Fibromyalgia is characterized by chronic widespread pain, among other symptoms but the underlying cause responsible for chronic pain in FM remains unclear. Recent and accumulating evidence suggests that central pain amplification is a key for fibromyalgia pathogenesis, a process characterized by augmented pain and central processing in the spinal cord and brain also known as central sensitization.
Researchers prepared the cutaneous silent period, a spinal reflex mediated by A-delta cutaneous afferents used to asses pain processing in both the central and peripheral nervous system, between fibromyalgia patients and normal healthy controls. A total of 124 fibromyalgia patients (diagnosed according the 1990 American College of Rheumatology classification system) and 24 age and sex-matched healthy controls were analyzed. Researchers measure CSP from the abductor pollicis brevis muscle (located in hand between the wrist and base of the thumb) using standard electro diagnostic equipment, along with patients’ parameter including demographic data, number of tender points, visual analog scale, fibromyalgia impact questionnaire scores.
Mean CSP duration was significantly longer in fibromyalgia patients when compared to healthy controls. Previous studies investigating CSP in patients with central nervous disorders have found that CSP duration was prolonged in brachial dystonia, Parkinson’s disease and multiple system atrophy. These findings suggest that CSP duration may reflect dysfunction of supraspinal control, which will cause an impact on spinal excitability.
These findings suggest that fibromyalgia is associated with dysfunction of pain modulation mechanisms in central nervous system. Notably, researchers found no correlation between CSP clinical parameters such as VAS score, K-FIQ score, age and height which poses doubts as to whether to use CSP to assess disease severity. Accordingly researchers emphasize that additional studies are required to further evaluate the relationship between CSP parameters and clinical data.
In conclusion dysfunction of supraspinal control may be for pain in FM, providing further evidence that central sensitization underlies the pathogenesis of the disease the authors write in their report.
The pain associated with fibromyalgia is dissimilar from other pain that a person has experienced. Those who have this pain not only feel as though they have pain in their muscles and joints, but they have the issue of having pain as soon as someone touches them.
It is not uncommon for a person to be touched in those pressure points on their bodies and physically cringe from the pain that this causes. The one question that many fibromyalgia sufferers have is what is causing this pain throughout their body? Many people theorize they have intense arthritis flare-ups. Other people have theorized that this illness is often worse with certain activities and certain diets, which has been proven correct.
However, new studies are showcasing that the pain these fibromyalgia sufferers have could be linked into spinal cord dysfunction.
The Results of the Study
A recent study is what has everyone questioning the idea that the spinal cord could be responsible for the pain that is associated with fibromyalgia.
The study was entitled “Lengthened Cutaneous Silent Period in Fibromyaglia Suggesting Central Sensitization as a Pathogenesis”. The study was originally published in PLOS One.
More Pain for Fibromyalgia Patients
For fibromyalgia patients, researchers have initially found that there is a correlation between pain and the central nervous system in those with have this illness.
Basically, the study found that the CSP duration in the fibromyalgia patients was much longer than those patients who were not diagnosed with fibromyalgia.
For researchers, this has made them state that there could be a spinal dysfunction in fibromyalgia patients that is leading to the pain that they are feeling.
So, what does this mean for those people with fibromyalgia? It means that the whole cause of fibromyalgia could be neuropathic in nature.
This changes the mindset that was seen years ago, in which many people believed that fibromyalgia was a disorder of the joints, and many people believed that this was an issue simply associated with the ligaments and muscles of the body. So, what could these changes mean for treating fibromyalgia?
Treating Fibromyalgia with These Results
With these results in hand, it could mean that the treatment options are going to change dramatically for those who suffer with fibromyalgia! This is good news for those who are suffering with this illness. What changes could be seen?
With this illness being more neurological, it could mean a change in what prescription medications are given to patients.
Many doctors were already speculating that this illness was neurological, and in turn were giving antidepressants and antiepileptics to help with the pain and other ailments associated with fibromyalgia.
However, with the results of this recent study, it could mean that doctors start looking at giving patients:
Sodium channel blockers, Calcium channel blockers, Serotonin-norepinephrine reuptake inhibits (SNRI), NMDA receptor antagonists and Nerve growth factor inhibitors (NGF)
These drugs could go a long way in helping with the pain that the person feels, along with other issues such as anxiety or nervous issues associated with this illness..
A few ideas for those who are dealing with fibromyalgia:
1- Hypnotic therapy is being used more and more for those with fibromyalgia. It is not meant to relieve the pain completely. However, initially people are finding that this hypnosis is helping to deal with the pain to get this to a level that is going to be easily managed!
2- Pilates is one physical exercise that can help with strengthening the muscles and improving the flexibility of the person. In turn, the person finds that the pain is often decreased in intensity with the use of this exercise.
3- Consider massage as a great option for dealing with the pain. While the pressure points in the body can make massage a bit painful. There are many patients who find that this can help them to feel better as it increases the blood flow to several areas of the body that are in pain due to this illness. The key is to find a massage therapist that is trained how to deal with fibromyalgia patients.
4- Take warm baths to soak these muscles and help relieve the pain that is seen. While this is just a temporary fix for the pain that is being felt, it is one that has high success rates. Many fibromyalgia patients enjoy tubs with jets in them for an added massage benefit for their pain.
5- Learn ways to take your mind off the pain. Many fibromyalgia patients find that doing a mental activity can help in doing this and it can prove rather successful.
With the latest studies that showcase just how fibromyalgia could be associated with a spinal cord dysfunction, it could open several great treatment alternatives for patients.
Reference: Study titled “Lengthened Cutaneous Silent Period in Fibromyalgia Suggesting Central Sensitization as a Pathogenesis” and published in the journal PLOS One.
-Reviewed by Muneeba Rana, MD.