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More Clues To Fibromyalgia Pain

More Clues To Fibromyalgia Pain

Fibromyalgia patients have more “connectivity” between brain networks and regions of the brain involved in pain processing, which may help explain why sufferers feel pain even when there is no obvious cause, a new study suggests.

Researchers had 18 women with fibromyalgia undergo six-minute fMRI brain scans, and compared their results to women without the condition.

Participants were asked to rate the intensity of the pain they were feeling at the time of the test. Some people reported feeling little pain, while others reported feeling more intense pain.

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Brain scans showed the connectivity, or neural activity, between certain brain networks and the insular cortex, a region of the brain involved in pain processing, was heightened in women with fibromyalgia compared to those without the condition.

The connectivity to the insular cortex was even stronger in participants who reported feeling more intense pain compared to milder pain, said study author Vitaly Napadow, a neuroscientist at Massachusetts General Hospital.

“We took advantage of the fact that there is a large discrepancy in the amount of pain patients happen to be in at the time they come in. Unfortunately some patients come in, and they are in a lot of pain. Other patients come in and they are not in pain,” Napadow said.

The study, by researchers from Massachusetts General Hospital and the University of Michigan, is published in the August issue of Arthritis & Rheumatism.

Fibromyalgia is a chronic pain syndrome that’s characterized by widespread pain, fatigue, insomnia, and the presence of multiple tender points. The syndrome can also cause psychological issues, including anxiety, depression and memory and concentration problems, sometimes called the “fibromyalgia fog.”

Prior research has shown that people with fibromyalgia feel a given amount of pain more intensely than others, Napadow explained. In other words, studies have shown a typical person might rate a painful stimuli a “one” on a scale or one to 10, while a person with fibromyalgia might rate the pain a 5 or higher.

The new study is different in that fibromyalgia patients’ pain responses were measured while they were at rest and not being exposed to anything painful, Napadow said.

The brain networks involved were the default mode network (DMN) and the right executive attention network (EAN). The DMN is involved in “self–referential thinking,” when you think about yourself or what’s happening to you, Napadow explained.

The EAN is involved in working memory and attention. When that brain network is occupied, or distracted, by pain, it may explain some of the cognitive issues that fibromyalgia patients experience, Napadow said.

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Dr. Philip Mease, director of rheumatology research at Swedish Medical Center in Seattle and a member of the National Fibromyalgia Association medical advisory board, said the study provides insight into what may be going on in the brains of people with fibromyalgia.

“This work shows there is increased connectivity between different brain centers that connect the purely sensory pain processing centers of the brain with some of the emotional and evaluative parts of the brain, or areas of the brain that take a sensory stimulus and say, “How do I interpret this? How do I feel about this’?” Mease said.

For years, fibromyalgia has been a highly misunderstood syndrome, with some doctors doubting it even existed, and others attributing the pain to depression or other psychological issues.

That began to change early this decade, when brain scans showed pain-processing abnormalities in fibromyalgia patients, Mease said.

“That first neuroimaging study really demonstrated fibromyalgia patients were different than normal individuals, and at a neurobiological level, were truly experiencing more pain at lower intensities,” Mease said.

The new research moves understanding of the condition a step further, by exploring what’s happening in the brain during a resting state.

“Regardless of poking or prodding them, this study is trying to get at an understanding of what is crackling in the brain, intrinsically, such that they have this higher sensitivity,” Mease said.

About 10 million Americans are believed to have fibromyalgia, almost 90 percent of whom are women, according to the National Fibromyalgia Association. Sufferers report a history of widespread pain in all four quadrants of the body for at least three months, and pain in at least 11 of 18 “tender points.”

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12/24/2022
Fibromyalgia Symptoms More Severe in Obese Patients

Patients with fibromyalgia who are severely obese have more severe symptoms and lower quality of life (QOL), according to a study published in the February issue of Arthritis Care & Research.

Chul-Hyun Kim, M.D., from the Mayo Clinic in Rochester, Minn., and associates measured body mass index (BMI) to determine its association with symptom severity and QOL in 888 patients in a treatment program for fibromyalgia. Participants completed the Fibromyalgia Impact Questionnaire (FIQ) and the Short Form 36 (SF-36) health survey.

