Saturday, September 15, 2012

Why pain from head to toe?

Article Samples Home > Free Articles > Article Samples > Why Head to Toe Pain From the Skin Tissue to the Brain It all signals pain! How can you hurt from heat to toe? Research shows the pain control system in the skin, spinal cord, and brain of fibromyalgia patients is overloaded, offering a reason for why you ache all over. In particular, immune cells that generally do not cause pain, contribute to the flu-like fibro symptoms that make your whole body hurt. Nerve Fibers in Skin Alterations in the way the central nervous system (brain and spinal cord) works are believed to be a major cause of your fibromyalgia pain, but researchers are finding that’s not the only source. The immune cells surrounding the nerve endings in your skin appear to be contributing to your pain as well. Seong-Ho Kim, M.D. and colleagues in South Korea took tiny biopsies of the skin tissue from a group of fibromyalgia patients and compared them to healthy controls.1 They found that most of the fibromyalgia patients, but none of the controls, showed enlarged or ballooned Schwann cells. These cells, which look like a string of sausage links, encase the nerve fibers that connect your spinal cord to peripheral tissues like your skin and muscles. These fibers relay information from your tissues to your spinal cord, and vice versa. Under normal situations, Schwann cells provide nutritional support and protection for nerves. But since they are part of your immune system, they are always surveying the nearby environment to make sure nothing happens to threaten or harm your nerves. Enlarged Schwann cells are in an activated state, usually triggered by infections and tissue injury. When activated, these cells pump out pain-causing chemicals to prompt your immune system to clean up debris and help repair damaged tissues. But in people with fibromyalgia, something unusual happens. Although the Schwann cells are enlarged, there are no obvious signs of tissue injury in fibromyalgia patients’ skin. But everything is not normal. When their skin is examined under an electron microscope, the pain-producing chemicals secreted by the immune cells are present in high concentrations.2 These chemicals, called cytokines, activate nearby nerve endings and make the skin hurt. Cytokines are also elevated in the blood and can cause flu-like achiness everywhere. Faulty Pain Filter In order for you to actually feel pain, transmissions from your skin, muscles and other tissues has to reach a level of consciousness in your brain. Otherwise, all sensations, including light touch, would hurt. That’s where your spinal cord comes in handy. The cord’s role is to filter out the less serious nerve signals traveling from your tissues to your brain and from your brain out to your tissues. In essence, your spinal cord works like a pain filter, but studies show it’s doing a poor job in fibromyalgia patients. Kim’s team suspects that fibro patients have too many signals are traveling down through the cord to the tiny nerves in the skin, causing the fibers to become overstimulated. The Schwann cells attempt to keep pace by clearing out the waste products and debris, while providing nutrients to the overworked nerve fibers. In the process, they become enlarged. How do ballooned Schwann cells impact your pain? They secrete pain-promoting cytokines that irritate nearby nerve fibers. The irritated nerve fibers in the skin then start relaying signals back to your spinal cord, saying, “Ouch … help me out!” But the cord fails to filter the signals and the brain shoots more transmissions back to the tissues. This process leaves you with painful skin, even though it looks normal. The same situation likely occurs in