Interesting Article about Fibromyalgia

Interesting Article about Fibromyalgia

Fibromyalgia: An Afferent Processing Disorder Leading to a Complex Pain Generalized Syndrome (2011) Howard S. Smith, MD1, Richard Harris, PhD2,and Daniel Clauw, MD2

A few comments will be seen in bold

This study mentions the overlap among fibromyalgia, CFS, and avariety of regional pain syndromes as well as psychiatric disorders – and shows that the common underlying pathophysiological mechanism seen in most individuals with fibromyalgia, and large subsets of individuals with

these other syndromes, is central nervous system (CNS) pain or sensory amplification.

The current thinking about these overlapping symptoms and syndromes is as follows:

• Groups of individuals with these conditions (e.g.fibromyalgia, irritable bowel syndrome [IBS], headaches,temporomandibular joint disorder [TMJD], etc.) display diffuse hyperalgesia (increased pain in

response to normally painful stimuli) and/or allodynia

Here in the community we often mention other associated illnesses including Plantar Faciitis, IC. Costohrondritis etc - interesting isn't it?

Although pain and fatigue are 2 of the most common fibromyalgia symptoms, sleep disturbances

and sexual dysfunction occur very frequently as wellin fibromyalgia patients.

I thought this may be of interest to meembers who have recently posted about personal issues

In addition to pain and sensory amplification, other shared mechanisms and/or epiphenomona include neurogenic inflammation,especially of mucosal surfaces, leading to increased mast cells and the appearance of a mild inflammatory process; dysfunction of the autonomic nervous system; hypothalamic pituitary dysfunction.

In addition to the heightened sensitivity to pressure noted in fibromyalgia, other types of stimuli applied

to the skin are also judged as more painful or noxious by these patients as well. Fibromyalgia patients

also display a decreased threshold to heat, cold, and electrical stimuli

A comment about how debilitating it can be compared to other conditions, interestingly, as many of us say how it effects our quality of life. As with the lack of Awareness & understanding many people may not realise this , however this as a statement may helpp help people to realise how debilitating it is as compared to RA, OA, COPD & IDDM he (conditions that people understand)

Fibromylagia affects all aspects of daily physical functioning. Women with fibromyalgia consistently

scored among the lowest in quality of life measures versus women with rheumatoid arthritis (RA), osteoarthritis (OA), chronic obstructive pulmonary disease (COPD), or insulin-dependent diabetes mellitus (IDDM). Patients with fibromyalgia have reported difficulty with multiple activities (41,42). Sixty-two percent have difficulty climbing stairs, 55% have difficulty walking 2 blocks, and 35% have difficulty with activities of daily life

Functional MRI studies (pictures in free text article)

Brain imaging studies also support the existence of central pain augmentation in fibromyalgia, IBS, low

back pain, and several other of these conditions . Gracely et al performed the first functional magnetic resonance imaging (fMRI) study of fibromyalgia patients in 2002. When stimuli of equivalent pressure magnitude were administered to fibromyalgia patients and controls, Gracely and colleagues found increased regional cerebral blood flow in fibromyalgia patients compared to control participants who did not have fibromyalgia

Interesting excerpt about neurotransmitters, susstances in CSF and also discussion again about the lack of efficacy of Opioids in Fibro

In fibromyalgia, there is evidence for increases in the CSF levels of substance P, glutamate, nerve

growth factor, and brain derived neurotrophic factor, and low levels of the metabolites of serotonin,

norepinephrine, and dopamine , any of which could lead to an “increase in the volume control”

and augmented pain and sensory processing The only neurotransmitter system that has been

studied to date and not found to be out of line in a direction that would cause augmented pain transmission is the endogenous opioid system. Both CSF levels and brain activity by functional neuroimaging appears to be augmented, not reduced (as would cause augmented pain processing) in fibromyalgia, which may be why opioidergic drugs do not appear to work well to treat fibromyalgia and related pain syndromes

Strangely, we have always mentioned this to members that what works for one may not work for another

It is of note that any one of these classes of drugs only works well in about a third of patients, which is

entirely consistent that this is a strongly genetic – but polygenic disorder – and thus different treatments are needed in different individuals

Please see the section about the Diagnosis and Assessment of Fibromyalgia in the full article if of any interest

Interesting a possible new treatment under research? Tizanidine - anyone taking this already?