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The researchers found that 28.4 percent of patients were nonobese, 26.8 percent were overweight, 22.2 percent were moderately obese, and 22.6 percent were severely obese. Group differences were significant with respect to the number of tender points (P = 0.003) and the FIQ and SF-36 scores, after adjusting for age. For the group with the greater BMI, there were significantly worse FIQ total scores, and significantly worse scores in the FIQ subscales of physical fitness, work missed, job ability, pain, stiffness, and depression. Significantly poorer SF-36 scores were seen in these groups in physical functioning, pain index, general health perception, role emotional, and physical component summary. The differences were mainly in the severely obese group compared with the other groups.

“In patients with fibromyalgia, severe obesity (BMI ≥35.0 kg/m²) is associated with higher levels of fibromyalgia symptoms and lower levels of QOL,” the authors write.

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12/23/2022
Scans Reveal Brain Abnormalities in Fibromyalgia Patients

Researchers have detected abnormalities in the brains of people with fibromyalgia, a complex, chronic condition characterized by muscle pain and fatigue.

“We showed in our study that the functional abnormalities observed were mainly related to disability,” and not to anxiety and depression status, said Dr. Eric Guedj, the study’s lead author and a researcher at Centre Hospitalier-Universitaire de la Timone in France.

While some researchers have suggested that the pain reported by fibromyalgia patients was the result of depression, the new study suggests otherwise. The abnormalities found on brain scans done by the study authors were independent of the women’s anxiety and depression levels, Guedj said.

The French researchers evaluated 20 women diagnosed with fibromyalgia and 10 healthy women without the condition who served as a control group. They asked all the women to respond to questionnaires to determine levels of pain, disability, anxiety and depression.

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Then, the researchers performed brain imaging called single photon emission computed tomography, or SPECT.

The imaging showed that women with the syndrome had “brain perfusion” — or blood flow abnormalities — compared to the healthy women. The researchers then found that these abnormalities were directly correlated with the severity of disease symptoms.

An increase in blood flow was found in the brain region known to discriminate pain intensity, the researchers found.

The findings were published in the November issue of The Journal of Nuclear Medicine.

An estimated 10 million Americans are thought to have fibromyalgia, the majority of them women, according to the National Fibromyalgia Association. They report a history of widespread pain in all four quadrants of the body for at least three months, and pain in at least 11 of 18 “tender points.”

Besides pain, fibromyalgia symptoms include fatigue; problems with cognitive functioning, memory and concentration; difficulty sleeping; and stiffness.

The cause of fibromyalgia remains a mystery, according to the association, but it may occur following physical trauma such as an injury, experts say. Treatments focus on relieving symptoms and helping patients function.

In previous research, Guedj and his team had found functional abnormalities in areas of the brain of fibromyalgia patients. The latest study goes a step further, demonstrating that the brain abnormalities are correlated with disease severity, he said.

Dr. Patrick Wood, senior medical adviser for the National Fibromyalgia Association, said the new study provides “further evidence of an objective difference between patients with fibromyalgia and those who don’t have the disorder.” Wood reviewed the study results but was not involved with the research.

Other studies have found a correlation between brain abnormalities and fibromyalgia symptoms, Wood said, adding that the new study adds more evidence and information on how the abnormalities affect patients.

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12/22/2022
Pain: Another Gender Gap

Like many other things in life, pain discriminates by gender. Women, studies show, feel pain more intensely than men, suffer disproportionately from conditions like chronic pain and migraines, and are more likely to be undertreated for pain than men.

More pain, no gain

More than 70 percent of people who report suffering chronic pain are women, according to a 2003 report in the journal Obstetrics and Gynecology Clinics of North America. Compared with men, women are more prone to a wide range of painful conditions, including migraines, irritable bowel syndrome, temporomandibular joint disorder, and fibromyalgia.

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Women also appear to feel pain more intensely than men. Lab studies show that if you expose women and men to the same painful situation, such as being exposed to gradually increasing heat, women are usually the first to say ouch. On the plus side, other studies show that women handle pain better than men do. This might be because women have more experience coping with the predictable pains of menstruation and childbirth, and know how to prepare for painful episodes.

