Not even doctors completely understand FM.
FM is frustrating for us and doctors alike; the condition is hard to diagnose and treat – and many doctors don’t even believe it’s real.
But new research on brain chemistry, better diagnosis methods and mind-based therapies, such as cognitive behavior therapy, are changing doctors’ attitudes and offering renewed hope for relief among all of us.
“Not only are we doing a better job at educating physicians in how to diagnose fibromyalgia, but new research [also] is helping us better understand the disorder’s effects on the body,” says Stuart Silverman, M.D., a clinical professor in medicine and rheumatology at UCLA.
The studies give credibility to FM as a real syndrome, while also uncovering new ways to reduce the intensity of symptoms and cope with the ones you’ve got.
Here’s how the latest research can help us:
1. You can learn to reduce pain.
A mind-body therapy called ‘affective self-awareness’ may offer relief, according to a 2010 Providence Hospital study published in the Journal of General Internal Medicine.
In the study, 45 women with FM learned techniques – such as mindfulness meditation and writing about their feelings – to recognize and deal with emotions that could exacerbate pain. They were also encouraged to resume any exercise or activity they avoided due to discomfort. In six months, 46% had pain reduced by 30% or more.
How it may help: “We’ve learned that the hypersensitivity of nerve pathways in FM patients is a ‘learned pain,’” says Howard Schubiner, M.D., director of the Mind-Body Medicine Center at Providence Hospital in Southfield, Mich., who worked on the study. That means pain can get worse when you expect to feel it.
“We also know there’s a link between FM and stressful life events and in coping with strong emotions,” Schubiner adds.
Practicing self-awareness can help you face feelings and gain a sense of control over improving your health. Some hospitals offer seminars in mindfulness and other mind-body techniques. Ask your doctor for a referral.
2. Cognitive behavioral therapy (CBT) may ease FM symptoms.
A 2010 research review published in the Journal of Rheumatology found that CBT helps patients cope with pain, improves depressed moods and reduces the number of follow-up doctor visits.
And in a separate 2010 study, published in Arthritis Care & Research, two-thirds of high-risk FM patients who received a combination of CBT and physical therapy had “clinically significant” improvements in their well-being.
How it may help: CBT teaches people to examine and change their thinking to deal with life’s challenges. For FM patients, it may reduce depression and anxiety often triggered by symptoms.
One successful method is “reframing,” in which you learn to replace negative, hopeless thoughts with positive ones.
It can help you realize that even if you have aches today, “it doesn’t mean you’ll be in pain tomorrow too,” Silverman says. “The next few days can be better.”
3. A medication awaiting Food and Drug Administration (FDA) approval could improve sleep and reduce pain.
A 2010 University of Toronto study found that sodium oxybate, a central-nervous-system depressant produced by Jazz Pharmaceuticals, improved sleep in FM patients.
As a result, 44% of those who took it reported pain reduction of 50% or more. They also were less tired and had more energy during the day than those who took placebos. BUT while the FDA has approved sodium oxybate to treat narcolepsy, its future as a FM treatment is in doubt. Also known as gamma-hydroxybutyrate (GHB), the compound is regulated strictly because it’s often abused as a “club drug” or date rape drug.
Citing safety concerns, an advisory panel recently voted against recommending it for FM patients. The FDA is expected to make a final decision by October.
How it may help: “In people with fibromyalgia, if you can improve their sleep, data shows you can also reduce their pain,” Silverman says. “If you get a good night’s sleep you’re in a better mood. You’re thinking better.”
4. Doctors have a better way to diagnose FM.
“Physicians sometimes didn’t check the tender points or, if they did, they weren’t always sure how hard to press,” says Robert S. Katz, M.D., a rheumatologist and professor of medicine at Rush University Medical Center in Chicago.
Also, FM pain may fluctuate, and the tender-points test didn’t measure the effectiveness of medication.
How it may help: The ACR’s new rules include an evaluation of other symptoms, including fatigue, sleep disturbances and cognitive problems.
“The new test makes it easier for physicians to diagnose FM and begin treatment,” Katz says.
5. Certain brain activity has been linked to increased pain in FM patients.
Doctors at Massachusetts General Hospital and the University of Michigan have found a link between resting brain activity and FM pain.
In a 2010 study of 36 women, those with FM had more neural connections between various brain networks and the insular cortex, which is linked with pain processing. That higher sensitivity in the brain’s “pain matrix” can help explain FM symptoms, Silverman says.
“If you lightly tap your thumb, this area of the brain would hardly register anything if you don’t have FM,” he says. “For those with FM, this part of the brain lights up like a Christmas tree.”
How it may help: The study provides more evidence that FM patients have different brain physiology, says lead researcher Vitaly Napadow, Ph.D., an assistant professor in radiology at Harvard Medical School.
“This research may help patients by better defining the specific brain regions affected by FM,” Napadow says. “The more we know about why patients experience pain, the more we can tailor treatment to combat it.”
6. Changes in brain chemistry have been linked to FM symptoms.
In 2010, University of Michigan researchers found a significantly higher amount of glutamate, a neurotransmitter associated with increased pain levels, in the brains of FM patients. Research suggests these changes may be partially responsible for pain and depression.
How it may help: Changes in brain chemistry may explain why pain is amplified in FM patients, Silverman says.
“Fibromyalgia is central pain, not peripheral,” he says. “You may feel pain in your leg, but [it’s] coming from your brain, which overreacts.”
Medications can reduce the pain volume control in FM patients.
“Since studies such as this one link changes in the brain to FM, they may [lead to] the development of more precisely targeted medicines and treatments,” Silverman adds.
See? They are trying…