Brain & Memory | Mental Health | Sleep
September 22, 2017

Understanding chronic fibromyalgia pain

by Woman sitting on couch looking tense

Chronic widespread pain, terrible fatigue, anxiety, depression — if you’re feeling all of this, it’s not ‘all in your head.’

 

Fibromyalgia is a mysterious condition that makes it difficult for someone to function well, and there’s no quick fix for it. But don’t lose hope. Tracy Jackson, M.D., a chronic pain specialist at Vanderbilt University Medical Center, explains what you should know about fibromyalgia.

What is fibromyalgia?

Fibromyalgia is a collection of several unpleasant symptoms: chronic pain that’s widespread throughout the body; fatigue that makes it difficult to function (not just everyday tiredness); mood problems such as anxiety or depression; and poor sleep, including chronic insomnia.

Fibromyalgia, Jackson said, “leaves someone feeling that they can’t function in their own life.”

Who tends to have fibromyalgia?

Fibromyalgia affects 2 to 8 percent of the population.  It can present at any age but is twice as likely in females. About a third of fibromyalgia patients feel ongoing pain in specific places (the jaw joint, headaches, back pain, etc.) before other, generalized symptoms start. Twin studies suggest the risk of developing fibromyalgia is half genetic and half environmental. Environmental factors most likely to trigger fibromyalgia include certain infections (Epstein-Barr virus, Lyme’s disease), trauma (like motor vehicle crashes, war) and psychological stress.

What causes fibromyalgia?

There is no single obvious cause.

For many years, this combination of problems came with a stigma, because there is no diagnostic lab test or imaging that can confirm someone’s symptoms or pinpoint a physical cause. “People felt completely judged and shamed” because tests couldn’t validate their complaints, Jackson said — or they were told their problem was “all in their head.”

In the past decade, however, researchers have learned that in people with fibromyalgia, the brain processes pain, stress, fear and sleep functions in an abnormal, hypersensitive way. So while the symptoms are not imaginary, they do originate in your brain.

“The area of the brain that processes pain also processes sleep and mood, so there is almost always overlap of symptoms,” Jackson said. “But there is a definitely a component of physical pain. Even seemingly minor physical injuries, when experienced by someone with fibromyalgia, can be debilitating.”

Scientists also have discovered a strong relationship between stressful or traumatic experiences in childhood or adolescence and chronic pain-related problems such as fibromyalgia in adulthood, Jackson said.

“Psychological trauma, particularly when it begins in childhood, is highly associated with the development of widespread pain as adults. It’s two to three times more likely that children who are victims of trauma will develop things like fibromyalgia when they become adults.”

The Centers for Disease Control even developed a list of stressful events, called Adverse Childhood Experiences, that specifically raise someone’s risk of pain and emotional problems in adulthood. Those events include abuse, divorce and more.

Not all patients with a fibromyalgia diagnosis had traumatic upbringings. However, highly stressful or frightening events at any age will affect the body’s central nervous system, effectively training the brain and nerves to be on high alert all the time and to be very sensitive to potential threats, Jackson said. The earlier this happens in life, the more sensitized these nerves become. The fibromyalgic brain is especially tuned to detect stress, fear and pain. The brain tells the body to pump out hormones such as adrenaline and other fight-or-flight chemicals that are designed to help us deal with danger. With a constant wash of these chemicals, the whole body feels pain, mood problems set in, and sleep gets disrupted.

If someone has these symptoms, what kind of doctor should they see?

Jackson recommends that people with these symptoms seek out holistic, integrative care from healthcare providers practicing evidence-based medicine. “Holistic” refers to the whole body, not just a problem or symptom in one part. “Integrative” refers to a combination of modern Western medicine — which emphasizes medications and procedures — and evidence-based “alternative” therapies such as acupuncture, yoga, nutrition, mindfulness and meditation.

Vanderbilt’s Osher Center for Integrative Medicine offers these treatments and more, such as yoga, to people dealing with a variety of chronic pain problems.

How is fibromyalgia treated?

There’s no cure per se, and some people never completely get rid of their fibromyalgia pain. But data on mindfulness, meditation, yoga, other movement-based therapy and acupuncture shows that these therapies help people reduce and cope with their symptoms, Jackson said. Long term, these treatments are a more effective source of fibromyalgia pain relief than medication because they retrain the brain pathways, instead of just treating symptoms. Some medications, such as antidepressants, can help calm the hypersensitive brain and reduce symptoms. Opioid medications are not useful, Jackson said, as they actually worsen the central nervous system’s sensitization.

Some health insurance plans cover some of these alternative therapies, though generally they are not typically covered by insurance. Jackson acknowledged that this can make fibromyalgia treatment an expensive out-of-pocket cost for many people. Anyone with fibromyalgia symptoms should check with their insurer to learn details of their coverage.

Don’t give up hope.

It’s hard to muster the energy to take on a long-term regimen of meditation, yoga and/or other strategies, and many fibromyalgia sufferers feel trapped and frustrated, Jackson said.

“People say, ‘I can’t change the fact that I had a difficult childhood. Does this resign me to this horrible life of fibromyalgia pain?’  The answer is no,” Jackson said. “You can absolutely retrain your brain over time.”

The coping and cognitive skills developed by these alternative therapies are slow but feasible methods that teach the brain not to misinterpret pain and danger signals, Jackson said.

“You can actually soothe the central nervous system — actually change the structure and function of your brain over time with regular utilization of these technique, including movement and mindfulness,” Jackson said, “which is why all the data show they work so much better than pills and procedures.”

Jackson compares the brain’s response to fear and stress in fibromyalgia to a truck constantly driving along the same path — it’s created deep ruts in the road that are hard to avoid. But if you practice steering the truck just a bit differently from its habitual path, over time you’ll lay down a new path.

Not everyone with fibromyalgia gets rid of pain completely, but “the quality of life and their function — pain, mood, sleep — all those things can really improve,” Jackson said. “People can recover and have phenomenal joy and function in their life.”

 

Depression, Sleep, Stress

The Osher Center for Integrative Medicine at Vanderbilt provides health care designed around your whole health: mind, body and spirit. The center cares for people with chronic pain and other ongoing health challenges. Call 615-343-1554 for an appointment.

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