Q: What is fibromyalgia? A: Fibromyalgia is a change in the way your brain and spinal cord listen to your body. I like to tell people that being told you have fibromyalgia is like being told you have a fever, i.e. its an indication that something is wrong - the trick is figuring out what that something is and addressing it. Now, whereas there are literally hundreds of reasons why one might have a fever, there appear to be five or six common reasons why people develop the pain that is labeled fibromyalgia. Plus an assortment of less common, more exotic reasons. Perhaps the most common reason that people develop fibromyalgia is related to a problem in the neck, namely contact between the soft spinal cord and the intervertebral discs. In most cases, the contact only occurs when the individual extends his or her neck, e.g. while looking up at the ceiling or stars, getting ones hair washed in a sink, at the dentist office getting dental work done. My colleague and friend Dr. Andrew Holman refers to as intermittent cervical cord compression. In other cases, the contact is more severe, a condition commonly referred to in medical circles as cervical stenosis. Another common reason for fibromyalgia is a problem with the brains ability to make and release a chemical called dopamine. Dopamine is a neurotransmitter that is important to a wide number of normal brain activities, including the natural ability to fight pain. In fact, dopamine may well be the most important natural pain killer. Brain imaging studies that I have conducted have demonstrated that persons with fibromyalgia have a significant reduction in their brains ability to make dopamine and to release it in response to pain. Several reasons may explain why a person might make less dopamine, including genetics (fibromyalgia tends to run in families!), low iron stores, low cortisol levels (sometimes referred to as adrenal fatigue), and chronic stress. A third reason for the development of fibromyalgia is problems with the activity of the autonomic nervous system. The autonomic nervous system is responsible for taking care of a lot of the housekeeping functions in our body, things you dont want to have to think about, like how fast is your heart beating, how smoothly are your bowel and bladder functioning, whether or not to sweat...etc. There are two branches of the autonomic system: the sympathetic nervous system (often referred to as the fight-or-flight system) and the parasympathetic system (also known as rest-and-digest). A number of studies have shown that most patients with fibromyalgia have a disruption in the normal function of this important system, which in turn can result in a number of symptoms, including pain. When an individual is under stress, the body releases adrenalin (aka epinephrine) as part of the stress response. While in the short term adrenalin can reduce pain, in cases of chronic stress, adrenalin sensitizes the body to pain. This likely explains in part why stress causes pain among patients with fibromyalgia. A fourth cause of fibromyalgia pain is an imbalance in hormones. While estrogen is important to reproductive health and to well-being in general, excessive levels of estrogen - a condition referred to as estrogen dominance - can contribute to the pain sensitivity that characterizes fibromyalgia. There are several reasons why a person might develop excessive estrogen levels, ranging from overactive ovaries, excessive body fat, and dietary intake just to name a few. Strategies to reduce ones estrogen levels are often successful in reducing pain levels along with other symptoms, including anxiety and insomnia. A fifth cause of the chronic widespread pain that characterizes fibromyalgia is inflammation. It has been my experience that patients and physicians use the word inflammation to mean different things. Technically speaking, inflammation occurs when the body releases a number of chemicals, called cytokines, which are intended to help fight off threats to the body, such as infections or cancer. There are, however, a number of conditions in which the body releases excessive inflammatory cytokines that have nothing to do with fighting off an infection, including sleep apnea, obesity, and under conditions in which the autonomic nervous system is out of balance. Because many cytokines increase ones sensitivity to pain, inflammation can contribute to the pain of fibromyalgia.
Posted on: Fri, 07 Mar 2014 16:21:09 +0000
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