Fibromyalgia – The Ache That Won’t Go Away

Fibromyalgia – The Ache That Won’t Go Away

Fibromyalgia

Fibromyalgia is a condition that many patients describe as a chronic, dull ache that is persistent all day long. People who have been diagnosed with it have associated fatigue, trouble with sleep patterns, numbness and tingling, and diffuse muscle pain. The theory is that people with fibromyalgia have heightened sensation of pain. Where a normal touch is perceived as mild to moderately painful. These tender areas are not just in one area such as the neck or back but diffuse throughout the body. People, at times, have categorized it like feeling like the flu. This widespread pain can range from mild to debilitating.

There are many treatment options for people with fibromyalgia. First, medications are beneficial and allow people to help manage their pain. These medications are varied and include muscle relaxers, neuromodulators, antidepressants, Low dose Naltrexone and NSAIDS. Opioid medications are not seen as a treatment choice.

Other treatment alternatives to help with this chronic pain include yoga, acupuncture, massage therapy, trigger point injections, and physical therapy. Many people try to avoid these therapies as these require them to use the muscles they perceive as painful. However, numerous studies show that exercise is the most important intervention to help with fibromyalgia.

Exercise helps patients gain strength, improve motion and foster better feeling of long-term health. People should start slow with stretching exercises and gradually increase to walking, water aerobics and even biking. Doing this a few minutes each day can turn into 30 minutes several times per week with the right plan. This will help with spasm, flexibility and endurance. Being active may initially increase the pain level these people experience but in the long term it will be beneficial and reduce pain levels.

The old saying of “no pain, no gain” is true for people with fibromyalgia but the rewards of putting in the work will lead to a better sense of well-being and improved pain scores. Making time for exercise throughout each week is essential for fibromyalgia treatment.

Chronic Pain and Depression

Chronic Pain and Depression

It is estimated that up to 85% of chronic pain patients suffer from severe depression.  Sometimes pain is a symptom of pre-existing depression, and sometimes the depression comes as a result of the effects of chronic pain.  With potentially one fifth of the US population suffering from chronic pain, understanding the association between depression and pain, and the subsequent treatment of the two, is becoming more and more important.

What controls your mood?

The areas of the brain in charge of mood management include the prefrontal cortex, the amygdala, and the hippocampus.  Evaluation of the brain post-injury shows that body pain is controlled by most of the same regions of the brain. The chemicals in the brain associated with depression, such as serotonin and norepinephrine, play a major role in pain perception.  When the regulation of these chemicals fail, which can be the case with depression, pain perception is intensified. Additionally, autopsies performed on patients who had chronic depression showed a consistently smaller prefrontal cortex. This could potentially mean that depression can cause a physical change in the brain, therefore leading to a chronic, and possibly permanent change in the brain structure.

In addition, due to the similar impacts both can have on someone’s quality of life.  Depression can cause a lack of interest in hobbies, activities, socialization, and can therefore lead to isolation. Without the ability or desire to partake in everyday activities, more focus is paid to pain, which increases the perception of pain.  Pain can cause immobility, loss of ability to work or function, also leading to isolation, and therefore depression. Therefore, regardless of which came first, the onset of chronic pain or depression can either cause or increase the severity of the other.

Treatment Discussion

Being aware of the correlation between these two debilitating diagnoses can help lead to more effective treatment.  Physical therapy can help increase a patient’s strength and mobility, which is widely known to help with pain, however movement itself produces endorphins, the chemicals which help with happiness and reward, and therefore can decrease depression symptoms as well.  Psychotherapy is widely known to help with depression, however this can also help to alter a patient’s perception and focus on pain, and can either decrease the pain symptoms, or help a patient better cope with chronic pain symptoms. Many antidepressant medications are also used with chronic pain management, regardless of whether or not a patient has been diagnosed with depression as well.

Overall, chronic pain can be extremely debilitating on its own, but unfortunately it commonly occurs with depression.  Treating one without acknowledging the other can lead to insufficient treatment of both, so understanding their correlation in onset, as well as treatment, can help patients improve their quality of life, both mentally and physically.

References

Depression and pain. (2009, June). Retrieved January 14, 2020, from https://www.health.harvard.edu/mind-and-mood/depression-and-pain.

Sansone, R. A., & Sansone, L. A. (2008, December). Pain, pain, go away: antidepressants and pain management. Retrieved January 14, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2729622/.

Sheng, J., Liu, S., Wang, Y., Cui, R., & Zhang, X. (2017). The Link between Depression and Chronic Pain: Neural Mechanisms in the Brain. Retrieved January 14, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5494581/.