Ironically, the half of the population that feels the most pain is also the half that is least likely to get the treatment they need. The National Women’s Health Resource Center reports that women with chronic pain often have trouble convincing doctors of the severity of their pain. As a result, they’re also more likely than men to have their pain undertreated.

Some may be tempted to write off these differences as attributable to cultural influences. After all, there’s no doubt that boys and girls grow up with different outlooks on pain. Girls often feel free to cry over small injuries, while boys feel extra pressure to hold in tears. But the gender gap in pain goes far deeper than culture or upbringing. As recently reported by the American Pain Society, researchers are finding fundamental biological differences in the ways male and female bodies sense and respond to pain. Learning more about these differences can help shed light on the basic nature of pain and may lead to improved treatments for all patients.

Hormonal differences

Not surprisingly, hormones explain many gender differences in pain. The monthly ebb and flow of female hormones such as estrogen can clearly help fuel migraine headaches, a potentially disabling condition that is three times as common in women as in men. Women are especially vulnerable to migraines during their menstrual periods, when estrogen levels are low. Studies suggest that drops in estrogen can also interfere with the body’s ability to control pain. During menstruation, women produce only meager amounts of endorphins, the body’s natural pain relievers. When estrogen levels are high — near the time of ovulation — women can produce about as many endorphins as men, as reported at the annual meeting of the American Association for the Advancement of Science.

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The brain also plays a role in the gender gap. In a small study of patients with irritable bowel syndrome, researchers at the University of California in Los Angeles have found that men and women use different parts of their brain to respond to pain. Scan results showed that women tend to turn on their limbic system, the emotional center of the brain. Men, in contrast, respond to pain with the cognitive or analytical part of their brain. Researchers speculate that these brain differences may reflect ancient gender roles. In the old days, women in pain often needed to protect and comfort their young, a highly emotional job. Meanwhile, injured men were more likely to attack the source of the trouble — with a spear, if necessary.

Unfortunately for women, an emotional response can make an already painful situation even worse. As reported by the American Pain Society, women are more likely than men to develop anxiety or depression along with their pain. Both anxiety and depression can sharpen feelings of pain while raising the risk of disability.

Men avoid pain treatment

Of course, the cool, calm approach often taken by men has its drawbacks, too. Men are less likely than women to take their pain seriously, according to the National Institutes of Health. Instead of getting treatment, men often just hope their pain will go away — at least for a while.

A study conducted over 36 months analyzing emergency room visits by more than 32,000 Baltimore men found that there was an increase in male visits immediately following televised sports events. The study, presented in October 2006 at the American College of Emergency Physicians conference, suggests that many men who visited the Baltimore VA Medical Center’s emergency room for various illnesses, including chest pain, abdominal pain, shortness of breath, and headaches chose to ignore their pain until they’d finished watching their football, baseball or basketball game.

As doctors learn more about gender differences in pain, both men and women should get more of the relief they need. There’s certainly room for improvement. Until attitudes change, women may have to be especially aggressive in getting the right treatment for their pain. Men and women may be wired differently, but in the end, relief should be gender-blind.

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12/21/2022
Scientists Spot Unexpected Player in Fibromyalgia

Fibromyalgia is a mysterious and misunderstood illness, but researchers may have uncovered at least one key to the disease’s origin: insulin resistance.

The new research compared a small group of people with fibromyalgia to two groups of healthy people and noted that a long-term measure of blood sugar levels was higher in the people with fibromyalgia. Insulin resistance develops when the body starts to struggle with breaking down sugar.

To see if treating those higher blood sugar levels might help, the researchers gave people who had blood sugar levels in the pre-diabetic range or higher a diabetes medication called metformin. People taking metformin reported significantly lower pain scores, according to the study.

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“We combined metformin with standard drugs used for fibromyalgia and saw a much greater degree of pain relief,” said study author Dr. Miguel Pappolla. He is a professor of neurology at the University of Texas Medical Branch at Galveston.

In fact, Pappolla said, the additional pain relief was so significant that the researchers actually called patients on different days to re-check their pain scores.

Because this is a preliminary finding, the researchers aren’t sure how insulin resistance might contribute to fibromyalgia or how metformin might reduce pain. “Metformin may have some analgesic [pain-relieving] activity on its own,” Pappolla said.

