Blog 3 from Lower Earley Osteopaths: Fibromyalgia; The Neurological Basis.

What is Fibromyalgia?

Fibro - fibrous tissues, myo – muscle, algos – pain: muscle and connective tissue pain.

It is a medical disorder characterized by chronic widespread pain and a heightened response to pressure. Common symptoms include fatigue (or brain fatigue) and sleep disturbances, frequent symptoms include Irritable Bowel syndrome and chronic headaches. It’s estimated 2% of the population is diagnosed with FM and a dominant female ratio of 9:1. There is not a routine blood test or x-ray that show abnormalities, it is diagnosed by a doctor who looks for a history of chronic symptoms, lasting over three months, with pain reported in all four quadrants of the body. They perform a physical exam of 18 specific points, diagnostic criteria includes 11 tender points or pain upon light pressure.

A large amount of my research consists of looking at Fibromyalgia from a neurological view point, to help explain fully lets explore the nervous system:

The nervous system is made up of: the central nervous system (consisting of the brain and spinal cord) and the peripheral nervous system (consisting of the nerves aka neurones and nerve cells). The neurones connect to each other as well as connecting the peripheral and central nervous systems. Neurons send signals to other cells as electrochemical waves, along fibres within called axons, they release neurotransmitter to cross junctions called synapses. There are two main types of neurones: sensory neurones (response to touch, sound light etc) and motor neurones (muscle contractions).

How nerves work:

A nerve is known as a transducer, it converts one form of energy into another. For example it converts temperature stimulation into an electrochemical impulse. It does this by developing something called an Action Potential which causes the nerve cell axon (a good analogy is a bit of wire in an electrical circuit) to conduct an impulse across synapses from the peripheral nervous system along to the central nervous system sending information to the brain.

When a nerve cell in the skin is stimulated sufficiently it sends an impulse to the spinal cord which, through a series of stages, directs the impulse upwards (the ascending tracts) to a part of the brain called the Thalamus (a sort of relay station). The Thalamus forwards this incoming message to 2 main areas of the brain; the 1^st is to the part that registers sensory information (sensory cortex) and the 2^nd is to a deeper more primitive part of the brain which deals with our emotions (limbic system). This is the area of the brain in which we are aware of the unpleasantness of pain.

This is how we become aware of pain. However that which comes up must go down: this is another part of the sensory nervous system which sends information down the spinal cord (descending tracts). These are inhibitory nerves which in effect turn off the ascending (excitatory) tracts which are sending information up to the brain telling us that we hurt.

In the normal nervous system there exists a balance between the ascending (excitatory) and descending (inhibitory) tracts. In chronic pain conditions this balance is disrupted. It appears that FM patient’s central nervous system has become hyper sensitive to painful stimuli and in some cases non painful stimuli are recorded subjectively as painful.

An fMRI study in the USA showed that when the same pressure stimulus was applied to FM patients they demonstrated increased activity in all areas of the brain concerned with pain processing as compared to healthy (non FM) subjects (Williams & Gracely, 2006). This condition, where the nerves in the central nervous system (The brain and spinal cord) respond inappropriately to noxious (unpleasant) stimuli, is termed Central sensitisation.

Another fMRI study showed that when FM patients were given a cognitive task, which required a rapid physical response (e.g. rapidly touching finger to nose), they recruited many more areas of the brain to respond and complete the task than the control group of healthy subjects. (Cook & Lange 2004). This leads to the conclusion that FM patients have to work harder to complete the same tasks as non FM people. This could be the basis for what is commonly called Brain Fog.

There is a mechanism which may help to explain the illness syndrome associated with FM. It may explain why we have the co-morbid conditions such as fatigue, morning stiffness and cognitive impairment. This has been discovered through recent research into cells called Glial cells: these are supporting and immune response cells that are spread throughout the central nervous system. They are normally in a resting state, but when the CNS is damaged or becomes infected these cells migrate to the damaged area and release various chemicals, this increases pain sensitivity and ultimately leads to the illness syndrome. This in turn makes us want to go and lie down, rest, recuperate and be cared for. (This could explain the recent phenomena of Manflu!!). There is evidence to suggest that in FMS these Glial cells do not get switched off so we always feel ill!

There is a great deal of research being done at present which is finally validating FMS as a distinct disease. It is my belief that a multidisciplinary approach to treating this disease is the most effective way forward. I am currently looking at exercise, breathwork and meditation as possible ways in which we can help to combat the effects FMS has on us.

References:

Cook, D.B., Lange, G., Ciccone, D.S., Lui, W.C., Steffener, J., Natelson, B.H., 2004. Functional imaging of pain in patients with primary fibromyalgia. Journal Rheumatol, 31 (2): p364-78.

Williams, D.A., Gracely, R.H., (2006). Biology and therapy of fibromyalgia. Functional magnetic resonance imaging findings in fibromyalgia. Arthritis Research and Therapy, 8 (6): p224