Understanding the nuances of the diagnosis and what it really entails.
Understanding Fibromyalgia is a challenge.
Those who suffer with it are fully aware of the havoc it causes on their lives, but let’s be honest, it’s not a simple diagnosis to explain. While more doctors are coming to accept the disease as a real illness, there is pitifully little research done to explain what exactly is going on.
What do you mean by ‘widespread’ pain? Why don’t you sleep? Have you tried (insert an expansive list covering diet changes, medication, and everything in between)? Why doesn’t it get better? Are you sure it isn’t something else? Is it in your head?
It’s a condition that is just as frustrating to try and explain as it is for someone to understand. The tricky part of the whole thing is that unlike some other illnesses, there isn’t any known cause and they have no idea how to cure it. So chances are, you may have differing opinions on some of the facts that I state. My goal is to present the research that has been done in a way that those of us who aren’t part of the medical field can understand. If you have access to other sources, send them my way!
I was thirteen when I started having symptoms and just about to turn fifteen when I was diagnosed. It’s been almost ten years now, so I feel like I’m somewhat qualified to discuss this topic, regardless of the lack of a medical degree.
Now, there are a few ‘words of the trade’ to understand before we continue:
Fibro = Fibromyalgia
Fibromites = someone dealing with Fibromyalgia
Alright folks, with that background information in mind, let’s take a semi-scientific deep dive into the ailment and try to sort things out.
Let’s start with the basics. What is fibromyalgia?
“Fibromyalgia was formerly classified as anti-inflammatory musculoskeletal disease but is now considered to be an illness that primarily affects the central nervous system.” (Understanding Fibromyalgia)
This is huge because it helps explain all the correlated issues that accompany widespread pain. Before we get into the multitude of symptoms let’s understand the basics.
What does your central nervous system do?
Well, your central nervous system is comprised of two parts; your spinal cord and your brain. Your spinal cord is what receives all the information from your muscles, skin, and joints. It also happens to carry the nerves that control all your movements. That’s pretty important.
The second half is your brain, the most complex muscle you own. It receives the information from your spinal cord as well as all sensory input from your eyes, ears, nose, and mouth.
All of this information is then used to help you with your memory, communication, reaction and allows your body to respond appropriately.
That’s some pretty important work right there. And fibromyalgia comes in, like the bully it is and messes with it.
“Clauw explained that fibromyalgia pain comes more from the brain and spinal cord than from areas of the body in which someone may experience peripheral pain. The condition is believed to be associated with disturbances in how the brain processes pain and other sensory information.” (Science Daily)
This is why Fibromyalgia is more than just widespread pain. Why those diagnosed with it frequently deal with comorbid illnesses such as IBS, ME/CFS, chronic migraines, depression, hypothyroidism, and chronic autoimmune diseases.
“The manner in which the brain and spinal cord process pain sensations is abnormal in fibromyalgia. The threshold at which stimuli cause pain or discomfort has been proven to be lower in fibromyalgia. The pain felt is more intense because the pain is amplified by the abnormalities in the central nervous system and in pain processing. Because of this, things that are not normally painful may be painful for someone with fibromyalgia. In addition, fibromyalgia causes the pain from any given cause to be worse.” (MedicineNet)
All of this because your central nervous system is under attack…by you. The joy.
So when we talk about pain, what are we referring to?
If you think of Fibromyalgia and it’s collective issues as a gang, the widespread pain would be the boss. He’s not the one doing the dirty work (hello chronic fatigue from hell) but he’s the name that everyone recognizes. When people hear about Fibromyalgia, the first thing they learn is that there’s a whole lot of pain.
“Pain itself often modifies the way the central nervous system works, so that a patient actually becomes more sensitive and gets more pain with less provocation.” (Sensitization in Chronic Pain)
But what is going on that triggers the pain receptors to react the way they do? Well before we can understand that, we have to understand the process in which normal people experience pain.
Somatic neurons transmit information from the skin and skeletal muscles, while the visceral neurons transmit information from the internal organs. Both send this information to the central nervous system.
Now, when something is dangerous or perceived to your body as dangerous, it’s the job of the sensory neurons (nociceptors) to respond by sending that ‘danger danger’ message to your spinal cord and your brain.
Makes sense? So you put your hand over a fire, the nocioceptors receive the information from your somatic neurons and tells your spinal cord and brain that damage is occurring. Therefore, it hurts. Once you eliminate the threat, the pain will disappear, and all is right in the world.
Now, how does Fibromyalgia fit in all of this?
“The problem with chronic pain is that the linear relationship between nociceptors and pain experience is inappropriate or even absent, and the expected recovery does not occur.” (Nociception and Pain)
So what we’ve learned so far is this:
- The nociceptors in patients who have fibromyalgia that receive the information from your skin, muscles, and internal organs are malfunctioning and responding as if your body is covered in injuries that don’t exist.
- Because the nocioceptors aren’t working properly, the recovery time that normally occurs when you’re injured isn’t present. Which makes the pain worse and last far longer than normal.
Now, we aren’t done. In order to fully understand the way the pain manifests itself in the body, we need to discuss something called “central sensitization.”
“Pain itself often modifies the way the central nervous system works, so that a patient actually becomes more sensitive and gets more pain with less provocation. This is called “central sensitization.”Sensitized patients are not only more sensitive to things that should hurt, but also to ordinary touch and pressure as well. Their pain also “echoes,” fading more slowly than in other people.” (Sensitization in Chronic Pain)
I think it’s fair to say our (fibromites)nervous system is crazy. They’ve proven this medically by studying pain sensitivity to 5 sensory testing tasks, and lo and behold patients with fibromyalgia had a lower pain threshold than healthy controls in all of the tests.
“Patients with fibromyalgia show enhanced sensitivity to a wide array of stimuli,” (Understanding Fibromyalgia)
Now, I’ve done MMA for three years, I can safely say that I can handle pain. But what these tests are proving is that the main issue lies in disordered sensory processing.
What are the implications of this revelation? Turns out, our body’s nervous system is an adaptable sensitive thing, and the stimulation of a nerve ending (think of a splinter) won’t produce the same intensity of pain if it occurs again.
According to Melzeck and Wall, pain “is a complex integration of noxious stimuli, affective traits, and cognitive factors. In other words, the emotional aspect to having a chronic pain state and one’s rationalization of the problem may both influence the final experience of pain.” (Science of FM)
Therefore, the emotional response to chronic pain actually has an impact on the level of pain experienced, and that can change (for better or worse) over time. It’s a frustrating problem because the worst thing you can do for your condition is to create more stress, but your condition is stressful, to begin with.
This leads to some major problems. The consequences of having pain that doesn’t go away can lead to the sinking understanding that this could be life-long. Sitting with that thought usually produces counterproductive coping mechanisms. The reason? Pain causes stress and combined can result in depression and anxiety.
One major step in ensuring you don’t go down this path is to understand as much as possible what is happening in your body. That way you’re able to realize it’s not an abstract issue that you are plagued with, but a real central nervous system problem.
And that, my friends, is the essence of Fibromyalgia.