Fibromyalgia
Fibromyalgia is a chronic disorder that causes pain, fatigue, cognitive issues and emotional distress. Symptoms include widespread musculoskeletal pain, fatigue, unrefreshing sleep with joint and muscle stiffness, headaches, tingling and numbness in the hands and feet, sensitivity to cold or heat, somatic and cognitive psychiatric symptoms, irritable bowel syndrome. It is often accompanied by temporomandibular joint disorders, anxiety and depression. Patients often describe that ‘everything hurts’, limits movement, sleep and thinking. Symptoms come and go in random times, sometimes feel stronger, sometimes in muscles, sometimes in joints, migrating from upper to lower body or different sides, sometimes mild, sometimes severe. This makes it challenging to understand and treat. Fm is not progressive or life threatening condition, it doesn’t cause organ damage.
US Centre for Disease Control and Prevention counts 2% of the US adult population to have fibromyalgia with 80% of them being women. The similar ratio is counted worldwide as 2-4% of population affected by this condition.
Causes
The underlying cause of fibromyalgia is not known but involves both genetic and environmental factors. Common triggers are different overwhelm experiences such as early childhood trauma, physical and emotional abuse, ongoing stress, infections (including covid), prolonged hospitalisation, injuries.
For decades doctors have struggled to understand it and talked about it as ‘arthritis like’. Early research has found that there are similarities with autoimmune diseases such as lupus, rheumatoid arthritis, multiple sclerosis, Sjogren syndrome but the evidence hasn’t confirmed the autoimmunity hallmarks:
damage from the immune system attack
inflammation as a part of immune and healing process
existence of auto-anti-bodies, autoimmune proteins that target a part of your body
Autoimmunity is an immune system turned against its body. Immune system makes a mistake and attacks healthy cell or tissue instead of dangerous pathogen like virus or bacteria. That creates tissue damage, inflammation and other symptoms. Some examples of autoimmune diseases are:
affecting brain: MS, autism, Guillaun Barre syndrome
affecting blood: leukemia, lupus, hemolitic disglycemia
affecting nerves: neuropathy
affecting lungs: fibromyalgia, Wegener’s granulomatosis
affecting skin: psoriasis,eczema, vitiligo
affecting muscles: muscular dystrophy, fibromyalgia
affecting bones: rheumatoid arthritis, spondylitis, polymyalgia rheumatica
affecting thyroid: thyroiditis, Grave’s disease, Hashimoto’s disease
Later research has referred to fibromyalgia as ‘central sensitivity syndrome’ considering the pain neurological or neuroimmune and including related illnesses in the bundle. The bundle of central sensitivity syndrome illnesses included:
myalgic encephalo myelitis (ME) / chronic fatigue syndrome (CFS)
Irritable bowel syndrome (IBS)
migraine
The most recent research suggests that there is evidence of autoimmunity hallmarks in people with FM. With regards to the damage from the immune system attack there is confirmed small fibre neuropathy in fm patients which is weakness and pain from nerve damage. With regards to the inflammation there is inflammation of the central nervous system parts (brain and spinal cord). WIth regards to the autoantibodies there is evidence of high occurrence of following autoimmune proteins:
- dysregulated neurotransmitter and hormone serotonin,
- gangliosides molecule that is linked to Alzheimer’s, Parkinson’s and lateral sclerosis
- phospholipids molecule that make up protective barriers around cells
- smooth muscle, striated muscle, moisture producing glands, thyroid glands
Furthermore, in a groundbreaking 2021 study by dr Goebel, Crock and Gentry the antibodies from FM patients were injected into mice and proved that mice developed increased pain sensitivity to hot or cold, muscle weakness and reduced movement. It turned out that antibodies attacked the white matter brain cells, grey matter brain cells and certain nerve fibres. This proves the direct link of autoimmune activity with neurological symptoms.
Neuroinflammation
Typical inflammation in the joints and soft tissues is a complex immune system response to injury and infection. It causes tissues to expand beyond their normal size which puts pressure on surrounding structures and causes pain .
Neuroinflammation is a bit different, as it causes neurological problems that lead to neurological symptoms. Research suggests that neuroinflammation is behind central sensitization of the nervous system which is a heightened response to pain in the central nervous system. When the pain becomes chronic it causes tissue damage which is especially harmful in the nervous system.
