Fibromyalgia Questions, Comments and the Brain
Many experts believe that fibromyalgia is less a disease than an abnormal body response to stress. Areas of the brain responding to stress react differently in fibromyalgia patients than in healthy people. There is decreased activity in the opiod receptors, which may be why there is often accompanying depression and poor response to painkillers in those with fibromyalgia.
This has been our experience at The Dubin Clinic. Every fibromyalgia patient that we see has been under a great deal of stress for a prolonged period of time before symptoms even start. Furthermore, each patient begins responding to Direct Neurofeedback with diminished stress and anxiety. The diminishment of sympathetic nervous system (“fight or flight”) tone and enhanced parasympathetic tone (“rest and digest”) that occurs with sessions of Direct Neurofeedback results in an almost immediate reduction of at least some symptom, pain reduction being one of them, along with anxiety and depression.
Alas, the question still persists: Does Fibromyalgia even exist?
Fibromyalgia is a syndrome of persistent widespread pain, stiffness, fatigue, disrupted sleep, and cognitive fog, often accompanied by anxiety and/or depression. Physicians often dismiss it as a psychological problem because there are no consistent physical findings, lab tests, or imaging studies that can confirm the diagnosis. Many physicians still do not believe fibromyalgia really exists. However along with Firbromyalgia being clearly worsened by chronic stress and anxiety, some consider fibromyalgia is also a neurosensory disorder characterized, at least in part, by abnormalities in pain processing by the central nervous system.
What causes Fibromyalgia?
Stress alone is too simplistic. No one cause explains all of fibromyalgia. However, many patients with fibromyalgia have low levels of serotonin. Serotonin affects sleep, pain perception, headaches, and mood disorders, which are common in fibromyalgia. It may be that the low serotonin levels are a result of chronic stress. There is also an important genetic component to fibromyalgia and related central sensitivity syndromes.
What doesn’t cause Fibromyalgia?
Trauma as a trigger of fibromyalgia has been very controversial. Until recently, it was an open question because there were no well-designed studies to support it. The large bulk of more recent research supports trauma NOT being a significant cause. Also, earlier beliefs that fibromyalgia was associated with inflammation in muscle fascia has been disproven. No tissue abnormalities are seen under the microscope in fibromyalgia.
The brain—a new avenue to treating fibromyalgia?
No real cure exists for fibromyalgia. There are however a few things that can help achieve significant improvements for those with fibromyalgia. These include education, lifestyle changes, regular physical activity, and medications. A new and very promising approach is the brain.
Noninvasive brain stimulation technologies, such as transcranial magnetic stimulation (TMS), transcranial direct-current stimulation (tDCS), and Direct Neurofeedback, show promise for treating certain types of pain. With only temporary effects, particularly for tDCS, they are not the panacea some were hoping for. The field is nonetheless an attractive alternative to invasive procedures and brain surgery for those with intractable pain.
In tDCS, weak electrical currents are applied to the scalp surface. The weak currents either stimulate or inhibit neurons. tDCS produces weaker localized effects, and has fewer discomforts than TMS, with patients feeling only a slight tingling under the electrode.
Both tDCS and TMS are used clinically, although the latter is approved by the US Food and Drug Administration for depression. They have demonstrated some efficacy for relieving neuropathic pain, and have had mixed success for fibromyalgia and chronic pain.
Direct Neurofeedback has a much weaker current than tDCS but the effects appear to be more global. Neurofeedback has also been around the longest and certainly has the safest track record. A pulsed AC current whose dominant frequency changes as the brain’s own frequency changes is applied. Initial effects are usually seen within minutes of a Direct Neurofeedback session, particularly if there is any anxiety component. Pain, particularly that seen in fibromyalgia, generally improves. Although no double blind studies have been done to date, clinical case series and retrospective studies along with many reports from clinicians have been very encouraging.