As more research is done on specific diseases, our understanding of them changes.
Fibromyalgia is a very common illness. Almost two people in a hundred will develop it at some stage in their life. It is typically diagnosed after ruling out a host of other illnesses.
It’s commonly called a basket diagnosis - it doesn’t show up in almost all tests (except for functional MRI). Fibromyalgia is something we get labelled with when a doctor can’t find any explanation for our symptoms in our test results, it’s diagnosis by exclusion.
However, there are multiple components that contribute to fibromyalgia: genetic, neurobiological (brain chemicals), environmental (allergies), and psychological (especially long term trauma).
But first, the older theories of fibromyalgia, widely believed by both normal healthy people and, sadly, many doctors and specialists.
Fibromyalgia is psychosomatic
If you have fibro, I’m positive you’ve heard very often that:
- "It's all in your head."
- "You are too stressed / too sensitive."
- "Change your thinking and beliefs and you will be cured."
- "It's just depression."
- "Just get over it."
psychosomatic /ˌsʌɪkə(ʊ)səˈmatɪk/ adjective
- (of a physical illness or other condition) caused or aggravated by a mental factor such as internal conflict or stress.
- relating to the interaction of mind and body.
This is an old theory of fibromyalgia, and it came from the 1800s, although it wasn’t given the name fibromyalgia until the 1970s.
Unfortunately, many older doctors still consider fibromyalgia to be synonymous with hypochondria - there is nothing physically or chemically wrong with your body. That you are thinking yourself into pain, sometimes due to ‘too much stress’.
We are stigmatized as chronic complainers and attention seekers.
And they send fibro patients off to see a psychotherapist. Unfortunately, few are trained in strategies for managing chronic painful illnesses. Or we are prescribed anti-depressants without regard to which ones could actually help.
While there is no question that fibromyalgia has a strong psychosomatic component, as all chronic pain illnesses do, our understanding of fibromyalgia has moved on from a pure psychological root cause.
That doesn’t mean you shouldn’t see a psychotherapist - cognitive behavioural therapy (CBT) and other body feedback and stress management techniques like meditation do help reduce fibromyalgia pain.
It is interesting that several anti-depressants have a positive effect for many fibro patients. More on that later.
Fibromyalgia is rheumatological
The next common diagnosis is of a musculoskeletal disorder that causes chronic pain, like arthritis.
Muscular rheumatism, fibrositis and and fibromyositis are chronic inflammatory problems, affecting the muscles, ligaments and tendons. The pain symptoms of these illnesses and fibromyalgia are quite similar.
While non-specific light inflammation is often found in the blood tests of fibromyalgia patients, there are many others who still have fibromyalgia, but absolutely no inflammation. So fibromyalgia is not an inflammatory illness like rheumatism.
Most patients are still referred to rheumatologists for diagnosis and treatment, although the standard treatments for rheumatic diseases (anti-inflammatory and cortisone medications) have no effect, unless the patient also has some form of rheumatism in addition to their fibromyalgia.
Fibromyalgia is genetic
Most recently, it was discovered there may be a genetic component to fibromyalgia, typically involving multiple genes that control the chemicals in our brains.
Fibromyalgia is neurological
Current fibromyalgia research is focusing on our brains and nerves, now that we can image the brain and it’s chemicals accurately.
One study compared muscle fibers of healthy people and fibromyalgia. They found cellular damage consistent with known neuromuscular disorders, and impaired blood flow to the muscles which can lead the pain nerve cells around the muscle being sensitized - sending signals of increased pain, fatigue and muscle weakness.
A recent study that caused a stir in my pain support groups, found that fibromyalgia sufferers have many more nerve fibers in their hands than healthy people, similar to patients with small-fiber peripheral neuropathy. But others have argued that this could be the result of fibromyalgia, not the cause.
In fibromyalgia patients, the levels of neurochemicals in the brain that signal pain are not normal, leading to us feeling the pain is more painful than it should be. Plus our brains’ pain receptors develop a memory of the pain, become more sensitive and don’t shut off correctly.
The neurochemicals that are commonly out of balance include serotonin, dopamine, substance P, and noradrenaline.
These same neurochemicals affect our sleep, cognitive function, and mood. This more accurately explains the primary symptoms of fibromyalgia - the muscle pain, pain from other stimuli like noise or light, insomnia, exhaustion, anxiety, depression and the fibro-fog.
Years of trauma in childhood permanently damages the production and balancing functions of neurochemicals. The environment around us, our psychological and physical state all affect these neurochemical levels. It would explain why people who have other chronic illnesses or have gone through childhood trauma often develop fibromyalgia.
The classes of medications that work for many (but not all) fibromyalgia patients mess around with our neurochemical levels - antidepressants (SSRI, SNRI, tricyclic), anti-convulsant medications, and muscle relaxants may work for many fibro patients.
Because everyone has a different balance of these brain chemicals, this would also explain why one medication works well for one fibromyalgia patient, and not for another.
Which in the case of fibromyalgia is looking more convincingly to be neurochemical.
A multi-modal approach is best
- Psychotherapists and cognitive behavioural therapy (CBT) is useful for reducing the mood and depressive symptoms.
- Psychiatrists (or an experienced GP) can prescribe appropriate anti-depressants that may balance the neurochemicals.
- Rheumatologists may be able to help with any inflammatory problems that are commonly found alongside fibromyalgia.
- General physicians or pain medication specialists can help reduce the sensitization and perception of pain.
- A neurologist or GP should also be able to help with sleep problems.
- Physical therapists can also help reduce physical pain and postural problems that worsen fibro pain.
What have you been told fibromyalgia is?
Most recently, someone tried to convince me it was muscular rheumatism, and the cure was lots and lots of exercise.
What have you been told your fibromyalgia is caused by?