Reducing Pain
Fibromyalgia Facts
Below: An excellent article from the authoritative medical journal MD LINE can help us get a handle on the array of changes to the body and brain that are related to Fibromyalgia and Chronic Fatigue. While the jargon is on the technical side, it is obvious that genuine physical issues come into play when one is dealing with these diseases.
"Central nervous system abnormalities in fibromyalgia and chronic fatigue syndrome: new concepts in treatment."
Fibromyalgia and Chronic Fatigue Syndrome are poorly understood disorders that share similar demographic and clinical characteristics . . . and they may share common pathophysiological mechanisms, namely:
Central nervous system dysfunction
Atypical sensory processing in the central nervous system
Dysfunction of skeletal muscle nociception
Hypothalamic-pituitary-adrenal axis
Recent pharmacological treatment studies about fibromyalgia have focused on selective serotonin and norepinephrine reuptake inhibitors
*****Research paper by Oktayoglu, G. (2008) Current Pharm Des. Vol. 14(13):1274-94
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Other ideas include one by Sörensen et al (1995) who suggested that a possible treatment for fibromyalgia would be a drug that changes the levels of a certain brain chemical called NMDA.
******Sörensen J, Bengtsson A, Bäckman E, et al. Pain analysis in patients with fibromyalgia. Scan J Rheumatol 1995;24:360-5.
Pain Facts
Painology: Acute Pain and Chronic Pain
There are several ways to label pain, here are the most frequently found helpful categories:
Acute pain – begins suddenly, limited duration, usually tied to damage to muscle, organs, bone such as a sports injury.
CHRONIC PAIN is pain that has been occurring for 6 months and is usually difficult to treat. This could include arthritis, Sciatica, SI joint dysfunction, Fibromyalgia, Shingles, and so on. Chronic pain can be from tissue damage (nociceptive pain) but it can also occur due to nerve damage (neuropathy).
Another important part of categorizing pain is to consider the social and emotional effects of on-going chronic pain. Sometimes your level of intensity of pain is irritated by feelings about the painful condition itself, feelings such as irritation, fear, stress, anxiety, shame/embarrassment and even depression.
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Costigan (2009) relegated pain into four main groups: nociceptive pain (occurs normally due to painful stimuli, reduces after healing)
Inflammatory pain (results of tissue injury and the subsequent inflammatory response and reduces after healing)
Dysfunctional pain (provides neither protection from injury nor support for the healing and repair processes)
Neuropathic pain (after damage to peripheral or central nervous system neurons)
******** Costigan M, Scholz J, Woolf CJ. Neuropathic pain: a maladaptive response of the nervous system to damage. Ann Rev Neurosci 2009;32:1-32
Opioid-induced pain sensitivity is noted in the medical literature in both some animals and some humans. In addition, most patients experience the development of Opioid tolerance, needing more and more to help.
Chang G, Chen L, Mao J. Opioid tolerance and hyperalgesia. Med Clin North Am. 2007;91:199-211.
Chu LF, Clark DJ, Angst MS. Opioid tolerance and hyperalgesia in chronic pain patients: a preliminary prospective study. J Pain. 2006;7:43-48.
Compton P, Charuvastra VC, Kintaudi K, et al. Pain responses in methadone-maintained opioid abusers. J Pain Symptom Manage. 2000;20:237-245.
Guignard B, Bossard AE, Coste C, et al. Acute opioid tolerance: intraoperative remifentanil increases postoperative pain and morphine requirement. Anesthesiology. 2000;93:409-417.
Mao J. Opioid-induced hyperalgesia. Pain Clinical Updates. 2008;16:1-4.
Chu LF, Clark DJ, Angst MS. (2006) Opioid tolerance and hyperalgesia in chronic pain patients: a preliminary prospective study. J Pain. 7:43-48.
Compton P, Charuvastra VC, Kintaudi K, et al. (2000) Pain responses in methadone-maintained opioid abusers. J Pain Symptom Manage. 20:237-245.
Guignard B, Bossard AE, Coste C, et al. (2000) Acute opioid tolerance: intraoperative remifentanil increases postoperative pain and morphine requirement. Anesthesiology. ;93:409-417.
Mao J (2008) . Opioid-induced hyperalgesia. Pain Clinical Updates.16:1-4.
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One publication reported that Opioids can cause more pain due to: " While there are many proposed mechanisms for OIH, 5 mechanisms involving the central glutaminergic system, spinal dynorphins, descending facilitation, genetic mechanisms, and decreased reuptake and enhanced nociceptive response have been described as the important mechanisms."
**************Salomons, T. et al (2014) A brief cognitive-behavioral intervention for pain reduces secondary hyperalgesia Division of Brain, Imaging and Behavior—Systems Neuroscience, Toronto Western Research Institute, Toronto, Ontario, Canada Department of Psychiatry. Published by Elsevier B.V.)
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Are you making things worse? http://www.somatics.com/pdf/Might_You_be_Strengthening_Your_Pain.pdf
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For the newest information on Chronic Fatigue Syndrome look up: Elizabeth Haney, MD et all (2015) Diagnostic Methods for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Systematic Review for a National Institutes of Health Pathways to Prevention WorkshopDiagnostic Methods for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Ann Intern Med. 2015;162(12):834-840. doi:10.7326/M15-0443
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For my take on the science of pain read my paper below:
Chronic Pain: Where Medicine and Psychology Meet
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