Fibromyalgia is a condition that causes widespread pain, fatigue, sleep problems and distress, according to the U.S. Centers for Disease Control and Prevention. Even celebrities aren’t spared from this painful condition — Lady Gaga reportedly had to cancel concerts on her tour due to pain from fibromyalgia.

Though the cause of the disorder isn’t clear, it appears that people with fibromyalgia may be more sensitive to pain than other people — what the CDC calls abnormal pain processing.

Pappolla said that studies have shown differences in the brain between people with fibromyalgia and those without, such as areas with a lower blood flow than expected. The researchers noted that similar problems have been seen in people with diabetes.

The study included 23 people with fibromyalgia. The researchers compared their hemoglobin A1c levels to large groups of healthy people from two other studies. Hemoglobin A1c is a simple blood test that measures what someone’s blood sugar levels were during the past two or three months. A level of 5.7% to 6.4% is considered pre-diabetes, according to the American Diabetes Association. A level of 6.5% or higher means a person has diabetes.

Only six of those with fibromyalgia had normal blood sugar levels. Sixteen had levels considered pre-diabetes and one met the criteria for diabetes.

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When the researchers compared the average blood sugar levels of the fibromyalgia group to healthy age-matched people in the other studies, they saw that the blood sugar levels were higher in the people with fibromyalgia, suggesting insulin resistance.

The findings were published online recently in the journal PLOS ONE.

Dr. Edward Rubin, an anesthesiologist and pain management specialist at Long Island Jewish Medical Center, said, “It’s interesting that there’s a possible connection between fibromyalgia and blood sugar. We’ve been attacking the symptoms of fibromyalgia, but we don’t have a good understanding of the root cause of fibromyalgia.”

Rubin, who wasn’t involved in the study, said there may be enough evidence here to try metformin along with other medications used for fibromyalgia for people whose blood sugar levels fall outside of the normal range, to see if they have a positive response.

Dr. Bharat Kumar, from the University of Iowa Hospitals and Clinics, said this study shows people with the disease that there is hope.

“People with fibromyalgia are often told [falsely] that they have a disease that simply cannot be managed. This article shows that it’s not true. Although it’s unclear if metformin will work for every person suffering from fibromyalgia, there is active research into finding solutions for this frustrating and overlooked condition,” he said.

Kumar said it’s biologically plausible that insulin could have an effect on pain. “We know that other hormone abnormalities can cause fibromyalgia-like symptoms, so [this finding] is not too surprising,” he added.

Still, he said, he didn’t expect that metformin would be a “silver bullet” for all fibromyalgia pain. He said there are likely a number of causes of the disease.

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12/20/2022
AHA News: Worried About Her Health, She Lost 163 Pounds – And Inspired Her Husband to Drop 55

A few weeks before Thanksgiving, Ken and Morgan House of Newington, Connecticut, spent a week at one of her favorite places – Disney World. They walked to all the theme parks, went on countless rides and shared healthy meals.

Every day, Morgan would smile broadly at Ken and shoot him an expression that said, “Do you even believe this?”

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The last time the Houses were there, Morgan weighed 357 pounds. Ken weighed 280.

While they enjoyed the trip, Morgan couldn’t walk for more than 10 minutes without needing to take a break, her knees hurt and she didn’t fit on some of the rides, including Avatar Flight of Passage, one of her favorites.

That was in January 2020.

In November 2021, Morgan weighed 194 pounds. Ken weighed 225.

“I wasn’t struggling to get in and out of rides,” Morgan said. “I wasn’t struggling to walk. In fact, I was doing 15,000 to 20,000 steps a day without batting an eye.”

One day, she cried with gratitude exiting Flight of Passage.

The tears of joy were as much about conquering her lifelong struggle as they were about enjoying that ride.

“Being overweight prevented me from being my best self, my confident self,” she said. “You internalize how society views you as a fat person.”

In high school, she began what would become years of trying various diets and workout plans. Her weight yo-yoed, always ending higher.

In her 20s, she started getting migraines and was diagnosed with fibromyalgia, a condition marked by pain. Later, she developed sleep apnea and prediabetes.

