A new study finds that the pain of fibromyalgia is linked to reduced activity in the areas of the brain that inhibit sensation and dispells the myth that the illness and severity of pain reported is linked to psychological causes.
These conclusions come from a thesis on fibromyalgia and pain studies authored by Karin B. Jensen, a postgraduate at the Department of Clinical Neuroscience at the Swedish medical university Karolinska Institutet.
Fibromyalgia is a chronic condition with multiple symptoms; the most prominent being widespread pain. Patients experience heightened sensitivity to pain, particularly at specific 'tender points' located around the body. Even a gentle touch can be experienced as pain. Despite an estimated 2%-4% of the population being affected by the condition and many left severely disabled, patients are often dismissed as hypochondriacs or misdiagnosed as suffering from depression, anxiety or other psychiatric illnesses. In 2007 Norwegian researchers published results of a survey in the journal Social Science & Medicine which found doctors didn't see fibromyalgia as a serious or "prestigious" disease.
After a thorough review of the evidence, including functional magnetic resonance imaging (fMRI) studies, Jensen said "It's a common misconception that fibromyalgia is a manifestation of mental problems. But in the studies that comprise my thesis, we've made careful measurements and have found no correlation at all between pain sensitivity in fibromyalgia patients and the degree of anxiety or depression they show."
In one of the studies conducted by Jensen and colleagues, fibromyalgia patients had both thumbs pressed hard enough for them to feel the same degree of mild pain as healthy control subjects. Using functional fMRI scans, researchers found that all participants had the same level of activity in the parts of the brain that deal with emotions and sensory information from the thumb; the fibromyalgia patients however had lower activity in a brain area that inhibits the experience of pain.
Jensen's work also confirmed a link between how the body regulates pain regulation and genetics. Evidence suggests that a particular gene controls the effects of a morphine-like drug on repeated pain stimulation but it only affects the body's pain regulating system in the presence of high psychological stress. By assessing levels of both pain and psychological stress it is believed that in the future pain treatment could be tailored to the individual, making it much more likely to be effective.
Of her paper's main findings on fibromyalgia and pain Jensen says that treatment with drugs such as antidepressants that have an effect on the central nervous system (CNS) by increasing levels of neurotransmitters like serotonin may be helpful in fibromyalgia. But the researcher was quick to point out that this is not a question of treating depression or psychological problems but using other properties of these drugs to combat the pain caused by the loss of pain regulation in the condition.
Finally it was found that early treatment of fibromyalgia is important. "The patients who had had their pain symptoms for the shortest amount of time were those that responded best to the drug treatments tested," says Karin B Jensen. "This shows how important it is that fibromyalgia is detected and taken seriously as early in its development as possible."
Given these findings and the poor recognition of fibromyalgia by doctors it is essential that health care providers are provided with better education in the biological basis of the pain experienced by fibromyalgia sufferers and the information needed to confidently diagnose it as early as possible so that effective treatment may be provided.
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