Some health care professionals claim fibromyalgia is psychosomatic because there are no X-ray images, blood tests, or biopsies that will definitively indicate the presence of fibromyalgia. The condition is not quantifiable. The debate is further heightened by the fact that Dr. Frederick Wolfe a researcher who spearheaded a 1990 paper that presented the world with a diagnostic protocol for fibromyalgia has since stated that “fibromyalgia exists as a continuum rather than a dichotomous diagnosis.” In other words, fibromyalgia exists on a spectrum and not as a black-and-white illness according to Wolfe.
Fibromyalgia, a medical mystery
For a long time, fibromyalgia was thought of as a medical mystery. Technological advancement has allowed us to look closer. Today, it is a recognized disorder, part of a group of chronic pain syndromes described as central nervous system disorders. Click Here to read on the “Causes of Fibromyalgia”
Interoception
It is contemporarily defined as the sense of the internal state of the body, which helps us understand what’s going on inside our body. This study investigates interoception in fibromyalgia and concludes that the hypervigilance towards potentially negative stimuli (i.e., pain) often associated with fibromyalgia may contribute to sensory overload, affecting the accuracy, sensibility and awareness of our pain.
Habituation mechanism
Studies showing that the parts of the brain that process pain signals are lit up like Christmas trees in fibromyalgia, migraine, and other chronic pain disorders indicate that the brain plays a major role in these diseases. Other fibromyalgia studies, which indicate that the habituation mechanism which should automatically reduce pain over time isn’t working so well, also indicate brain involvement.
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Types of nerve fibers
Two different nerve fibers in the skin exist: one transmits pain signals and the other sympathetic nervous system signals. Since problems in both the pain response and sympathetic nervous system exist (and are likely intertwined), it’s possible that both types of nerve fibers have been damaged in FM. Plus, since the sympathetic nervous system (SNS) or “fight or flight” response is immediately triggered by pain, its potential relevance to FM comes as no surprise. Some researchers such as Dr. Martinez-Lavin believe the pain sensitivity in fibromyalgia is directly triggered by aberrant sympathetic nervous system activity. The big question right now is if the two findings central nervous system problems and the skin nerve issues in fibromyalgia are connected. That’s what the Italian researchers in the study below tried to find out.
Based on observations on the relationship between somatosensory processing and pain in FM and considering the affective symptoms of this disorder, we tested in FM three dimensions of interoception: interoceptive accuracy (IA), interoceptive awareness (IAW) and interoceptive sensibility (IS). Multiple regression analyses showed that increased pain-related affect and reactions decrease IA in FM. When the results of each group were examined separately, such effect was found only in FM patients. On its turn, IS was predicted by emotional consciousness and pain-related affect and reactions, but these effects did not differ between FM and controls. Finally, none of the variables we used predicted IAW.
Laser-evoked potentials
In the present study, the Italian researchers attempted to cross the divide between body and brain by assessing two seemingly disparate processes in a single group of patients. A “laser-evoked potentials” (LEP) test was used to determine if the habituation process in the brain which should tamp down pain signals was working in FM. The “sympathetic skin response” test measured whether the sympathetic nerves in the skin were working properly. Study findings indicating that sympathetic skin response (SSR) is delayed in FM suggest that problems with these nerves in the skin may exist. One research group even proposes that SSR testing could provide the first biological test for FM.
Reclassification of fibromyalgia
Wolfe’s assertion and other research have led to several medical professionals calling for a reclassification of fibromyalgia from a categorical illness to a spectrum health condition. However, any such decision could have significant repercussions. Andrea M. Risi, LPC, a Denver-based counselor and Topic Expert in health, illness, and medical issues, said, “The problem with a spectrum diagnosis is that it can be unacknowledged in the medical community. Some doctors refuse to diagnose a condition that’s not quantifiable (such as the result of an X-ray or blood test). Therefore, it can be difficult for the patient to find and obtain the most effective treatment with a spectrum diagnosis.”
Effect of depression on the intensity of pain
According to Risi, “If a person is depressed or anxious about the illness, there can be a greater frequency and intensity in pain and flare-ups. A therapist can help identify negative thoughts, feelings, and behaviors that are adding to the pain cycle and when the person uses coping skills, those flare-ups can diminish.” If someone you love is affected by fibromyalgia, be a source of comfort by showing patience, affection, and understanding. Increase your understanding of the condition and, if appropriate, encourage your loved one to seek the help of a therapist. A qualified mental health professional can help alleviate symptoms and some conditions that may accompany fibromyalgia.
Treatment options
We don’t know exactly what causes fibromyalgia, but treatments need to be developed based on what we do know. For instance, we know there are brain changes. One promising treatment may therefore be brain stimulation techniques like Transcranial Magnetic Stimulation (rTMS); a non-invasive technique that can change the activity of neurons in the brain. There is a clearly an urgent need to provide targeted and effective treatment options for fibromyalgia sufferers. Considering how far we have come in explaining the unexplained pain of the condition, there is real hope for the future.
Also Read: Fibromyalgia Diet: What to eat and what not to eat
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Reference:
- What Signals Is The Body With Fibromyalgia Telling The Mind? via Pro Health
Study Source: Borg C, Chouchou F, Dayot-Gorlero J, Zimmerman P, Maudoux D, Laurent B, Michael GA. Pain and emotion as predictive factors of interoception in fibromyalgia. J Pain Res. 2018 Apr 19;11:823-835. doi: 10.2147/JPR.S152012. eCollection 2018.