Fibromyalgia

Fibromyalgia is a chronic pain disorder characterized by widespread musculoskeletal pain, fatigue, and tenderness in localized areas. The exact cause of fibromyalgia is unknown, but it is thought to involve a combination of genetic, environmental, and psychological factors.

The symptoms of fibromyalgia can vary widely from person to person, but common signs and symptoms may include:

• Widespread pain: This may be felt throughout the body, and can vary in intensity and location.
• Fatigue: A feeling of tiredness, even after adequate rest.
• Sleep disturbances: This can include difficulty falling or staying asleep, and waking up feeling unrefreshed.
• Cognitive difficulties: This may include trouble with memory, concentration, and attention.
• Depression or anxiety: Fibromyalgia can often co-occur with mental health conditions such as depression or anxiety.

To help manage the symptoms of fibromyalgia, a physiotherapist may recommend exercises to improve overall physical fitness and strengthen specific muscles. A chiropractor may also be able to provide manual therapy and adjustments to reduce pain and improve joint mobility. An osteopath may use a variety of manual techniques, including vascular, neural, fascial, and cranial interventions, to address the underlying imbalances contributing to the condition. Here are five exercises that may be helpful for managing the symptoms of fibromyalgia:

1. Low-impact cardio: Activities such as swimming, cycling, or brisk walking can help improve cardiovascular fitness and overall endurance.
2. Yoga: Gentle yoga poses can help improve flexibility, strength, and relaxation.
3. Resistance training: Light resistance training can help improve muscle strength and reduce pain. This can include exercises such as squats, lunges, and bicep curls, using light weights or resistance bands.
4. Stretching: Gentle stretching can help improve flexibility and reduce pain. This can include static stretches such as hamstring stretches, or dynamic stretches such as arm circles.
5. Mind-body exercises: Activities such as meditation or deep breathing can help reduce stress and improve mental well-being, which can have a positive impact on fibromyalgia symptoms.

Pain and Centrral Sensitization

CENTRAL SENSITISATION

BiM review of a J Pain paper by Alban Latremoliere and Clifford J. Woolf (AKA L&W) By Kerwin Talbot & Lorimer Moseley Another of our series on the Journal of Pain’s most downloaded articles – this one on central sensitisation. There is no doubt that central sensitisation has such a prominent role in our pain lexicon that it almost deserves upper case letters. This paper examines the role that CENTRAL SENSITISATION has in enhancing the function of the neurons and circuits in nociceptive pathways. CENTRAL SENSITISATION (OK – I will now leave the upper case thing alone) provides a physiological explanation for the many alterations in the temporal, spatial and threshold systems associated with persistent pain. This review is clearly a fan favourite and I can understand why – it is comprehensive in the extreme and to cover it here is a distant second to you getting a copy and reading it. There are heaps of pictures that are well captioned and the text is not intimidatingly jargonised.

I want to flag one important issue, but let’s first set the scene:

Central sensitisation, as it is discussed in this paper, concerns changes in the functional properties of spinal nociceptors in the dorsal horn.

Broadly speaking, there are two patterns of sensitisation – homosynaptic and heterosynaptic.

Homosynaptic refers to sensitisation of the spinal nociceptors that code for the tissue in which the primary nociceptor – the nociceptor that started it all – sits. Homosynaptic sensitisation leads to allodynia and hyperalgesia in the culprit area.

Heterosynaptic refers to sensitisation of nearby spinal nociceptors, which code for areas adjacent to those in which the primary nociceptor – the nociceptor that started it all – sits. Heterosynaptic sensitisation leads to secondary hyperalgesia and allodynia – when the pain and sensitivity to noxious stimuli spreads to adjacent body areas. L&W take care to emphasise that central sensitization provides an explanation for the presence of ongoing pain in the absence of ongoing primary nociception, tissue damage or inflammation. They then hone in on the two ‘causes’ of central sensitisation – ongoing inflammation or peripheral nerve damage/dysfunction – and describe the differences in central sensitisation in these two situations. They stress that the multiple inputs to the spinal nociceptor is what determines central sensitisation although they do not seem to consider descending modulation as part of that mix. I am surprised at that, but it is very difficult to think of experiments that would successfully interrogate that in animals, or humans for that matter.