A quote from the Pharmacological Treatment of Fibromyalgia Tizanidine is a centrally acting alpha-2 adrenergic agonist considered a muscle relaxant which might have beneficial effects on spasticity. Tizanidine might produce significant improvements in several parameters in fibromyalgia including sleep, pain, and measures of quality of life . Additionally, tizanidine treatmentresulted in a significant reduction in substance P levels in the CSF of patients with fibromyalgia.

Information about Tizanidne

Some information about Tramadol explaining the way it works to provide analgesic plus is Tapentadol a potential treatment to next be researched

Tramadol is a compound that has some weak analgesic effects by binding to the mu-opioid receptor, but the majority of its analgesic effects are from serotonin/norepinephrine reuptake inhibition. Tramadol appears to possess some beneficial effects in the management of fibromyalgia both alone and as a fixed-dose combination with acet-aminophen (153,156,157). Tapentadol, an atypical opioid

that has some opioid effects as well as inhibits the reuptake of norepinephrine, has not been studied yet

for the treatment of fibromyalgia

Information about Tapentadol

We often talk about relaxation techniques and here PMR is discussed so have added it as many of you say it does help alongside other treatments

Relaxation techniques are commonly part of CBTfor fibromyalgia, (211,213). Relaxation techniques likely to be helpful for fibromyalgia symptoms include but are not limited to PMR, autogenic training, guided imagery,and meditation.PMR involves the systematic tightening and relaxing

of various muscle groups with the goal of decreasing muscle tension overall, and thus ameliorating anxiety, which was presumed to be linked to muscle tension. Patients with fibromyalgia should be cautioned not to tense their muscles too tightly during this exercise because this could result in exacerbating pain.

A conclusion excerpt and prognosis discussion

In the past decades, our understanding of fibromyalgiahas evolved tremendously, and the study of

fibromyalgia has taught us about the mechanismsthat might underlie chronic pain or other somatic

syndromes, in individuals without fibromyalgia per se. A better understanding of the underlying mechanisms and most effective treatment for this spectrum of illness is critical to rheumatologists, because as Wolfe has taught us, many patients with rheumatic disorders have a little, or a lot, of “fibromyalgianess.”

As we mention regularly here in the community about a combined approach may be considered best in trying to manage Fibro symptoms, see below

Although there is no known cure for fibromyalgia, multidisciplinary team efforts using combined

treatment approaches, including patient education, aerobic exercise, cognitive behavioral

therapy, and pharmacologic therapies (serotonin norepinephrine reuptake inhibitors [e.g.,

duloxetine, milnacipran] and alpha 2-delta receptor ligands [e.g., pregabalin]) might improve

symptoms as well as function in patients with fibromyalgia.

Free Full Text at:

Picture from the same article : Fibromyalgia: An Afferent Processing Disorder Leading to a Complex Pain Generalized Syndrome (2011) by Howard S. Smith, MD1, Richard Harris, PhD2,and Daniel Clauw, MD2

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7 Replies

  • Thanks for posting thisit is most interesting

  • A very interesting read, Thank you for posting :)

  • Very interesting, thanks you x x

  • Ive found quite a few things out about Fibro's quirks that arn't in the open over here.

    My cousin sent me a link from OZ where they have found it interferes with your hormones

    Well these things like Fibro/CFS are hormonally controlled not like normal pain as i call it working through backdoor where as if you break a bone etc that's through front door! which is why most meds don't work

  • Thank you for sharing, very interesting and I will be reading it a few times I'm sure.

  • I've had Fibro for over 10 years. Was incredibly active, playing golf, racquetball, tennis, jogging, and going to the gym. Then one day I couldn't get out of bed and the journey began. Of all the meds I've tried, including a non-med, bio feedback, Tramadol probably provided the most relief. Of course I can't take it, because it tears up my skin, creates sores, itching, and hives. Now I'm on lose doses of OXY and it helps quite a bit, but is short acting, and the side effects aren't pleasant. But at least I can get out of bed in the morning. I truly believe I know more about this illness than most doctors I've gone to, that's why I ask other sufferers, who are in a better position to know, this question? What med have you tried, or use, that helps you the most? With the understanding of course that we are all wired differently and what might work for one will not work for another.

    I should add that my comment about doctors is not an indictment of the profession, but when you walk into a new doctor's office for the initial interview and the first words out of his mouth are "I've been looking at your chart. Sorry, but I can't help you. Wish I could, but this is such a complicated illness I can't suggest anything different than what you've already tried."

    And then you go home, seek a nice quiet place, and reflect. Where do I go for the most help? Forums like this one.

  • Very Interesting

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