignorant of fibromyalgia. Find a different doctor or a different treatment which might work for you. Join support groups with people in the same boat who understand you. They may have insight and connections you don't know about.