L&W instead attribute central sensitisation to these two processes – inflammation or nerve injury. In clinical terms, this is profound – central sensitisation applies to your patients who have an inflammatory disorder, for example rheumatoid arthritis and to those who have a peripheral nerve injury. What proportion of your patients is that? Does this seem odd to you? I reckon it does and I think this is because the term central sensitisation is used to explain the pain of anyone with reduced pain thresholds away from the primary nociceptive site (if indeed a primary site can be identified). The review article itself even slips into this ambiguity by referring to central sensitisation in fibromyalgia, yet they cite papers that describe reduced pain thresholds and temporal wind-up of repeated stimuli at remote sites, and decreased conditioned pain modulation at remote sites, in people with fibromyalgia. As far as I can see from the L&W review, these phenomena are consistent with neither homosynaptic nor heterosynaptic mechanisms. I contend that they point to a different mechanism altogether. I concede that there are human studies, also cited by L&W, that show enhanced activation of cortical structures in states of central sensitisation, but that would make sense the spinal nociceptor is upregulated wouldn’t it?

Aside from offering a top shelf review of true central sensitisation, L&W present to us a challenging reality – that central sensitisation causes allodynia and hyperalgesia in the problem area (primary allodynia and hyperalgesia) and the surrounding tissue (secondary….), but it does not cause reduced pain thresholds, temporal wind-up or deficient conditioned pain modulation elsewhere; and central sensitisation is caused by ongoing inflammation or nerve damage, which means it does not explain the vast majority of the patients we see.

Clearly there is an alternate version of central sensitisation out there that is applied, more and more, to the people we do see. But where did this alternate central sensitisation come from? I wonder if it is another manifestation of the difficulty we have in separating pain from nociception. I think reduced pain thresholds at remote sites and dodgy conditioned pain modulation would be a very appropriate adaptation for an organism with good reason to be hyperprotective of their body, and I can see no other place this would happen than in the brain (not necessarily via neuronal mechanisms per se). However, to call it central sensitisation is a bit misleading. When I talk about this stuff to people in pain, or to clinicians who treat them, I refer to ‘facilitation of protective neurotags’ and it seems to work. I know that any self-respecting journal editor would feel nauseous at such a term, but it seems easy to grasp down here at the coalface.

There is no doubt that this is a fantastically comprehensive coverage of central sensitisation and I highly recommend it to anyone who really wants to understand AND who has the temperament to take on the gaggle of acronyms. I think you should read it and then decide if central sensitisation as L&W know it, is an explanation for widespread pain, for chronic non-specific low back pain that moves or swaps sides or just covers your whole back and legs, or spreads up to your neck, or for fibromyalgia or for CRPS or for whiplash associated disorder or for myofascial pain syndrome (whatever that is).

This article is a review of a paper by Alban Latremoliere and Clifford J. Woolf on central sensitization and its role in enhancing the function of neurons and circuits in nociceptive pathways. Central sensitization provides an explanation for the many alterations in the temporal, spatial and threshold systems associated with persistent pain. The paper discusses two types of sensitization: homosynaptic and heterosynaptic. Homosynaptic sensitization leads to allodynia and hyperalgesia in the area where the primary nociceptor is located, while heterosynaptic sensitization leads to secondary hyperalgesia and allodynia in areas adjacent to the primary nociceptor. The paper also explores the causes of central sensitization, which are ongoing inflammation or peripheral nerve damage/dysfunction.

The article highlights that central sensitization applies to patients who have an inflammatory disorder or a peripheral nerve injury, but it does not explain reduced pain thresholds, temporal wind-up, or deficient conditioned pain modulation elsewhere. The author suggests that an alternate version of central sensitization, which is more applicable to patients, may be due to an organism’s hyperprotectiveness of its body. The article concludes that this paper is a comprehensive coverage of central sensitization, but the use of the term central sensitization to explain pain away from the primary nociceptive site may be misleading. Regulating the Autonomic Nervous System

How learning to control you autonomic nervous system can speed recovery, give you more energy and get you out of chronic pain

The Autonomic Nervous System: Why Chronic Stress is Making You Inflamed, Sick and in Pain.