your muscles to make them ache. Spinal Cord Opioids When experiencing fibro pain, you would think the neurons in your spinal cord and brain would release lots of pain-killers to get your symptoms under control. Operating under this assumption, James Baraniuk, M.D., of Georgetown University, and Daniel Clauw, M.D., of the University of Michigan in Ann Arbor, measured the spinal fluid level of naturally produced opioid-like endorphins called enkephalins. They compared a fibro group to chronic low back pain patients (regional pain) and healthy pain-free controls.3 The concentration of enkephalins in the fibromyalgia group was almost fourfold greater than the controls, but pain alone was not the reason for this difference. The enkephalin levels were nowhere near as high as in the chronic back pain patients. This means a fibro patient’s spinal cord is pouring out natural pain-killers (e.g., enkephalins) in a valid attempt to contain the pain, but given its widespread nature, that’s just not enough. Opioid Receptors in Brain You may wonder if the high concentration of enkephalins in the spinal fluid (which bathes the brain) are not properly activating the pain-relieving centers in your brain. After all, given the high concentrations of spinal opioids, you should not be feeling any pain whatsoever. Clauw’s team measured the number of receptor sites in the brain that opioid-like substances target to put out the pain. He compared a group of fibromyalgia patients to a group of healthy controls using brain imaging.4 The opioid receptors in the brain were almost completely occupied in the fibromyalgia patients, particularly in the areas known to regulate pain. So the higher amount of enkephalins (opioid-like substances) in the spinal fluid appear to be properly working on the brain’s receptors to control your pain. So Why Do You Hurt? If you are producing plenty of opioid-like enkephalins and they are activating the pain-relieving receptors in your brain, why do you still hurt all over? Researchers don’t know all the details, but the foregoing findings offer some important clues. Studies show the skin is a source of continuous pain transmissions traveling to your spinal cord. The cytokines produced by enlarged Schwann cells cause local irritation, which would be expected for injuries or infections, but there is no evidence of destroyed tissue in fibro. Yet cytokines continue to be produced for unclear reasons, causing your flu-like achiness. Substantial elevations of the opioid-like enkephalins in your spinal fluid could be doing more than trying to provide analgesia. They might also be activating the immune cells in your spinal cord to produce pain-promoting cytokines, and one study indicates this is the case.5 Your body is trying to put out your pain by producing large amounts of opioid-like endorphins (e.g., enkephalins). But opioids don’t just relieve pain, they also activate immune cells to release cytokines to help heal injuries (usually a temporary process). Despite there being no tissue destruction in fibro, your immune system seems to think there is. This means your body’s attempts to ease discomfort backfires (e.g., the pain-promoting cytokines win out over the opioids), leading to more rather than less pain. Curious about other symptoms caused by pain-promoting cytokines and your treatment options? The topic was covered in the Summer 2012 issue of the Fibromyalgia Network Journal. Get more with Membership. Learn about Member benefits. 1. Kim SH, et al. Clin Rheumatol 27:407-11, 2008. 2. Salemi S, et al. J Rheumatol 30:146-50, 2003. 3. Baraniuk JN, et al. BMC Musculoskel Dis 5:48-54, 2004. 4. Harris RE, et al. J Neurosci 27:1000-6, 2007. 5. Kadetoff D, et al. J Neuroimmunol 242(1-2):33-8, 2012.

