Fibromyalgia: A Brain Problem

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By: Dr. John Conde Special to the Boca and Delray newspapers

Primary Fibromyalgia Syndrome (PFS) is a disabling disorder characterized by widespread musculoskeletal pain and stiffness described as aching, burning, throbbing, and shooting. The pain is typically greatest in the morning and in muscle groups that are used repetitively. Fatigue and sleep disturbances (stage 4) are also cardinal signs of this disorder. Associated symptoms may include irritable bowel and bladder, headaches and transformed migraines, restless leg syndrome, TMJ and face pain, numbness and tingling, impaired memory and concentration, dizziness, anxiety, and depression.

According to the American College of Rheumatology, the criteria for diagnosis of PFS includes finding tenderness or pain in at least 11 of 18 specified tender points when pressure is applied.Widespread pain must also be experienced in all four quadrants of the body for a minimum of three months.

The human brain has inherent pain modulatory systems responsible for the suppression of pain transmission. Current research is pointing towards faulty brain processing as the causative agent of PFS. A study conducted by the National Institute of Health found that patients with PFS who were given relatively low levels of pressure seemed to experience the same amount of pain and subsequent brain activity as the control group which were given high levels of pressure. Due to this faulty brain processing the brain becomes very efficient at transmitting pain so that even a soft touch may produce a pounding sensation.  Over time, an individual may experience pain even without a pain producing stimulus or injury.

Another area of involvement is what is termed the autonomic nervous system.  This is a part of the nervous system that regulates blood vessel diameter, diaphoresis (sweating), digestion, gland activity, and heart rate to name a few. Many individuals with PFS exhibit dysautonomia, or dysfunction of the autonomic nervous system. This can be manifested as irritable bowel syndrome, insomnia, xerostomia (dry mouth), irregular heartbeat, and even excessive sweating. The autonomic nervous system is regulated primarily by the frontal lobe region of the brain and an area in the brain stem called the reticular formation.

The human brain is highly plastic (changeable). Sixty percent of the brain is genetically predetermined while forty percent is constantly changing according to environmental influences (work, home, exercise, food, etc.). We also know that our brain cells require oxygen, proper nutrients, and stimulation for optimal function.  Understanding these concepts, neurophysiologic rehabilitation utilizes oxygen acquiring techniques, nutrition, and specific forms of stimulation (light, sound, touch, oculomotor exercises, one-sided balance exercises, cognitive exercises, one- sided chiropractic adjustments) targeted to the under functioning brain regions. The goal is to restore proper function. Specifically pertaining to PFS, we have also found that graded aerobic exercise and supplementation of malic acid, magnesium, and melatonin are highly effective.

Lastly, Class IV High Power Laser Therapy has been proven to be effective in treating some of the sore and tender points in the musculoskeletal system. This therapy, also known as photo-bio-modulation, sends particles of light called photons trans-dermally into the cell level.  The photons dock on receptor sites on the cells and trigger the cells to produce more proteins and energy, thus stimulating the healing effect. This is the gold standard in conservative treatment of the tender points in PFS.