Fibromyalgia – it’s not “all in your head” but rather “all in your brain”

In recent years awareness to fibromyalgia which is expressed by extensive and migrating pain in many areas of the body has been increasing. As there is no diagnostic laboratory test for fibromyalgia, such as an x-ray or a blood test, to date many patients were told that “it is all in your head”, and they were recommended to undergo mental assessment, to gather their strength and get over it. Therefore, apart from the fact that many patients did not receive any help for their suffering, they describe a feeling a severe loneliness from the system, alienation and lack of empathy. In recent years, new researches which is throwing light on the source of fibromyalgia, confirm that this is a genuine syndrome for all intents and purposes and is even prevalent, and help patients to understand that they are not alone, and give them hope of finding effective treatment. In this article we will review some of the innovations in the field.

Fibromyalgia: its principal characteristics

 The prevalence of fibromyalgia diagnosed in the population is estimated at some 1-3%, however pursuant to updated data it is possible that the rate of the disorder that is undiagnosed could reach 8%. Women suffer significantly more from the disease, two to ten fold more than men, for a reason that is still unknown. The disease is 50% genetic and the outbreaks are very influenced by risk factors such as emotional stress, illness or trauma – physical or mental. Contrary to the prevailing opinion there is no proof that the disease is affected by an infectious disease (such as Lyme’s Disease) or from silicone implants. Fibromyalgia as a rule is accompanied by additional diseases such as chronic fatigue syndrome, sleep disorders, anxiety, depression, chronic urinary tract infection, jaw pain, headaches, back and pelvic pains. Fibromyalgia is connected with significant functional damage and pursuant to recent research however only 46% of those suffering from the disease who work, lose 22 work days on average a year, and those who do not work – find it difficult to function in their homes for some 100 days a year.

As there is no, as aforementioned, any blood test or x-ray that can diagnose fibromyalgia, the clinical diagnosis is based on a description of the characteristic symptoms which include extensive pain in several areas of the body, and additional symptoms such as sleep disorders, headaches, depression and pain in the abdomen and pelvis. Furthermore oversensitivity to pain is also characteristic of the disorder which can be diagnosed by physical examination by pressing on several key areas on the body.

What causes fibromyalgia?

 Although the precise cause of fibromyalgia is unclear, in recent years it has transpired that the cause of fibromyalgia is a cerebral over sensitivity to pain – central sensitization – following emotional stress, or pain from a defined source such as following an accident, the brain “gets used” to feeling pain and this is accompanied by over activity of areas of the brain which are responsible for feeling pain, such as the thalamus. Although these are tests that are used at present mainly for research and not for diagnosis, there are testimonies in regard to changes in secretion of “natural” pain relievers in the body (endorphins), over activity of the secretion of cortisol in the body (which testifies to prolonged stress or pain) and plastic changes in several areas of the brain which testify to increase of the sense of pain.

The decrease in the “filtering” of feelings coming from the body to the brain also causes stimuli which are not supposed to be painful, such as a warm hug from a relative, could suddenly become painful; to the fact that the pain could “migrate” to be present on certain days and not on other days and so forth, a phenomenon that we would not anticipate to see if the pain was derived from a certain organ.
The “strangeness” of the pain in fibromyalgia has caused to date many physicians to suspect that this is a pretence at symptoms, or pain that has an “emotional” source –however at present we know that the source of the pain is in a disorder in regulation of the pain in the brain. As the source is not in the body, but rather in the brain itself, the pain could “act strangely”.

Treatment of fibromyalgia

 Just as the disease is complex, so too the treatment is complex and could include a variety of methods, some more “medical” and some from the world of complementary and integrative medicine. It is interesting that although many patients suffering from fibromyalgia take medications, non-medicinal treatment has been proven to be more effective than medicinal treatment, and has fewer side effects.

Physical activity adapted and customized for the patient is an intervention that has been proven to be more efficient and it is recommended for all the patients. Cognitive behavioural therapy (CBT) has also been proven to be effective as well as relaxation methods and meditation, headed by mindfulness and movement meditation such as yoga and tai chi. Additional methods have been demonstrated in several researches as being partially effective such as biofeedback, a method in which the body “is taught” to relax, acupuncture and treatment methods using touch such as massage and chiropractic treatment. Concentration of treatment by one therapist and not by several different clinics, has been proven to more effective than split treatment.

Medicinal treatment includes some of the anti-depressants such as Cymbalta or medications from the tricyclic group, or pain killers such as Lyrica. It is important to note that “strong” pain killers from the opioid group (such as Tramadex) could make the pain worse in the long term and cause addiction, and they are not recommended.

Although medical cannabis is promising in treatment of fibromyalgia, mainly by treating the accompanying sleep disorders, there is still not sufficient evidence in order to understand whether this is an effective and safe treatment, and the treatment can be attempted with caution and under supervision pursuant to the circumstances of the matter.

Nutritional supplements that have been found to be effective include inter alia turmeric and magnesium, and have good results.

Fibromyalgia is a complex phenomenon, which causes significant distress and functional harm. Recently science has thrown light on the causes of the disorder, and mainly describes cerebral over sensitivity to pain as a central factor.

Fibromyalgia has a range of treatments that could help to reduce the level of the pain and improve the quality of life, and it is advisable that management of the treatment shall be by a professional with experience and knowhow in treating this disorder.

The information presented in this article is general. It does not constitute medical advice or replace consultation with a physician. It should not be regarded as a recommendation or an alternative for medical treatment.

The information presented in the English website is partial. For full info please visit our Hebrew website

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