| Fibromyalgia is a condition characterised by | | | | (not the mind!) to motivate some action. This is |
| generalised muscle pain, stiffness, and tender | | | | the same as a thirst or hunger that motivates |
| points in specified locations with accompanying | | | | the action of seeking food or water for survival. |
| sleep difficulties, morning stiffness and fatigue. | | | | Other components of this protective response |
| There have been differing ideas as to why this | | | | include reflexive action (pull hand away from the |
| problem starts and how it is maintained, however | | | | fire), changes in blood flow and immune activity to |
| there is still much to learn and understand. Despite | | | | promote healing. Often the tissue will heal after |
| this there is now good evidence to support the | | | | being damaged and the sensitivity that develops |
| concept that fibromyalgia is a condition driven by | | | | normally will ease. Sometimes this sensitivity |
| a central nervous system (spinal cord and brain) | | | | reduction does not occur and persists. This means |
| that is processing pain in a dysfunctional way. Pain | | | | that the tissues heal but the nervous system |
| science research has shown that we need to look | | | | remains in an excitable state, sending danger |
| at the function and changes that occur in the | | | | messages despite the fact that there is no |
| central nervous system in order to be more | | | | danger. Clearly the management of this type of |
| effective in managing chronically painful conditions, | | | | problem is different and requires a 'wide lens' to |
| including fibromyalgia. | | | | consider the varying influences upon the pain |
| Similar to other persisting pains, there are often a | | | | experience; recall the pain matrix and the regions |
| myriad of other symptoms that are experienced, | | | | involved. With a chronic condition the treatment |
| some of which may make no sense. One of the | | | | must focus on the activity of the central nervous |
| most important parts of managing and treating | | | | system and the way in which it processes pain |
| chronic conditions is to explain the nature of the | | | | information. Normal movement and touch are |
| problem and the reasons for the symptoms. | | | | painful because the processing of the information |
| 'Explaining' pain is fundamental in allaying fears and | | | | results in the brain believing there to be a threat |
| answering questions that are provoking fears and | | | | to the tissues. We know that the tissues are |
| anxieties which alone can amplify pain as will be | | | | actually not unhealthy but rather the nerves that |
| described. Understanding the influences upon pain | | | | supply the tissues are excitable and that the |
| and the factors that can aggravate will help in | | | | central nervous system is sensitive and these |
| your self-management and enhance the | | | | states mean that normal touch and movements |
| treatment process. This has been evidenced by a | | | | are perceived to be 'dangerous'. Changing the |
| study that looked at the effects of pain education | | | | brain's perception of this requires more than just |
| on a particular test that is commonly used in the | | | | tissue targeted treatment (e.g. massage, joint |
| clinic (straight leg raise). It was found that the test | | | | mobility) with interventions such as education, |
| improved following an education session that | | | | coping skills, relaxation and tactile discrimination |
| focused on pain science. | | | | having a significant role. Some 'hands on' |
| There have been many studies that have used | | | | treatments are indicated and should be applied |
| brain scanning techniques to assess brain activity | | | | wisely alongside the aforementioned. |
| during the pain experience. The findings support a | | | | Science clearly tells us that pain is not an accurate |
| useful pain model called the 'pain neuromatrix' that | | | | indicator of tissue damage. Examples such as |
| was developed by Ron Melzack. This model | | | | phantom limb pain and pain-free trauma suggest |
| described a network of nerves (neurons) in the | | | | that the brain must prioritise the information from |
| brain that when active in a particular way would | | | | the tissues in the light of survival, and decide what |
| create the conscious experience of pain. The | | | | action is most important. Stepping on a nail is |
| regions of the brain that form this matrix include | | | | usually painful, unless of course a bus is hurtling |
| areas that are responsible for control of | | | | toward you when you will almost certainly run out |
| movement, sensation, anxiety, memory, | | | | of way despite the injury to your foot. This fact |
| concentration, emotion, belief, planning and vision | | | | is significant in both understanding and managing |
| to name a few. Any one of these regions when | | | | pain in an effective way. |
| activated can trigger the other regions through | | | | Suffering with the symptoms of fibromyalgia |
| interconnections (the matrix), thereby initiating | | | | often means widespread pain, stiffness, |
| activity, a 'neurosignature', within the network. For | | | | tenderness in the tissues, fatigue and mood |
| example, seeing someone bending can provoke | | | | changes. The activity in the central nervous |
| your back pain by the visual input from observing | | | | system underpins many of these symptoms and |
| the movement stimulating activity in other parts | | | | it is vital that as a sufferer this is understood. |
| of the matrix. We have a 'neurosignature' for all | | | | Linked with the pain processing pathways are the |
| activities and thoughts, this being a pattern of | | | | activities of the immune system and stress |
| activity within a network of neurons that is | | | | physiology. This means that if you are unwell the |
| responsible for our experience, e.g. walking, | | | | pain can be amplified by the increased release of |
| speaking and writing. One region that is particularly | | | | immune chemicals that sensitise the nervous |
| worthy of mention is the amygdala which is | | | | system. The cascade of hormone releases that |
| involved with fear and anxiety. Through its | | | | occur as the body deals with stress (pain is a |
| connections with other parts of the pain | | | | stressor) can also amplify the pain and be |
| neuromatrix the amygdala can trigger the | | | | responsible for stiffness in the tissues, particularly |
| neurosignature for pain. This means that if you | | | | in the morning. There has been much work done |
| are feeling fearful or anxious because of not | | | | on both of these systems so we can understand |
| understanding your symptoms for example, the | | | | the links between general health, sleep, mood and |
| pain can be amplified. In the light of this knowledge | | | | pain. |
| we can see that education about the condition | | | | Fibromyalgia is a complex condition with numerous |
| and associated symptoms is fundamental. | | | | contributing factors. The understanding of the |
| Pain is a normal sensory experience that is part | | | | causes and pathology has greatly increased but |
| of a protective response created by the brain | | | | we have much further to go. |