Unlocking the Secrets of Fibromyalgia

Figuring Out Fibromyalgia: Getting Under the Surface

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It's hard to see a loved one suffer from fibromyalgia, and not just because of the pain or other symptoms, such as fatigue, mental fogginess (aka, brain fog), and digestive problems. Yes, those are heavy burdens. But the fact that no one knows why your family member is suffering can make caregiving even more difficult, especially when it adds to your loved one's despair. Fortunately, while researchers don't know what causes fibro, they're collecting pieces of the puzzle—discovering differences in brain chemicals, identifying alterations in sleep patterns, and teasing out the role of stress. Read on for scientists' best guesses about what's fueling your loved one's pain and what may help.

Medically reviewed in March 2020.

P is for Pain

2 / 7 P is for Pain

Even though fibro pain can make a sufferer flinch when a tender point is pressed, doctors typically find no inflammation or tissue damage. Instead, researchers are pursuing the idea that the problem lies in the way the brain and spinal cord process input, maybe because of "princess and the pea" genes that make run-of-the-mill sensations feel overwhelmingly intense. Scientists point out that people with fibro have about three times the amount of substance P in their spinal fluid—a substance that amplifies pain signals. Whatever the cause, the result is clear: "For some people with fibro, a gust of wind can make them miserable because it hurts their skin," says Dr. Mehmet Oz, MD.

The Toll That Stress Takes

3 / 7 The Toll That Stress Takes

Chronic stress can gnaw at you, causing headaches, a sour stomach, and an increased vulnerability to colds and flu. But that's not all—researchers think severe stress may also trigger fibromyalgia. In one study, almost half of the people with post-traumatic stress disorder also met the criteria for fibromyalgia, says health educator Dede Bonner. The stress can come from something as shattering as wartime combat or as everyday as a car crash: As many as 25% of people with fibro say they had some sort of accident not long before their symptoms started. What's the connection? Researchers say emotional trauma may change the brain in ways that trigger fibromyalgia symptoms.

The Brain-Pain Connection

4 / 7 The Brain-Pain Connection

Researchers have a couple of clues that things are a little different inside the skulls of fibromyalgia sufferers. One bit of evidence comes from the drugs that help ease pain—many were originally designed to quiet the abnormal brain activity that leads to seizures in people with epilepsy, says Dr. Dawn Marcus, MD. Certain antidepressants are also useful for fibromyalgia, even in people who aren't depressed. Researchers believe these medications work by raising levels of brain chemicals like serotonin and norepinephrine—chemical messengers that are well known for their mood effects, but that also help regulate pain. Boosting their levels reduces pain for some people with fibromyalgia.

A Shocking Approach

5 / 7 A Shocking Approach

Because researchers think abnormal brain activity may play a role in fibromyalgia, some are investigating therapies that aim directly at the brain—not with drugs, but with a shot of electricity. In transcranial magnetic stimulation (TMS), an electromagnetic coil is placed on a patient's scalp, and then an electric current is passed through it. That creates a small electric current in the part of the brain right under the coil. TMS has been used for treatment-resistant depression, but studies show it may also reduce pain. "In one small study," says Dr. Mehmet Oz, MD, "people with fibromyalgia who received TMS experienced a 29% reduction in pain symptoms."

A Refreshing Possibility

6 / 7 A Refreshing Possibility

Researchers have noticed a strange thing: People with fibromyalgia share some characteristics with people who have obstructive sleep apnea (OSA), a condition that makes them momentarily stop breathing, sometimes hundreds of times a night. OSA leaves sufferers not just exhausted, but more sensitive to pain. And women with OSA are ten times more likely to have fibro. One of the most common treatments for OSA is continuous positive airway pressure (CPAP), which uses a mask to gently blow air into nasal passages to keep the airways open during sleep. Can this help your loved one? Research is ongoing, but a small study found that when people with fibromyalgia used CPAP, their symptoms eased.

Putting Research Into Action

7 / 7 Putting Research Into Action

Scientists are finding more clues about how best to treat fibromyalgia, but to benefit as much as possible from this growing understanding, your loved one needs to work with the right doctor. Find a doc who's knowledgeable about fibro and its treatment. It might be a family physician, internist, or rheumatologist (a doctor who specializes in arthritis and other diseases of the joints, muscles, and bones). It could also be a pain-management specialist—a neurologist or a physical medicine and rehabilitation doctor, with a subspecialty in pain medicine. When it comes to your loved one's health, energy level, and quality of life, the right medical team can make all the difference.

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