Wednesday, September 21, 2011

Aren’t we a motley crew? The diversity of chronic pain and its relationship to fibromyalgia.

Chronic pain differs from acute pain in that chronic pain has worn out its job as an alarm system, and our body doesn’t send in the firemen to put out the fire. Instead it becomes disrespectful to treatments that otherwise work for an acute pain process. As a result our brain and body shuns input from the autonomic nervous system, especially in fibromyalgia, our brain fails to play nicely.

It appears there are similarities of fibromyalgia to other chronic pain in sharing the phenomenon of pain centralization. Chronic pain becomes diffuse and makes it difficult for the patient to relate their symptoms on the pain scale devised to assess acute pain. There is no tool for assessing chronic pain, but one is greatly needed. I wish the “acute pain 1-10 scale” and questions like, “where do you hurt today?” would go by the wayside. Assessment for response to treatments and medication should be directly related to ability to function. This holds true for all chronic pain patients. Once the pain becomes centralized, the pain scale presently used doesn’t document success or failure of therapeutics and in my opinion is a disservice to the patient.

A recent article “Evidence for Shared Pain Mechanisms in Osteoarthritis, Low Back Pain, and Fibromyalgia” (Staud, 2011) suggests that chronic pain from these sources share the effect of centralization. This means that the peripheral pain input to the brain causes hypersensitivity and the normal orchestration for homeostasis is disrupted. Keywords of the article are peripheral stimulation and centralization. Where there are diseased joints or vertebrae pulling on muscle, myofascial trigger points can develop. We know myofascial trigger points occur at an alarming rate in fibromyalgia, activation requires little stimulation, but they can occur in any person, any sports medicine specialist will tell you MTPs are not specific to fibromyalgia.

Management of fibromyalgia includes identifying aggravating and perpetuating factors. This includes bringing co-existing conditions under control, including the presence of myofascial trigger points, metabolic disturbances, sleep dysfunction, anxiety, restless leg syndrome, multiple chemical sensitivities, migraine and other comorbid conditions.

Centralization of pain is part of the chronic pain process and we need to do as much as we can to diminish harmful input to the brain that keeps it in this sensitized state. This should include treating the centralization in the brain itself, and bringing pain under control by whatever pain measures work for one particular patient.

This blog is based on the question and my original answer to “How is fibromyalgia related to chronic pain,” at ShareCare.

View my other answered questions as fibromyalgia expert

All blogs, posts and answers are based on the work in Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection by Celeste Cooper, RN, and Jeff Miller, PhD. 2010, Vermont: Healing Arts press and are not meant to replace medical advice.


A. M. Abeles, M. H. Pillinger, B. M. Solitar, and M. Abeles. Narrative Review: The Pathophysiology of Fibromyalgia. Ann INter Med. May 15, 2007 146(10):726-734

Affaitati G, Costantini R, Fabrizio A, Lapenna D, Tafuri E, Giamberardino MA.Effects of treatment of peripheral pain generators in fibromyalgia patients. Eur J Pain. 2011 Jan;15(1):61-9.

A. M. Castro-Sanchez, G. A. Mataran-Penarrocha, N. Sanchez-Labraca, J. M. Quesada-Rubio, J. Granero-Molina, and C. Moreno-Lorenzo. A randomized controlled trial investigating the effects of craniosacral therapy on pain and heart rate variability in fibromyalgia patients. Clin Rehabil January 1, 2011 25(1):25-35

D. Clauw, M. Schmidt, D.Singer, A. Singer, P Katz∗, J. Bresette
The relationship between fibromyalgia and interstitial cystitis. Journal of Psychiatric Research. Volume 31, Issue 1, January-February 1997, Pages 125-131

J. E. Helms and C. P. Barone. Physiology and Treatment of Pain. Crit Care Nurse December 1, 2008 28(6):38-49

Kindler LL, Bennett RM, Jones KD. Central sensitivity syndromes: mounting pathophysiologic evidence to link fibromyalgia with other common chronic pain disorders. Pain Manag Nurs. 2011 Mar;12(1):15-24. Epub 2009 Dec 2. Review.

R, Staud. Evidence for Shared Pain Mechanisms in Osteoarthritis, Low Back Pain, and Fibromyalgia. Curr Rheumatol Rep. 2011 Aug 11. [Epub ahead of print]

S. Tang, H. Calkins, and M. Petri. Neurally mediated hypotension in systemic lupus erythematosus patients with fibromyalgia. Rheumatology (Oxford) May 1, 2004 43(5):609-614

1 comment:

Fergie said...

More than 116 million Americans--about one-third of the population – live with chronic pain, according to a new report from the Institute of medicine. This figure is greater than the combined number of people who suffer from heart disease, diabetes, and cancer.

But despite the large amount of people who experience pain for months or even years, there is very little awareness about it.

Prevention and treatment of chronic pain is commonly "postponed, inaccessible or inadequate" for many racial and ethnic minorities, women and children. "Nor is easy so to receive people from low income and education, cancer patients, seniors, and people who are in the final stage of their lives," according to ABC News.

Chronic pain costs amount to $365 billion per year, taking into account the costs of treatment and monetary losses resulting in diminished productivity of this disorder, according to the report of the Institute of medicine.

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