Fibromyalgia now considered as a lifelong central nervous system disorder

[J William M Tweedie]

Published on May 18, 2015 at 6:10 AM ·

Fibromyalgia is the second most common rheumatic disorder behind osteoarthritis and, though still widely misunderstood, is now considered to be a lifelong central nervous system disorder, which is responsible for amplified pain that shoots through the body in those who suffer from it. Daniel Clauw, M.D., professor of anesthesiology, University of Michigan, analyzed the neurological basis for fibromyalgia in a plenary session address today at the American Pain Society Annual Scientific Meeting.

"Fibromyalgia can be thought of both as a discreet disease and also as a final common pathway of pain centralization and chronification. Most people with this condition have lifelong histories of chronic pain throughout their bodies," said Clauw. "The condition can be hard to diagnose if one isn't familiar with classic symptoms because there isn't a single cause and no outward signs."

Clauw explained that fibromyalgia pain comes more from the brain and spinal cord than from areas of the body in which someone may experience peripheral pain. The condition is believed to be associated with disturbances in how the brain processes pain and other sensory information. He said physicians should suspect fibromyalgia in patients with multifocal (mostly musculoskeletal) pain that is not fully explained by injury or inflammation.

"Because pain pathways throughout the body are amplified in fibromyalgia patients, pain can occur anywhere, so chronic headaches, visceral pain and sensory hyper-responsiveness are common in people with this painful condition," said Clauw.

"This does not imply that peripheral nociceptive input does not contribute to pain experienced by fibromyalgia patients, but they do feel more pain than normally would be expected from the degree of peripheral input. Persons with fibromyalgia and other pain states characterized by sensitization will experience pain from what those without the condition would describe as touch," Clauw added.

Due to the central nervous system origins of fibromyalgia pain, Clauw said treatments with opioids or other narcotic analgesics usually are not effective because they do not reduce the activity of neurotransmitters in the brain. "These drugs have never been shown to be effective in fibromyalgia patients, and there is evidence that opioids might even worsen fibromyalgia and other centralized pain states," he said.

Clauw advises clinicians to integrate pharmacological treatments, such as gabapentinoids, trycyclics and serotonin reuptake inhibitors, with nonpharmacological approaches like cognitive behavioral therapy, exercise and stress reduction.

"Sometimes the magnitude of treatment response for simple and inexpensive non-drug therapies exceeds that for pharmaceuticals," said Clauw. "The greatest benefit is improved function, which should be the main treatment goal for any chronic pain condition. The majority of patients with fibromyalgia can see improvement in their symptoms and lead normal lives with the right medications and extensive use of non-drug therapies."

Source:
American Pain Society (APS)
News-Medical.net

 

[Cort]

Thanks - Clauw is one of the top experts in the field. I wonder if this is true though"

Most people with this condition have lifelong histories of chronic pain throughout their bodies," said Clauw. "

I qualify for FM and I was completely healthy before I got ME/CFS/FM. That could be another distinguishing factor between FM and ME/CFS. Perhaps people with FM had pain problems BEFORE they got FM...

There's no indication that I know of that ME/CFS patients had any unusual health problems prior to getting ill.

I also think Clauw may be overstating things a bit. Functioning is important but it does not imply the absence of pain. It simply means finding a way to work in the presence of pain - hopefully moderated by drugs or other therapies. I doubt that many people with FM lead "normal lives" even if they're working - and I would be shocked if they stated they were leading normal lives. Clauw may be undercutting his own research funding by suggesting that if you just take the right drugs and do the right non-drug therapies - you'll be fine...

"The greatest benefit is improved function, which should be the main treatment goal for any chronic pain condition. The majority of patients with fibromyalgia can see improvement in their symptoms and lead normal lives with the right medications and extensive use of non-drug therapies."

 

[Grace2U]

I'm happy to see I'm not the only reader to be taken back by this article. Count me (and many) in the minority when Dr Clauw refers to the "majority" leading normal lives... Knowing now that Clauw is one of the top experts in this FM field Cort, I am totally puzzled...and discouraged....almost cynical . Curious to read others' opinions.