Doctors recommended bariatric surgery. Morgan saw that as a last resort. She wanted to continue trying to lose the weight on her own.

In her 30s, her struggles continued. Between pain from the fibromyalgia and a lack of activity, “I kind of spiraled,” she said.

“Once my weight got to a certain point, I had depression, anxiety and felt out of control,” she continued. “My life was feeling unmanageable.”

Morgan was in her early 20s when she met Ken. They married five years later.

“She was always beautiful to me, and I’ve always loved her,” Ken said. “But I saw the weight as impacting her quality of life and self-esteem.”

A few years ago, a doctor encouraged Morgan to learn more about gastric bypass surgery. It’s not enough to want the operation; patients must meet certain guidelines to qualify. These include a willingness to make permanent lifestyle changes.

“I thought, ‘This is a tool that can physically help me,’” Morgan said. “It was very scary, and I had a lot of emotions, but it also felt promising.”

Ken, meanwhile, was having his own middle-age wakeup call. He’d long been on medication for high blood pressure.

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“I always knew I was too heavy, but it just didn’t bother me,” he said. “Then my physician told me I was a ticking time bomb for stroke and heart attack because of my blood pressure, heart rate and metabolic panel.”

He was also developing sleep apnea. He’d wake up in the middle of the night feeling like he was drowning. He feared leaving behind Morgan and his daughter from a previous relationship.

“I want to be there for both of them,” he said.

Ken vowed to walk 10,000 steps a day. He aimed to limit his daily diet to 2,000 calories.

As he began slimming down, Morgan received the OK for the bariatric surgery. She underwent the procedure in September 2020, then began adjusting to her new life.

“I might think, ‘Oh, I can’t fit between that chair and the wall’ – when, in fact, now I can,” she said. “It’s a weird feeling.”

Another weird feeling: Adjusting to people treating her differently just because there’s less of her. It makes her angry.

“At 357 pounds, I felt invisible,” she said. “Then when you’re the same person but 163 pounds lighter, you’re suddenly visible.”

The weight loss has made them healthier.

Ken said his sleep apnea is gone and he’s in the best shape of his life. Morgan is especially excited about walking long distances without knee pain.

She’s looking forward to their Disney-themed vacation for her 40th birthday on Jan. 28.

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12/19/2022
New Awareness For Fibromyalgia

It’s an unfortunate fact that Fibromyalgia doesn’t always get as much media attention as it deserves – leaving many of us feeling isolated in our pain. The good news is, things might be starting to change. This past Novemeber, The British Medical Journal published a Clinical Review of Fibromyalgia – validating the condition, the underlying causes as well as the tested therapies used to treat it.

The review had some incredibly interesting statistics, explaining that fibromyalgia could be present in 10% of the population. This figure is substantially more than the 2-4% that was previously estimated. While the article focuses mainly on more well established treatments, The Fibro Clinic is able to pick up where they leave off with the newest, most cutting edge treatments spanning from around the world.

Keep an eye out for future blog posts with the latest and best fibromyalgia treatment news!

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12/18/2022
The Symptoms of Fibromyalgia for emails with over 12,000 patients

We know what it means to have Fibromyalgia. Throughout the years, our team at The Chronicillness.co team have talked and exchanged emails with over 12,000 patients, read countless articles, watched more DVDs than we could count, and attended numerous local, national, and international conferences.

When it comes to symptoms, the first thing patients say to us is normally along the lines of, “The pain is so bad, I’m so stiff I can hardly move and I can’t sleep well at all. My life is misery.” When we meet face to face, the look of despair is almost always there, despite trying to be brave facing a condition that many still pretend doesn’t exist.

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Other symptoms mentioned are commonly anxiety, depression, post-exertional fatigue/malaise, problems with temperature control or cold intolerance, sensitivity to many stimuli including bright lights and noise, irritable bowel (often this presents itself as constipation or diarrhoea and bladder/urinary frequency problems), headaches, brain fog (many patients find this one of the most distressing symptoms), hypermobility (often causes weakness in muscles or joints leading to frequent injuries), alcohol and medicine intolerance, dizziness, restless leg syndrome, and occasionally Neurally Mediated Hypotension. Oftentimes they also have a family member with Fibromyalgia.

