How the Medical Approach to Fibromyalgia is Changing—For the Better

Author| Ben Bobrow, MD

Fibromyalgia is regularly defined as chronic generalized musculoskeletal pain accompanied by fatigue, anxiety and mood disorders. Recently, the medical community has come to understand much more about this severe form of widespread chronic pain. The Centers for Disease Control and Prevention (CDC) estimates that fibromyalgia affects more than five million adults annually in the U.S., and significantly more women are impacted than men.

Many now view the cause of fibromyalgia as a malfunctioning of the brain’s normal processing of physical sensations. One way to think about this is, as you are sitting right now reading this, there are multiple normal sensations (such as pressure, body position and temperature) that are transmitted from your body to your brain for processing. Normally, the brain can distinguish between these everyday sensations, and the type of experiences that ought to produce pain.

For reasons that are not yet clear, people with fibromyalgia don’t distinguish between the non-painful and painful stimuli and/or specific parts of their brain don’t properly process their sensations. Either way, the result is diffuse and persistent pain which is often debilitating.

Fibromyalgia frequently leaves people depressed and anxious, often without understanding why. Because the cause of this disorder is so poorly understood, it often creates enormous confusion and frustration for patients, their families and healthcare providers. This lack of understanding also often results in feeling stigmatized, which can further exacerbate the pain. Similar to other forms of chronic pain, this pain is very real, even though it just doesn’t show up on routine medical tests.

Without an intentional and focused approach addressing the frustration, depression and anxiety along with the sensation processing dimensions, there is often little improvement.

However, very exciting new research using functional MRI scans of the brain in people diagnosed with fibromyalgia suggest that there are specific markers or neurological patterns that correlate with hypersensitivity to pain.1

The treatments showing promise are ones focused on self-management, cognitive behavioral therapy and aerobic exercise. Many consider fibromyalgia to be an extreme form of chronic pain, so while people with less diffuse forms of chronic pain may have good results using one therapy—such as mindfulness meditation or cognitive behavioral therapy—people with fibromyalgia may require multiple therapies and treatment over a longer period of time.

For more on what's happening with fibromyalgia guidelines, check out this summary from Neurology Reviews.

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  1. López-Solà, M., Woo, C. W., Pujol, J., Deus, J., Harrison, B. J., Monfort, J., & Wager, T. D. (2016). Towards a neurophysiological signature for fibromyalgia. Pain.

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