You know that music you often here playing in an elevator, or in the waiting room at the doctor’s office? Usually it’s played at a low level to provide a soothing background noise. However, let’s say that the volume control on the radio playing this music starts to malfunction and the volume turns itself up. The once barely noticeable tunes now boom uncontrollably and uncomfortably.
Now picture for a second that instead of a malfunctioning radio it was actually your nerves that had gone haywire. This is in part what fibromyalgia sufferers experience, leading to widespread, chronic pain. Despite increased advertising for treatments, there is very little understanding about the causes of this invisible, but extremely painful, condition. Additionally, there are no tests available to aid in the diagnosis. In 2001, September was declared Chronic Pain Awareness Month so I would like to devote my September post to raising awareness about fibromyalgia, a condition that affects an estimated 2-4 percent of Americans (that is as many as 12 million people).
Scientifically speaking, the ability to sense harmful stimuli is referred to as nociception, or nociperception. The processing of pain involves both components of our nervous system: both the peripheral and central nervous systems. Normally, there is a balance between the transmission of pain signals from the body to the brain and subsequently signals from the brain back to the site of injury that either enhance or decrease the pain signals, in essence acting as a type of volume control. In a patient with fibromyalgia, for reasons not yet understood, this process gets disrupted - it is turned up, resulting in higher amounts of pain. This abnormal pain processing can actually be seen in brain scans, which show increased brain activity in the pain processing centers of the brain of fibromyalgia patients compared to that of healthy subjects.
In recent years, many research groups have made important discoveries about physiological changes that occur in the bodies of fibromyalgia suffers. Changes have been observed in both the peripheral and central nervous systems. One study found that patients have a higher concentration of sensory nerve cells, nociceptors, in their hands, a region commonly found to be sensitive in the patients. Another study suggests that regions in the brain that help prepare the body for pain and reward it following the relief of pain do not properly activate in subjects with fibromyalgia. There is also evidence that pain increasing neurotransmitters are present in higher levels, while neurotransmitters that reduce pain transmission are present in lower levels in cerebrospinal fluid of patients.
Unfortunately, the triggers that lead to the development in fibromyalgia have yet to be discovered. There is some evidence that there may be a genetic component, with relatives of patients being eight times more likely to develop fibromyalgia. However, there may also be some environmental factors such as a traumatic injury or infection.
Great strides have been made to help us understand this complex condition. However, there is still a long way to go which is why funding for basic science and clinical research is so important.