Fibromyalgia pleasing or unpleasing immune response, you decide.

I met some resistance regarding my answer to the question, “Could fibromyalgia be caused by an aberrant immune response?” The comment suggested it was a waste of the readers time and requested that I “Stop repeating the same from 20 years ago. PLEASE!”

I believe it is important to validate my response to the question, so others understand why I answered the question the way I did.

YOU DECIDE.

Here is my original answer to “Could fibromyalgia be caused by an aberrant immune response?”

“Good question. It’s really about which came first the cart or the horse.
We do not know the cause of fibromyalgia, but we do know that there is centralization of pain. Comorbid conditions, those that occur more frequently with FM also indicates there is an upset in communication between the brain and the periphery, including the autonomic nervous system. Certainly, an aberrant immune response could exist, and research has been done and continues on this possibility, but it has also been hypothesized that FM is the result of a poor immune system.”

The research does continue today. Fibromyalgia is a comorbid condition to Lupus, RA, Sjorgrens, Hashimoto's, and AS, all autoimmune disorders. The following study was done in 2008, not 20 years ago. X. J. Caro, E. F. Winter, and A. J. Dumas, “A subset of fibromyalgia patients have findings suggestive of chronic inflammatory demyelinating polyneuropathy and appear to respond to IVIg,” Rheumatology 47, no. 2 (2008): 208–11

‎2011. Coaccioli S, Varrassi G. Chronic degenerative pain: an update on abdominal pain in comparison to rheumatic diseases. J Clin Gastroenterol. 2011 Aug;45 Suppl 2:S94-7." Extra-articular syndromes, notably fibromyalgia, can be a lifelong rheumatic condition characterized by widespread musculoskeletal pain and functional impairment, without any known structural or inflammatory cause. Irritable bowel syndrome (IBS) occurs in around half of patients with fibromyalgia raising the possibility of a possible overlapping or underlying pathophysiology. The dysfunction of bidirectional neural pathways and viscerovisceral cross-interactions within the central nervous system has been proposed as a possible central hypersensitization disorder responsible for the extraintestinal manifestations of IBS. Common inflammatory and molecular pathways may also be present in which a dysregulation of the immune system leads to a chronic inflammatory response. "

Possibly the most exciting research of late suggesting immune dysfunction is Light AR, Bateman L, Jo D, Hughen RW, Vanhaitsma TA, White AT, Light KC. “Gene expression alterations at baseline and following moderate exercise in patients with Chronic Fatigue Syndrome and Fibromyalgia Syndrome.” J Intern Med. 2011 May 26. doi: 10.1111/j.1365-2796.2011.02405.x. [Epub ahead of print]
http://www.ncbi.nlm.nih.gov/pubmed/21615807
“FM-only patients showed no postexercise alterations in gene expression, but their pre-exercise baseline mRNA for two sensory ion channels and one cytokine were significantly higher than controls.”
Cytokine=referring to the immunomodulating agents (interleukins, interferons, etc.).

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. www.thesethree.com

Fibromyalgia and Chronic pain, Consistent Cousins, Shared Machinery

A recent article “Evidence for Shared Pain Mechanisms in Osteoarthritis, Low Back Pain, and Fibromyalgia” suggests that chronic pain from these sources have a common effect called centralization. This means that the peripheral pain input to the brain causes it to become hypersensitive. You can view the article and the authors at PubMed


The keywords I see are peripheral stimulation and centralization. Where there are diseased joints or vertebrae pulling on muscle, trigger points can develop and we know myofascial trigger points are seen in FM.


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.

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 expert at ShareCare. 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.

Fibromyalgia the orphan, are our adoptive parents the right ones?

Where do we belong? “Sometimes described as an “orphan” disorder, FM is much like an unclaimed waif. Finding its closest molecular relative will determine its scientific classification.” (Cooper and Miller, pg. 16).

Since the decision was made to classify fibromyalgia as a rheumatological disorder, I have felt ill at ease, because rheumatologists, while highly educated in clinical problems involving joints, soft tissues, autoimmune diseases, vasculitis, and inherited connective tissue disorders, their expertise does not involve conditions affecting the central nervous system or myofascial pain syndrome, both present in most fibromyalgia patients.

The research has exploded showing fibromyalgia is due to an upset in neurotransmission in the brain leading to “centralization” of pain, and most experts, including rheumatologists that treat FM, believe this. So we ask, “Should fibromyalgia be classified a neurological condition and thereby treated by neurologists instead of rheumatologists?” Well, yes and no, basically for the same reasons listed above. Most neurologists do not understand the role of myofascial pain caused by myofascial trigger points, what they are, or how they are best treated. Myofascial trigger points are peripheral pain generators for other conditions too, such as, dysfunctional pelvis, migraine, restless leg syndrome etc. The question is, are they willing to learn?

