Fibromyalgia – a tale of baby brains and guitar amplifiers
By Daniel Jordan - LifeForce Physiotherapist
Fibromyalgia is not just a difficult word to say - it is also a difficult condition to live with. But "difficult" does not mean "impossible"! To understand how to treat FM, we need to learn what it is and what it feels like.
- Widespread muscle pain or tender points
- Impaired sleeping patterns
- Altered sensation
- Tingling, numbness and nerve pain
- Altered bowel function
- Abnormal (heightened) response to normal stimuli
HOW IS IT DIAGNOSED?
A diagnosis of FM is made by the combination of a few factors, with the main one being widespread pain that has been there for at least 3 months, with no diagnosed cause. It can be seen as an umbrella term, rather than a specific diagnosis, and there is no true single cause or reason for someone to have FM. What we do know, however, is that it can impact lifestyle dramatically, and that it is not a nice thing to live with.
SO WHAT ACTUALLY IS WRONG?
To understand FM, we first need knowledge of a process called central sensitisation; this involves the idea that pain is not generated by our bodies, but by our brains, in a process called nociception. For a long time, pain was thought to be an input – meaning a message of pain was sent from our body to our brain, indicating tissue damage. What we know now, is that it is actually the opposite; pain is an output, a message sent from the brain to our body, to warn of the threat of potential tissue damage. Pain can be a good thing; it is what stops us from putting our hand on a hot stove, or continuing to run when there is an injury to our knee. It is quite a complicated topic, but if we can understand that pain is caused by the brain, then we are a long way to understanding how FM works.
I like to think of our pain sense as being controlled by a guitar amplifier. Let’s imagine that our interpretation of pain sensation is modulated by lots of little volume and tone dials on the guitar amplifier, with each dial having an effect on the nature of the perceived pain; that is, how strong the sensation is, whether it is sharp, dull, or burning, how long it lasts for, etc. There is also a master volume control, which dictates how loud the overall sound of the guitar is, or in our allegory, how high the pain output is. With me so far?
Let’s say that your standard Joe has an overall “master” volume level of 1. Joe gets knocked in the shoulder by a passerby on the street, and feels a brief dull pain, which is his brain letting him know that he was bumped. Now, if Joe has FM, his master volume knob may be set at 9, and instead of a brief, dull throb, he gets a strong, sharp, burning pain, which might last for much longer than it needs to. The reason the master volume knob is set to 9 is because the brain is, for one reason or another, overly protective, and has gotten a bit confused about what is a threat to the body’s tissues, and what is not. This is not a conscious decision or thought process, but an automatic reaction, and a sub-conscious behaviour learned over time.
HOW IS IT MANAGED?
Did you notice how I wrote “Managed” instead of “Cured”? As of right now, there is no known cure for FM, though there are a number of things that can be done for people with FM to make their lives more comfortable; physiotherapy, massage, psychology and medication can all help. The one thing that can provide truly meaningful, long-term benefits can only be performed by the patient themselves; exercise! Exercise for people with FM has been shown time after time to be a very effective form of treatment and management.
The challenge in exercising for people with FM lies in where to start; when you are in pain, and tired, and depressed, it can be very difficult to find the motivation to get up and exercise. One thing is certain though – once the process of exercising begins, that is when the management of FM becomes truly successful.
If we want to understand how exercise can be effective, we need to revisit our guitar amplifier analogy, and confuse things a little further by imagining our brain is a baby. Stick with me here! The baby, who has learned that sending a message of pain is a good way to protect us from any potential tissue damage, has cranked the volume all the way up to 9. Still with me? If we think of how a baby learns, it is often via experience and association. If you reward him for good behaviour, it will perform the behaviour more often. In the same way, if we can repeatedly show our baby brain that movement and exercise is in fact NOT a threat to the body’s tissues, then slowly, the baby will come to learn this, and will begin to turn the volume knob down. Over a period of time and with a gradually progressive exercise program, Joe’s baby brain turns the volume knob back down to a more normal, manageable level.
As for the type of exercise that should be done, that is something for another day, but speaking to a physiotherapist can yield a progressive exercise program to help FM become a background nuisance rather than an all-encompassing problem.
Desmeules, J., Cedraschi, C., Rapiti, E., Baumgartner, E., Finckh, A., Cohen, P., Dayer, P. and Vischer, T. (2003). Neurophysiologic evidence for a central sensitization in patients with fibromyalgia. Arthritis & Rheumatism, 48(5), pp.1420-1429.
Jentoft, E., Kvalvik, A. and Mengshoel, A. (2001). Effects of pool-based and land-based aerobic exercise on women with fibromyalgia/chronic widespread muscle pain. Arthritis Care & Research, 45(1), pp.42-47.
Mannerkorpi, K., Nyberg, B., Ahlmen, M. and Ekdahl, C. (2000). Pool exercise combined with an education program for patients with fibromyalgia syndrome. A prospective, randomized study. Journal of Rheumatology, 27(10), pp.2473-2481.
Photo courtesy of ponsuwan of freedigitalphotos . net