Friday, September 7, 2012

Morning Stiffness Among Common Symptoms of Fibromyalgia

Morning Stiffness Among Common Symptoms of Fibromyalgia

Morning Stiffness in Fibromyalgia

by Kristin Thorson, Editor, Fibromyalgia Network
Posted: March 27, 2012
Morning Stiffness in Fibromyalgia“When clinicians are asked which symptoms are the most debilitating in patients with fibromyalgia, the most common responses include pain, fatigue, and sleep disturbances,” states lead author of a recent study by Robert Bennett, M.D., of Oregon Health and Science University in Portland.1 He also adds patients report stiffness as an important symptom. And who wouldn’t complain about waking up each morning to a body that feels in the final stages of rigor mortis?
Indeed, 90 percent of the fibromyalgia patients in the Fibromyalgia Network’s recent survey of Fibro Over Time endorsed significant problems with morning stiffness (see our Winter 2012 Journal). But what do most doctors think of your stiffness? Bennett says they “generally regard it as a minor symptom,” or a sign of inflammation unrelated to the fibromyalgia.
When doctors think of stiffness, they conjure up rheumatoid arthritis and other inflammation-related joint diseases that make it harder for these patients to get going in the morning. Yet studies in fibromyalgia patients show stiffness is usually worse in the morning and Bennett points out, “morning stiffness has been rated as more severe in fibromyalgia than rheumatoid arthritis.” He says people with both conditions have worse stiffness than those with fibro alone. But why would fibromyalgia patients be troubled by stiffness?
As people age, they get arthritis, become less active, and expect a little morning stiffness. However, this does not explain why 25 or 45-year-old fibromyalgia patients showed signs of joint stiffness on a test involving the ankle.2 A detailed report was provided in our February 2011 eNews Alert, but suffice it to say, fibro patients showed twice as much stiffness as age-matched healthy controls.
Stiffness sometimes correlates with pain, and since Cymbalta is FDA-approved to treat the pain of fibromyalgia, Bennett and colleagues thought it might relieve the symptom of stiffness. The study was supported by Eli Lilly, the maker of Cymbalta, to see if the drug could help with this symptom. Stiffness did improve, but only by a tiny amount of 10 percent. This compares closely to the 13 percent benefit found in the trials of Lyrica.
If the pain of fibro was solely related to the stiffness, the FDA-approved drugs should be able to produce significant improvement in this symptom. Yet they don’t.
Fibromyalgia is a rather “messy” multi-system condition. There is the central nervous system component involved in processing pain, an area all three FDA-approved drugs work on (Cymbalta, Lyrica and Savella). People with fibro also have trigger points or knots in their muscles, which cause serious pain and restrictive movement.3 In addition, one has to remember the circulatory system, and fibromyalgia patients have increased arterial stiffness (see the Winter 2012 Journal).4
Your arteries should be flexible, but studies show a reduction of the elastic-like qualities in fibro patients compared to age-matched controls. An overly active sympathetic nervous system is thought to be partly to blame.
Therapies to relax your sympathetic nerves, such as a hot shower and many other approaches, often ease morning stiffness. Even one of the three FDA-approved drugs may help, but just don’t expect too much from them.

1. Bennett R, et al. Clin Ther 34(4):824-37, 2012.
2. Dierick F, et al. Eur J Appl Physiol 111:2163-71, 2011.
3. Ge HY, et al. Arthritis Res Ther 13(2):R48, Mar 22, 2011.
4. Cho KI, et al. Clin Rheumatol 30:647-54, 2011.

Avoiding Distractions With Fibromyalgia & Chronic Fatigue Syndrome

Avoiding Distractions With Fibromyalgia & Chronic Fatigue Syndrome

Avoiding Distractions With Fibromyalgia & Chronic Fatigue Syndrome

By , GuideSeptember 5, 2012
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When you have cognitive dysfunction along with your fibromyalgia and chronic fatigue syndrome, distractions can be a big problem. It can be hard enough for us to follow our trains of thought, and a distraction can derail us completely.
Being distracted isn't just an annoyance and possibly embarrassing. It can also make our brain fog worse, and sometimes it can really increase our anxiety.
It's easy to spot some possible distractions - such as a TV on while you're having a conversation - but others aren't nearly as obvious.
I was recently watching a science special that tested how distracting it is to hear different types of conversations. They had people perform simple tasks in quiet, then while two people in the room were talking, and then while someone was talking on the cell phone.
It turns out that the cell phone conversation was far more distracting than the two people talking. Researchers said it was because the human brain occupies much of itself by trying to fill in the parts of the conversation we can't hear. Most of us know that it's annoying to sit and listed to one side of a conversation, and this explains why - it over-taxes our brains.
So how does this help us? I know that now I'll make an effort to leave the room if someone is talking on the phone, or ask the other person to leave the room.
Researchers also looked at how distracted people were when on a cell phone in public. To a person, they were so oblivious to their surroundings that they didn't notice a clown on a unicycle buzzing by them multiple times. They compared the level of distraction to driving drunk. It's made more more cognizant of how dangerous it is to talk while driving, especially since I know I'm easily distractable.
Other things I found to be really distracting are:
  • White noise
  • Repetitive background noises
  • Music with lyrics
  • Visual clutter
What distracts you? Have you noticed that cell phones are a big distraction, whether it's you or someone else talking? Leave your comments below!

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Fibromyalgia Awareness Day May 12, 2013

Fibromyalgia Awareness Day May 12, 2013
Let us all be VISIBLE! May 12, 2013

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