The nervous system and autoimmune system work together to create neuroinflammation. Neurological components include: microglia cell involved in nervous system immune response, astrocytes cell involved in information processing and implicated in neurodegenerative diseases, oligodendrocytes white matter cells that form myelin sheats and regulate neural circuits, brain derived neurothropic factor bdnf molecule which is a key for learning and memory.
Autoimmune components include: mast cells which are type of white blood cell that keeps the immune system in balance, chemokines cells which attract white blood cells to sites of infection, cytokines protein which creates inflammatory response, interleukin proteins which regulate inflammatory response, T-cells specialised immune cells that target foreign proteins.
Abnormal neuroinflammation in people with fm happens in this brain areas:
primary somatosensory cortex > process physical sensation, especially touch
primary motor cortex > skilled movement
superior frontal gyrus > higher cognitive function and working memory
left superior parietal gyrus > attention, spacial perception
left precuneus > memory based tasks
left medial frontal gyrus > development of literacy
There was also inflammation in medulla, amygdala and left superior temporal gyrus. These areas are related to message relay between brain and spinal cord, regulating cardiovascular and respiratory systems, fight/flight response, language processing, remembering what you've just heard.
If this new research gets recognised and fm treated as autoimmune disease and complex multi-symptom illness a wide range of therapies that reduce the number of antibodies in fm patients are likely to be effective.
Treatment overview
In order to improve quality of life and control the pain, influence fatigue and downgrade sensitivities it’s important to understand that fm symptoms come from the brain which sends danger signals all over the body. The brain is being stuck in survival mode which has a cascading effect on body systems creating faulty circuits.
Fibromyalgia is all about chronic pain and brain processing information about danger incorrectly. We have enough scientific evidence to know that chronic pain is not about tissues and simple danger signals coming from it. It’s always complex, based on the pattern called ‘neurotag’ which is a particular network of brain cells evaluating danger in relation to learning, memory, emotions, family, beliefs, culture, habits and other factors. Pain neurotag is sort of a trigger map. The neurons form connections that are indicating we are not safe and if that continues over a prolonged period of time the danger signals get amplified, spread faster and make the nervous system sensitized through circulation of stress hormones, inflammatory signals and danger neurotransmitters.
In order to influence and change the faulty circuits in fm best practice is to start with treating the brain as a circuit breaker. Moving from overwhelm towards simplification of the healing process based on 3 pillars: education, self-care and pain control. Focusing on medication is often not a solution ending in complication and more medication needed. Self-care through nutrition, better sleep management, movement. Pain control through cognitive behavioral therapy, pain reprocessing therapy, acceptance and commitment therapy, mindfulness, biodynamic craniosacral therapy, relaxation techniques.
Craniosacral therapy as a treatment for fibromyalgia
Biodynamic craniosacral therapy is treating the whole body and regulating the nervous system through gentle touch. Trained practitioner is orienting towards the subtle body flows and rhythms, supporting the involuntary rest’n’digest processes. This connection with the parasympathetic nervous system can reduce inflammation and sensitization of the whole nervous system.
Slowing down and stimulating neurological pathways that create safety helps to unlearn pain and improve fibromyalgia symptoms. It involves experimenting with processes that change the pain trigger map. BCST works exceptionally well in that respect giving fm patients opportunity for deep connection with the body through processes that support mapping our body in a more conscious, resilient way and retraining the nervous system. It’s about shifting from linear thinking about pain being in the tissues to thinking about pain as an output of the nervous system processing information about danger. That shift creates space for relearning the way we feel, move and think which then changes the pain neurotag and calms down the whole system. It also builds capacity to experience positive feelings and hormonal chemistry.
The scientific research about it is still limited and small in scale but findings promising. A small randomized study by Matarran-Penarrocha was conducted in 2011 with 86 fm patients - some of them receiving 1hr craniosacral treatment and some 2 x 30min placebo treatment. The researchers measured pain, depression, anxiety, sleep and quality of life during a period of 25 weeks. All patients wore for 24hrs heart monitor to measure their heart rate and measured pain by evaluating tender points.The group that received craniosacral therapy showed vast improvement in their mental and physical symptoms.
