Fibromyalgia FM Researcher Says FM, IBS, Institial Cystitis - Similar Underlying Pathophysiology

[Cort]

I look forward to reading this. Clauw was one of the first to argue that FM is a real biological condition. Now he's arguing that IBS, FM, IC, tension headache and others are all deeply related. That's a good thing because it means research into those areas should help us understand FM...the more research the better!

He's also giving sensory problems the same emphasis as pain in FM - another step forward.

He's not saying that FM is an inflammatory disorder, but he is finally acknowledging that the damage caused probably by inflammation - the peripheral nerve damage - is common in FM and contributes to the central sensitization in the disorder.

It's a pretty big step forward for this important voice in fibromyalgia.

• http://www.ncbi.nlm.nih.gov/pubmed/25939940

Mayo Clin Proc. 2015 May;90(5):680-692. doi: 10.1016/j.mayocp.2015.03.014. Fibromyalgia and Related Conditions. Clauw DJ1.Author information
Abstract

Fibromyalgia is the currently preferred term for widespread musculoskeletal pain, typically accompanied by other symptoms such as fatigue, memory problems, and sleep and mood disturbances, for which no alternative cause can be identified. Earlier there was some doubt about whether there was an "organic basis" for these related conditions, but today there is irrefutable evidence from brain imaging and other techniques that this condition has strong biological underpinnings, even though psychological, social, and behavioral factors clearly play prominent roles in some patients.

The pathophysiological hallmark is a sensitized or hyperactive central nervous system that leads to an increased volume control or gain on pain and sensory processing.

This condition can occur in isolation, but more often it co-occurs with other conditions now being shown to have a similar underlying pathophysiology (eg, irritable bowel syndrome, interstitial cystitis, and tension headache) or as a comorbidity in individuals with diseases characterized by ongoing peripheral damage or inflammation (eg, autoimmune disorders and osteoarthritis).

In the latter instance, the term centralized pain connotes the fact that in addition to the pain that might be caused by peripheral factors, there is superimposed pain augmentation occurring in the central nervous system.

It is important to recognize this phenomenon (regardless of what term is used to describe it) because individuals with centralized pain do not respond nearly as well to treatments that work well for peripheral pain (surgery and opioids) and preferentially respond to centrally acting analgesics and nonpharmacological therapies.

 

[Merida]

Well, this is an improvement in thinking, I think. However, it is totally my experience, and that of many others( probably spoke to 800 plus patients/ family members over 13 years as group leader) that the central nervous system starts the peripheral problems in the first place.

Case in point: My son (age 4 -1985) had lab documented Epstein- Barr. Seriously ill for 2 weeks - didn't know why. Then, suddenly he developed severe urinary frequency, irritable bowel, severe pain in fingers, so many problems. No answers from docs at HMO - just needed more attention or Mom was 'doctor shopping.' ( I was a stay at home Mom at that point!)

Finally went outside HMO. He ended up having a bladder biopsy. Viruses can cause bladder problems, but he had no evidence of that - no inflammatory markers. Had to be central nervous system.

Please, everyone read : Gilden DH, et al. Herpesvirus infections of the nervous system. Nat Clin Practice Neurol. 2007;3(2):82-94. He holds an endowed chair in Colorado. I quote: " the neurological complications of Epstein-Barr are diverse, and include meningitis, encephalitis, myelitis, radiculopathy, and even autonomic neuropathy. "

The other part of this : several of my son's preschool friends had a mild case of this - fever, and this odd onset of sudden urinary frequency. But they got well within a few weeks. My son was sick for months, then on/ for years? Why??? Did it something to do with a neck injury at birth - delivered with suction? Was it his immune system that is different? Does being Rh D neg confer immunological differences? ( there is some research with Toxoplasma that looks at poorer neurological outcomes for those with RhD neg blood when infected with this organism. )

And this whole thing about opiates not being beneficial. The 'father' of 'syringomyelia' ( forget his name) - a great neurosurgeon - reported that it was a tragic situation that the only really effective meds for syringomyelia patients were... Opiates! Opiates are also given to calm sympathetic surges after spinal cord trauma. But, like all meds, there are always downsides - constipation and physiological tolerance.

Hope this spurs some new thoughts. This can not take 20 years to figure out.

 

[Merida]

When this is all sorted out, Cort should get the Presidential Gold Star of Valor ( is there such a thing?) for battling an enemy that we can't even see. ( a Memorial Weekend thought)