How did Fibromyalgia become a brain disease? Disentangling conjecture and truth.

[Jonathan Edwards]

I think Clauw's wording is speculative and often clumsy but it is not circular. It is clear what he implies - what Snow Leopard points out would be putative abnormal central sensitization. And that might not be as high as brain. Genetic studies might well show a plausible basis for that.

I agree that Clauw's crowd have hyped the idea in the clinical arena but the critics are just as much wilfully blinding themselves to reasonable biological speculation.

 

[Snow Leopard]

Just out of curiosity since this is not my field—how would you go about controlling for those peripheral factors?

I'm not an expert on this but I'd suggest methods that modulate the excitability of the DRG and/or spinal cord independently via several methods

- Dorsal root ganglion stimulation ('placed near the cell nuclei of the afferent neurons of the dorsal root ganglia')
or tonic spinal cord stimulation ('electrical field over the dorsal columns of the spinal cord')

-local anaesthesia and steroid block of pain in the DRG (not a 100% block but partial)

-pulsed radiofrequency (heat)

 

[jnmaciuch]

I'm not an expert on this but I'd suggest methods that modulate the excitability of the DRG and/or spinal cord independently via several methods

- Dorsal root ganglion stimulation ('placed near the cell nuclei of the afferent neurons of the dorsal root ganglia')
or tonic spinal cord stimulation ('electrical field over the dorsal columns of the spinal cord')

-local anaesthesia and steroid block of pain in the DRG (not a 100% block but partial)

-pulsed radiofrequency (heat)

Thanks!

 

[rvallee]

But they spoil it all by arguing that the biology cannot be tested when it can. Most of the things they call circular are not.

I haven't seen any evidence for a biological observation of central sensitization. What are you referring to?

 

[rvallee]

Because the issue of 'tender points' has been brought up, and this is something notable, I must say that I have never once seen any discussion of anyone having such problems in the fibro community, outside of people commenting about this being used as some sort of test, which doesn't seem to have any evidence for.

Not once. Not a single time. It's all about widespread pain, fatigue and mostly flu-like symptoms. Also some PEM. I see constant discussion of PEM, OI, POTS and other issues out of both the LC and ME/CFS. I have never once seen a single comment from someone suffering from fibro about 'tender points', or even localized pain, which I assume were mostly the product of someone's imagination, and things got out of hand, like the deconditioning and 'unhelpful beliefs' did in ME/CFS.

This feels significant to me.

 

[Jonathan Edwards]

The tender points are very real. The scapular one is very common. But, no, they have nothing to do with widespread pain and were removed from criteria. The patient doesn't complain of tenderness any more than someone with RA does. It is an elicited sign.

 

[shak8]

My FM pain levels were intense 25 years ago and I had to apply for disability benefits. I had too much pain "interference" to think clearly enough to function as a nurse. Not to mention sensory overload from lights, and needing to lie down after one hour of working.

The scariest thing that happened to me at work was reaching for a blood pressure cuff for a patient and suddenly I lost the ability to produce any coherent speech. This state persisted and I was sent home. After resting, I was okay.

So, there is much going on in the brain. Or maybe it was linked to a prior concussion that affected my ability to speak for a similar short while.

During the physical exam for my disability application, I had no reaction when the doctor pushed one by one on the 12 or so tender point locations---neck, down the spine, and elbow. I recall that these were developed for use in research only, not for clinical diagnosis..

 

[petrichor]

I'm not an expert on this but I'd suggest methods that modulate the excitability of the DRG and/or spinal cord independently via several methods

- Dorsal root ganglion stimulation ('placed near the cell nuclei of the afferent neurons of the dorsal root ganglia')
or tonic spinal cord stimulation ('electrical field over the dorsal columns of the spinal cord')

-local anaesthesia and steroid block of pain in the DRG (not a 100% block but partial)

-pulsed radiofrequency (heat)

Wouldn't these have limited effect in fibromyalgia due to the widespread nature of the pain? eg. you would have to block all ganglia, which isn't feasible. Maybe it could still indicate something, though

 

[Snow Leopard]

Wouldn't these have limited effect in fibromyalgia due to the widespread nature of the pain? eg. you would have to block all ganglia, which isn't feasible. Maybe it could still indicate something, though

We're talking about targeted scientific studies on nerve function rather than as a treatment effect though.