Chapter Titles:

1. Understanding the Autonomic Nervous System: Its Function and Importance
2. The Link between Chronic Stress and Inflammation
3. How Chronic Stress Affects the Immune System
4. The Role of the Autonomic Nervous System in Pain Perception
5. The Connection between Chronic Stress and Chronic Pain
6. How Chronic Stress Affects the Cardiovascular System
7. The Relationship between Chronic Stress and Gastrointestinal Disorders
8. Chronic Stress and Respiratory Disorders
9. The Effects of Chronic Stress on Reproductive Health
10. The Link between Chronic Stress and Mental Health
11. Chronic Stress and Sleep Disorders
12. Coping Strategies for Chronic Stress Management
13. Mindfulness Meditation and Its Effects on the Autonomic Nervous System
14. The Role of Nutrition in Managing Chronic Stress
15. Holistic Approaches to Chronic Stress Management

Book Introduction:

Are you suffering from chronic pain, inflammation, or illness? Do you find yourself feeling exhausted, anxious, or depressed on a daily basis? If so, you may be experiencing the negative effects of chronic stress on your autonomic nervous system. The autonomic nervous system (ANS) plays a critical role in regulating the body’s response to stress. However, when stress becomes chronic, the ANS can become overactive, leading to a range of health problems, including inflammation, pain, and illness. In this book, we will explore the intricate workings of the ANS and its relationship with chronic stress. We will examine the ways in which chronic stress affects the immune, cardiovascular, respiratory, and gastrointestinal systems, as well as mental and reproductive health. We will also discuss coping strategies for chronic stress management, including mindfulness meditation, nutrition, and holistic approaches. By understanding the link between chronic stress and the ANS, you can take proactive steps to manage your stress levels and improve your overall health and wellbeing.

Chapter 1: Understanding the Autonomic Nervous System: Its Function and Importance

The autonomic nervous system is a complex network of nerves and ganglia that controls involuntary bodily functions, including heart rate, digestion, respiration, and blood pressure. It is composed of two branches: the sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS). The SNS is responsible for the “fight or flight” response, which prepares the body for action in response to a perceived threat. The PNS, on the other hand, is responsible for the “rest and digest” response, which promotes relaxation and the restoration of bodily functions.

The ANS is critical to our survival, as it helps us respond to danger and regulate bodily functions. However, when stress becomes chronic, the ANS can become overactive, leading to a range of health problems. Research has shown that chronic stress can lead to an imbalance in the ANS, with an overactive SNS and an underactive PNS. This imbalance can lead to inflammation, pain, and a range of health problems, including cardiovascular disease, respiratory disorders, and gastrointestinal disorders.

By understanding the function and importance of the ANS, we can begin to take proactive steps to manage our stress levels and improve our overall health and wellbeing.

Explain the difference between the ventral vagal and dorsal vagal system.

The ventral vagal and dorsal vagal systems are two branches of the autonomic nervous system, which controls various bodily functions that are mostly involuntary, such as breathing, heart rate, digestion, and response to stress.

The ventral vagal system, also known as the social engagement system, is responsible for the body’s state of relaxation, connection, and social engagement. It helps regulate breathing and heart rate, and is involved in the release of neurotransmitters that promote feelings of safety, trust, and connection. When the ventral vagal system is activated, the body is in a state of rest and digest, and the person is able to engage in social interactions, form relationships, and enjoy pleasurable experiences.

The dorsal vagal system, on the other hand, is responsible for the body’s state of shutdown, immobilization, and dissociation. It is activated during extreme stress, trauma, or life-threatening situations, and causes the body to conserve energy and shut down non-essential bodily functions. This can result in symptoms such as slowed heart rate, decreased respiration, and digestive issues. The dorsal vagal system is also involved in the release of stress hormones, such as cortisol, and can lead to feelings of anxiety, depression, and disconnection.

Overall, the ventral vagal system promotes feelings of safety and social connection, while the dorsal vagal system promotes survival in extreme situations. Balancing the activity of these two systems is important for maintaining overall health and well-being.