The proposed preliminary diagnostic criteria for fibromyalgia will move us from a musculoskeletal classification (for insurance coding, ICD) into somaticism of mental health. All evidence suggests FM is a disorder of the central nervous system, involving the autonomic and immune systems.

I don’t think the rheumatologists really knew what to do with us. We certainly weren’t a patient type they would ask for, because so little was known about FM at the time. But, some did hang in there with us, and we began to learn more about this once illusive illness. As the research evolves, I cannot say with certainty that FM belongs under the care of rheumatology. So for now, if you have a doctor that understands and is current with the research on FM, you are in the right place. Educate them as you can by sharing what you find regarding myofascial pain. Pain from myofascial trigger points has been found in 90% of FM patients. This is a significant piece of information.

Learn more about chronic myofascial pain at http://www.thesethree.com/cmp/chronic-myofascial-pain.php

Ask your doctor for a referral to physical therapists who are advanced trained to treat myofascial trigger points with various hands on treatments. Do your homework and check your area, doing a phone interview with the physical therapy group. Generally, sports physical therapy is your best bet.

Healing, Harmony and Hope, Celeste

This blog is based on my original answer at ShareCare, What qualifies a neurologist to treat fibromyalgia? View my other answered questions as fibromyalgia expert for Dr Oz.

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. http://www.thesethree.com

Only one nerve left -The use of TENs units in FM

T.E.N.S. stands for Transcutaneous Electrical Nerve Stimulation. It is a device that transmits electrical pulse to the underlying nerves to block the pain impulse.

As many as 90% of fibromyalgia patients have comorbid myofascial pain syndrome/chronic myofascial pain from myofascial trigger points, a muscle to nerve problem which perpetuates central sensitization in fibromyalgia. These myofascial trigger points are great neurological imitators. Blocking these painful impulses and input to the brain may help.

The TENs unit certainly does help me, but others tell me they have too much sensitivity. For these folks it is important to know that interferential and micro-current stimulators are available and have shown benefit. (This is discussed in length in chapter 4, “My Body is Matter and it Matters.”)

*There are specific cautions and contraindications for some patients, be sure to follow the advice of your therapist and the warnings included with the TENs unit

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.

Resources:

Ge HY, Wang Y, Danneskiold-Samsøe B, Graven-Nielsen T, Arendt-Nielsen L. The predetermined sites of examination for tender points in fibromyalgia syndrome are frequently associated with myofascial trigger points. J Pain. 2010 Jul;11(7):644-51. Epub 2009 Nov 14.

Hubbard JE. Myofascial Trigger Points: What Physicians Should Know about these Neurological Imitators Minn Med. 2010 May;93(5):42-5.

Löfgren M, Norrbrink C. Pain relief in women with fibromyalgia: a cross-over study of superficial warmth stimulation and transcutaneous electrical nerve stimulation. J Rehabil Med. 2009 Jun;41(7):557-62.


Nijs J, Meeus M, Van Oosterwijck J, Roussel N, De Kooning M, Ickmans K, Matic M. Treatment of central sensitization in patients with 'unexplained' chronic pain: what options do we have? Expert Opin Pharmacother. 2011 May;12(7):1087-98. Epub 2011 Jan 22.

Rodríguez-Fernández AL, Garrido-Santofimia V, Güeita-Rodríguez J, Fernández-de-Las-Peñas C. Effects of burst-type transcutaneous electrical nerve stimulation on cervical range of motion and latent myofascial trigger point pain sensitivity. Arch Phys Med Rehabil. 2011 Sep;92(9):1353-8.

Taming the Lion Inside, anger and chronic illness

“Holding on to anger is like grasping a hot coal with the intent of throwing it at someone else; you are the one who gets burned.” ~Buddha

Anger is a natural stage to the grieving process, and one we must pass through to accept our new life with chronic illness.

Anger can be used constructively when put to the right task, at the right time, for the right reasons.

Anger should never be overdone in any case, sustained anger creates stress and stress is a great aggravator to our symptoms and block to healing.


How can I let go?

See chapter 5 The Power of Mind, Body, and Spirit; and
chapter 6 Dealing with Circuit Overload


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. http://www.thesethree.com

Cravings of and Staving off the Yeast Beast: Is diet assessment in order?

The risk of candidiasis (yeast) overgrowth in Fibromyalgia and Chronic Fatigue Syndrome/Myalgic Encephalomyelitis is high.

THE WHY
Yeast is a fungi, and a certain amount is considered normal. It provides a natural flora in the mouth, skin, intestinal tract, and vagina, but when it overgrows, it can become the Incredible Hulk and cause a variety of infections.

