Tuesday, May 5, 2009
CURRENT THOUGHT ON PAIN REDUCTION IN MYOFASCIAL PAIN SYNDROMES (Part 3)
Despite having a long history (as far back as the 1600s), fibromyalgia was not recognized as an actual medical issue until the 1980s. Some physicians still do not accept fibromyalgia as a distinct condition in spite of its inclusion in the official list of diagnoses since 1987.
Fibromyalgia is complex to diagnose and to treat. There is no defining orthopedic or laboratory test that is diagnostic for fibromyalgia. The physician must look for a combination of exam findings and correlate those with pertinent information from a detailed history. If certain criteria are met, then the doctor can assume you have fibromyalgia.
Treating fibromyalgia can be complicated and, sometimes, frustrating for you and your doctor. Although inflammation is frequently present with fibromyalgia, it seems unconnected with the condition. There may be a connection, either as a cause or an affect, but recent research shows no demonstrable relationship. This is unfortunate because it precludes treating an inflammatory condition and having pain go away. Treating inflammation when you have concurrent fibromyalgia may decrease or eliminate some pain but the fibromyalgia and associated symptoms remain.
What causes fibromyalgia is not clear. As studies continue, more information emerges. Currently, it appears that fibromyalgia is associated with changes to the central nervous system (CNS). More specifically, there seems to be a change in how your body processes pain messages. It is unclear at this point whether this change is due to a previously minor pain message being “multiplied” by your nervous system or because your CNS has become hypersensitive to pain stimuli. This is similar to hearing a radio more loudly but not being sure if the cause was someone turning up the volume or that your ear is working better.
Most recent studies suggest that the problem may lie with alterations in normal chemical activity in your body. A number of CNS chemicals are frequently found to be outside normal ranges in fibromyalgia patients. I will gladly forward more specific information on these imbalances to those who are interested.
There also appears to be a familial component to fibromyalgia. In other words, there may be a genetic predisposition toward fibromyalgia because it seems prevalent in some families but not in others. Remember, though, that a genetic predisposition is like a gun. If the trigger isn’t pulled, the gun doesn’t fire. Similarly, if you don’t do a sequence of activities or behaviors that might initiate the fibromyalgia, it is unlikely to occur.
I will discuss other findings and selected treatment considerations in part 4 of our discussion.