Pain in the Brain
We Don't Know What Causes the Pain
We say it over and over again: Fibromyalgia pain is not instigated by specific causes. The muscles and tissues of someone with fibromyalgia do not show any signs of degeneration and the bones are strong and healthy - just like any normal person. To have pain without having any damage is a challenge because it is hard to treat and even harder to understand. For decades, people with fibromyalgia were told that the pain was psychological (all in their heads), when in fact, recent research shows it is probably physiological - all in the brain.
We Just Process Pain Differently
Research now shows that the neurological abnormalities of fibromyalgia (FM or FMS) cause people with FMS to process pain differently than those without the syndrome. According to the website UpToDate, a very well-respected site for medical information, the pathogenesis of fibromyalgia pain is explained this way:
"Some differences in pain processing that may be important in pathogenesis include the following:
· Upregulation of opioid receptors in the periphery, as well as reduced brain opioid receptors.
· Elevated levels of substance P were found in the cerebrospinal fluid of FMS patients compared to controls.
· Differences in activation of pain-sensitive areas of the brain, as determined by increased regional brain blood flow using magnetic resonance imaging (MRI), and function MRI (fMRI), and MR spectroscopy have been noted in FMS."
Understanding the medical jargon can be daunting. We'll attempt to bring it into laymen's terms.
· Upregulation of opioid receptors: This means there is an increase in the number of opioid receptors, which are specific cell parts that bind to opiate pain killers
· in the periphery: The periphery here is parts of the nervous system that exist outside of the brain and spinal cord
Upregulation is thought to increase the effect of opiates and upregulating opioid receptors is a common practice in situations where there is significant, severe pain - as in inflamed tissue, nerve pain (neuropathy), or bone damage.
A reduction in brain opioid receptors will make the brain less sensitive to opiate pain killers, which gives understanding to why most people with FMS do not respond well to opiates in fibromyalgia treatments.
· Substance P is connected to the pain threshold, which is the place where sensation transfers to pain. A low pain threshold, common in FMS sufferers, can be attributed to high levels of substance P.
In the final point,
· Increased regional brain blood flow using MRI, fMRI and MR spectroscopy allows the doctor to see how much activity is going on in the brain.
The three scans mentioned in this point have all indicated that people with FMS have higher levels of activity in the areas of the brain that register pain. That translates to pain signals attacking the brain or inappropriate processing of pain signals.
I Want to Know Why I'm in Pain
People with FMS, especially those who have just been diagnosed or are coming to terms with the fact that they do have FMS, want to know why they hurt and what is causing the pain. Research has uncovered the findings that the pain is, first of all real, and secondly may begin in the brain. Further studies have opened options that have, in turn, opened more treatment opportunities that may target the possible sources for the pain. For instance, recent studies have linked FMS to central nervous system disorder where for years it was considered to be an arthritic condition.
What Comes First?
This all proves that people who are dealing with FMS pain are dealing with real pain and that their bodies are highly sensitive to pain. So, the question is: Does the pain come from abnormal pain signals or normal pain signals being processed abnormally? Research and time will hopefully provide the answers.
If you are a fibromyalgia sufferer you are already aware of how challenging it can be to try to explain to a doctor where you hurt. You can learn more about fibromyalgia pain on this site and by looking at the article entitled "Widespread Pain" to help you identify some of what you are experiencing.