Intestinal yeast overgrowth has been linked to small bowel bacterial overgrowth (SIBO). The symptoms of excessive gas, bloating, abdominal pain, and altered bowel habits are well known to the fibromyalgia and ME/CFS patient.

Thrush is an overgrowth of yeast in the mouth.

Insulin resistance and some medications (particularly antibiotics that knock out the normal growth environment of healthy amounts of yeast) may perpetuate yeast or leaky gut.

Yeast infections are exacerbated by excessive and unbalanced intake of sugar and carbohydrates causing bloating, brain fog, abdominal complaints, and the muscle aches connected with fibromyalgia and chronic myofascial pain. And chronic candidiasis syndrome has been identified as a possible trigger of chronic fatigue syndrome/myalgic encephalomyelitis (ME/CFS).

IS SOMETHING IN MY DIET PUTTING ME AT RISK?
The answer is YES, though our bodies do require some sugar and carbohydrates for cellular energy and brain function, excessive intake increases the risk of developing yeast overgrowth, particularly those who are immune compromised.

Sneak Peek from “Managing Your Diet,” Chapter Four, “My Body is Matter and it Matters”©

“The way food is converted, used, and stored depends upon the body’s metabolism. Sugar and complex carbohydrates trigger insulin release from the pancreas into the blood. Insulin plays a major role in carbohydrate metabolism and helps regulate the way our bodies utilize carbohydrates, lipids (fats), and amino acids (protein element) for cellular energy.” (Cooper and Miller, pg. 191)

WHAT CAN I DO?
Probiotics are recommended by specialists of the gastrointestinal tract, and eating yogurt with live cultures help maintain the natural flora. Equally important is a balanced diet, (discussed at length in Chapter Four, “My Body is Matter and it Matters.”)

See what Dr. Oz has to say at ShareCare, on daily protein intake. You will receive some great advice for taking control of some of your symptoms.

Related blog “SIBO, Yeast & Leaky Gut and YOU!



Resources:

D. W. Acheson and S. Luccioli, “Microbial-gut interactions in health and disease. Mucosal immune responses,” Best Practice & Research Clinical Gastroenterology 18, no. 2 (2004): 387–404.

R. E. Cater, 2nd, “Chronic intestinal candidiasis as a possible etiological factor in the chronic fatigue syndrome,” Medical Hypotheses 44, no. 6 (June 1995): 507–15.

Celeste Cooper and Jeff Miller, Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection (Vermont: Healing Arts Press, 2010).

R. S. Ivker and T. Nelson, Arthritis Survival: The Holistic Medical Treatment Program for Osteoarthritis (New York: Jeremy P. Tarcher, an imprint of Penguin Group, Inc., 2001).

T. Hung, J. L. Sievenpiper, A. Marchie, C. W. Kendall, and D. J. Jenkins, “Fat versus carbohydrates in insulin resistance, obesity, diabetes and cardiovascular disease,” Current Opinion in Clinical Nutrition & Metabolic Care 6, no. 2 (2003): 165–76.

Mehmet Oz, What Should Be My Required Daily Protein Intake? (accessed 9-7-11).

Devin. J. Starlanyl and Mary. E. Copeland, Fibromyalgia & Chronic Myofascial Pain Syndrome: A Survival Manual (Oakland, Calif.: New Harbinger Publications, Inc., 2001).

Arresting the tidal flow: Pelvic dysfunction in fibromyalgia.

Pelvic dysfunction is prevalent in woman, but can also affect men. Sexual dysfunction and pain, impotence, bladder and uterine dysfunction, rectal pain and other disruptions involving the pelvis and surrounding structures and organs can be caused by the presence of chronic active myofascial trigger points. Since we now know these neurologic imitators exist in as many as nine out of ten fibromyalgia patients, and are body wide, we can better understand why what is, is. It warms my heart to know that all we talk about in the book is being validated providing hope.

Sneak Peek from page 111, Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome and Myofascial Pain: The Mind Body Connection, Chapter Two “Communicating Your Healthcare Needs ©:

“Vulvodynia is pain in the external female genitalia. It can be caused by untreated pelvic floor trigger points. Oragel may help numb the pain of vulvodynia. As discussed under irritable bladder, there are pelvic floor treatments available. If you find TrPs in the pelvic floor (between the vagina and rectum, or the vulva, sitting on a therapeutic ball can be used to treat them.

I would suggest that you use a soft chair to avoid applying too much pressure to the area.”

If you have internal myofascial trigger points causing pain and dysfunction, chronic urinary tract infection, interstitial cystitis or any of the aforementioned problems, you won’t want to miss this report by pelvic messenger, Elisabeth Oas.


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. www.thesethree.com