We have spoken to many patients who also suffer with ME/CFS and fatigue is their main problem, very often followed by pain, stiffness and sleep problems. No one really understands fatigue as a symptom on its own, however much is now known about the pain, stiffness and sleep problems of FM and CFS/me.

Although it’s not a symptom, but more a result of these symptoms – most patients mention an overall feeling of despair. Many struggle in their personal relationships and regret having to miss out on time or activities with family. Often they’ve had to put careers on hold or have stopped working completely – leading to a breakdown in hopes, dreams and aspirations.

Here at The Chronicillness.co team, we urge you to remember that you are not alone. Fortunately there are ways to better your overall condition and total health. Our hope is that those who stumble across this page may find solace in the fact that there are indeed people out there just waiting to help you – and we hope to hear from you soon.

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12/17/2022
Mindfulness for Fibromyalgia by best possible treatment in our holistic

In order to provide patients with the best possible treatment in our holistic approach at our Multi-disciplinary Clinic we try to consider everything available and as part of that we’ve looked at many non-drug therapies over the years. Many of these treatments or therapies are for reducing the Sympathetic Nervous System over stimulation (or the heightened fight or flight reaction most readers will have heard of) of Fibromyalgia have been studied and now part of our scientific treatment.

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One therapy that’s getting a lot of attention lately and is thought to reduce the Sympathetic Nervous System over stimulation and has shown improvements in Fibro symptoms is Mindfulness. Kim Jones, PhD recently completed a clinical study on Fibromyalgia and Mindfulness and it was the cover article in the USA Fibromyalgia and Chronic Pain Life Winter Magazine 2014 issue, where they state “These results indicate that practicing mindfulness techniques may be a low-cost, side effect free option for people wishing to reduce the severity of their fibromyalgia.”

Basically practicing mindfulness techniques starts with the concept of living in the moment and not looking back into the past or forward into the future. Try to keep your mind in the present moment of whatever you’re doing, so if you’re ironing, doing paperwork or walking, just focus on those things in your mind and don’t think about other things. My best Mindfulness moments are when I walk my dogs, no matter how stressed I am at the beginning of the walk I come back….calm.

Another good principal is to stop multi-tasking. You really can’t be calm if your mind is racing, trying to do several things at one. Try to just do the one thing and do it well, then move on to the next thing that needs doing and just focus on that one thing.

Finally, meditation and deep breathing are also essential to obtaining Mindfulnesses possible stress reducing effects, which should then hopefully reduce the Sympathetic Nervous System over stimulation and possibly help reduce your Fibro symptoms. The body can’t heal if it feels it’s under threat, so being calm and rested are thought to be essential to one’s recovery.

There are many sources of Mindfulness online and most CBT (Cognitive Behaviour) Therapists will be familiar with it and be able to offer advice. So relax and don’t stress if you don’t get Mindfulness at first – as that defeats the entire purpose!

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12/16/2022
Research shows a Car Accident Influence Chronic Pain

At the 2014 American Pain Society Meeting, a hot topic of conversation focused around the emotional and physical repercussions following a car accident.

Because persistent pain and disability often occur after whiplash or other musculoskeletal injuries, it is of interest to understand to what extent poor expectations of recovery influence overall outcomes.

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A 2007 study published in the Journal of Rheumatology concluded that poor expectations of recovery can be a powerful predictor of adverse outcomes. To expand on these findings, a team from the University of North Carolina has now conducted research to further analyse recovery outcomes following accidents.

In the study, it was found that physical recovery expectations were lowest in the hours just following the accident due to high stress levels and emotion. This acute psychological distress was most strongly associated with poorer expected recovery.

Additionally, a large factor in expected recovery period was the overall mentality of the patients prior to the accident. Patients who had reported good physical health and traits of optimism before the accident in turn had shorter estimated recovery time.

In contrast, those who had a slightly more negative outlook, perhaps having previously suffered pain, felt that the other driver was at fault, or suffered from depressive symptoms, had a longer expected recovery.

In short, acute pain in addition to preexisting psychological symptoms were found to be directly correlated with physical and emotional recovery following a traumatic accident.

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12/15/2022