Understanding Fibromyalgia, Part I

Editor’s Note: Dr Mailis-Gagnon will be writing for CARP Action Online on a semi-regular basis. Should you have any questions about pain please write to us at [email protected]. We will try to integrate some of your concerns in Dr. Mailis- Gagnon’s future columns.

Responding to readers’ request I am addressing this complex issue in a 2-part article. Of note:, I will respond periodically to readers’ requests that I can cover as “general topics”. However, I will not be addressing your own special case (as some readers ask me for specific treatment or diagnosis), nor do I intend to replace your own physicians.

Numerous papers have been published over the past 20 years and numerous theories have appeared, evolved and changed to describe fibromyalgia (FM). I will attempt in this article to summarize some of the latest information from a major paper that appeared in an international scientific journal by two well known medical doctors and researchers in the area of FM (Understanding fibromyalgia. D.A. Williams and D.J. Clauw. The Journal of Pain 2009(10)8:777-791). I will use quotation marks to report exactly what the scientists have said. Please be aware, that I am trying to convey to you information that is as objective I can possibly find in the scientific literature. I will, however, clearly state and take responsibility for comments that are my own.

FM is “merely the current term given to individuals with chronic widespread musculoskeletal pain for which no alternative cause can be identified”. Multiple other symptoms in patients with FM can coexist, such as irritable bowel syndrome (IBS) , esophageal dysmotility, headaches, facial pains, pelvic pains including interstitial cystitis, chronic prostatitis, vulvodynia, temporomandibular disorders (TMD), and the list goes on and on. Evidence now appears from studies that individuals with these syndromes:

• May belong to families where more than one members have several of these conditions; • Women are more likely to have these conditions, however, these differences appear to be intense in rheumatology and pain clinics (that see the most difficult cases) and are less intense in the general population; • Individuals with all these conditions (FM and all others I mentioned) display variable degrees of “diffuse hyperalgesia” (they feel higher levels of pain for normally painful stimuli) and/pr “allodynia” (a term that indicates pain produced by non painful stimuli such as mere touch). “These abnormalities suggest that such persons have a fundamental problem with pain or sensory processing, rather than a specific abnormality in the body region where pain is felt”. In other words, these patients feel more pain than normal people do, and the origin of pain seems to be “central” within the central nervous system, than with something been wrong in the muscles, ligaments or other soft tissues, as it was originally thought for so many years. • All these conditions seem to have somewhat favourable response to certain drugs (such as tricyclic antidepressant, pregabalin and duloxetine) and non-pharmacological treatments (such as exercise or behavioural/ cognitive treatments). Typically also, these conditions fail to respond to therapies that are effective when pain is due to damage or inflammations (such as aspirin-like drugs, opioids, injections or surgical treatments).