 

[Cort]

I'm happy to see I'm not the only reader to be taken back by this article. Count me (and many) in the minority when Dr Clauw refers to the "majority" leading normal lives... Knowing now that Clauw is one of the top experts in this FM field Cort, I am totally puzzled...and discouraged....almost cynical . Curious to read others' opinions.

He's in kind of a weird place. He's fought for FM patients - and for it's recognition as a field - for years - and now it's almost like he's on the top of the heap - he's the guy - and he's saying hey - everything's going pretty well. He actually reminds me of Andrew Lloyd who's taking a very conservative approach as well.

Clauw is very interested in functionaliity - in getting patients functioning - which is good but that doesn't mean they're healthy or having quality lives.....
The Decline and Fall of an ME/CFS Researcher? the Case of Andrew Lloyd

 

[Seeksassy]

Thanks - Clauw is one of the top experts in the field. I wonder if this is true though"



I qualify for FM and I was completely healthy before I got ME/CFS/FM. That could be another distinguishing factor between FM and ME/CFS. Perhaps people with FM had pain problems BEFORE they got FM...

There's no indication that I know of that ME/CFS patients had any unusual health problems prior to getting ill.

I also think Clauw may be overstating things a bit. Functioning is important but it does not imply the absence of pain. It simply means finding a way to work in the presence of pain - hopefully moderated by drugs or other therapies. I doubt that many people with FM lead "normal lives" even if they're working - and I would be shocked if they stated they were leading normal lives. Clauw may be undercutting his own research funding by suggesting that if you just take the right drugs and do the right non-drug therapies - you'll be fine...

I never had pain problems before fm....well except crps resulting from injury one year prior to fm dx. I was 35 at time of accident.

 

[J William M Tweedie]

There's no indication that I know of that ME/CFS patients had any unusual health problems prior to getting ill.

Much of the literature points to some illness (as minor as the flu) being the trigger for the onset of ME/CFM. In my case I had an 8 month battle with Polycythemia Vera that eventually (miraculously according to the specialists) disappeared but left me the chronic fatigue as a reminder; 5 years now, joined by FM last year. I need a jolt of hope.

 

[Maisi]

I have fibromyalgia, including severe allodynia and hyperalgesia, IBS, SI joint dysfunction, tension-type headaches, multi-chemical sensitivities, and a long history of chronic pain complaints beginning in early childhood and continuing, in different permutations, to the present. I have followed the work of Dr. Clauw very closely as well as Clifford Woolf's work regarding central sensitization in the processing and amplification of pain. Please see the documents below. Dr. Clauw is the first physician I heard speak about "brain pain" and how it is fundamentally different than acute pain and even peripheral pain syndromes. His normalization of the fierce challenge of treating and living with chronic pain, his presentations which helped me make sense of what was occurring in my body, and his tentatively hopeful outlook regarding future advances in the management of pain conditions provides a different perspective than those who posted earlier. The document which lists his brief comments from the American Pain Society Annual Meeting seem to me to be more "summary" statements. Thus, I have provided 3 documents below related to either/both Clauw and Woolf.

 

[KweenPita]

I don't know how I missed this article, I agree with a lot of the thoughts other than the catch all cure to normalcy, if the ever illusive "NORMAL", were ever to be achieved that would mean one of us MFers, excuse me Freudian slip FMers would all have to be NORMALLY NOT WELL. And I have yet to meet my Fibromyalgia Soul Mate whose perceived incident of origin, progression of misery, symptoms, what helps, what doesn't, and all our subsequent maladies that happen to our physical self that aren't considered Fibromyalgia and yet have not diagnosis of why the h3!! it happened. We are different. And if one more person tells to let go of my stress, eat an anti-inflammatory diet, take these supplements and exercise, I will be all good, I will hunt them down like a dog and do what my ancestors stereo typically do best. If it were that simple there would be no such misnomer as Fibromyalgia. Oh, I share history with those fictional guys "The Sopranos". Side bar Cort, was trying to find Holland Researcher who traced Fibromyalgia to B19 and broke it into 4 sub categories. Do you remember where that was in your massive knowledge?

 

[Paw]

I can trace possible symptoms decades back before getting suddenly sick four years ago. Things like IBS, RLS, GERD, plantar fasciitis, and, maybe most importantly, chronic energy shortages that I was able to overcome only by relying on stress energy (which seems to have burned out something in my glutamate system).