Some Fibromyalgia Highlights for 2009
December 2009
In the face of growing evidence over recent years, most FM researchers now believe Fibromyalgia is a neurologic disorder primarily affecting central pain processing that also adversely impacts sleep, cognition, and mood. It also causes often immobilizing fatigue. There have been no major advances this year, but old theories are losing currency, and I suspect the new model of FM has directed
attention along more productive lines. This article can only touch on a few items.
Research: Researchers have discovered more objective and quantifiable differences between “controls” (normal people) and people with FM. Many of these findings are presented from the neurologic disorder paradigm. Some of these new biological markers and findings help explain FM symptoms, while the full implications of others are not yet understood. Such objective findings legitimize fibromyalgia as a true organic disorder.
People with FM are losing “gray matter” in certain regions of the brain involved in regulating pain and managing stress, as well as areas involved in cognition. The annual loss of gray matter is 9.5 times higher than in controls. Similar gray matter loss has been found in other chronic pain groups, as well as in CFS, though the specific regions vary. The progressive nature of this damage may worsen FM over time. At least one study will investigate the use of neuroprotective agents to slow or stop this degeneration.
Past studies concluded that “Fibrofog” and cognitive deficits were subjectively experienced as being much more severe than objective test results suggested. Symptom magnification was one possible explanation. Now a 2009 study has found that cognitive deficits are most severe in the presence of distractions. Earlier studies were conducted under quiet, controlled conditions, without distractions. The new study found that while only 31% of FM subjects were impaired in quiet settings, 86% were impaired when distractions were present.
Why exercise can hurt: Too much exercise causes people with FM to over-produce “adrenergic receptors” for 48 hours or longer, causing stiffness and soreness.
Medications: The FDA approved Savella for FM pain, but like Lyrica and Cymbalta, 20-30% quit because of side effects. A “strong” response (50% or more reduction in pain) occurs in only about 30% of patients.
Exercise and Stay Active: Staying as active as practical, improving your posture, and engaging in the right kinds of exercise tends to improve the quality of your life and your level of function. Both Fibromyalgia Aware and Fibromyalgia Network frequently run articles on exercise programs for people with FM, including modified versions of Pilates, the Alexander Technique, the Feldenkrais Method, and Yoga.
Practice Good Sleep Hygiene: The best predictor of improvement and recovery is getting more restorative sleep. Go to bed at a regular time, observe nighttime rituals, get any sleep disorders treated, and if you have trouble sleeping, talk to your doctor. Many medications are used off-label for sleep.
Learn to Accept Your Condition: Fix what you can, and then focus on the hard part: learn to live well despite the pain and impairments that remain. Researchers found that people who accept their condition and move on with their lives are happier and more engaged in living. Support groups are often helpful, and talk therapy can help individuals make this transition.
