Healthy Beginnings

Fibromyalgia: Putting Together the Pieces: Part 1

The evolution of the condition of fibromyalgia started back in the 1990s when the American College of Rheumatology came up with the series of guidelines as to how to diagnose “fibromyalgia” due to a growing population of patients who had pain throughout their entire body and didn’t have rheumatoid arthritis, lupus or multiple sclerosis. At that time, doctors couldn’t explain why patients having that symptomological profile would be experiencing pain when testing to all “known” factors was negative. So, they developed the “diagnostic test” of pushing on you and 18 specific points on your body and, if you were tender in 11 of those, they would diagnose you with “pain in your muscle fibers” – which is the meaning of the term fibromyalgia.

In 2010, the American College of Rheumatology said, “well maybe our 1990 criteria for fibromyalgia wasn’t so good.” So they revised them and, in essence, said fibromyalgia is someone who had pain throughout their entire body, are unrested, fatigued, have “Fibro fog” and “there is no other explanation of the pain.” Unfortunately, this remains the state of diagnosis of fibromyalgia in 2017 in the medical model.

In actuality, since 1990 we’ve learned a lot about fibromyalgia and its causes – through medical research and clinical trials and experience. The five pillars of fibromyalgia are:

  1. Brain (central sensitization)

  2. Childhood trauma and chronic stress hormones
  3. Thyroid (Hashimoto’s)

  4. Intestinal dysfunction
  5. Peripheral neuropathy of the small fiber type

Let’s start with the brain and its relationship to the pain of fibromyalgia. All fibromyalgia patients suffer with central sensitization. We have probably all experienced the tender-to-touch spots in our muscles called “trigger points.” The problem in fibromyalgia is that this small trigger point can expand to include the entire body. So, it’s muscle right? Wrong. We have systems in our brain and tracks in our spinal cord that shut off pain. We all have pain signals that come into our body through numerous pain sensors in our hands, legs, skin, muscles, etc. One of our brain’s many functions is to shut off these pain signals by secreting chemicals such as morphine. If we didn’t have these pain controlling mechanisms we wouldn’t be able to put our clothing on due to the severe sensitivity that we would experience from them touching the pain sensory nerve endings in our skin and throughout our entire body. In fibromyalgia, the balance in these mechanisms becomes tipped with excess pain symptoms being sent to the brain, and these pain signals begin to overwhelm the brain’s ability to shut off the pain. Then, to add insult to injury, the brain learns these pain signals. And that is called central sensitization. Thus, the brain and spinal cord are becoming sensitized with these pain signals. So, fibromyalgia is a neurological condition, not a rheumatological condition. And it’s definitely not a muscle problem.

More on the brain: Regularly, we observe that most, if not all, fibromyalgia patients have experienced childhood or adult emotional trauma and are in some degree of post traumatic stress syndrome. We humans have a brain-based stress response to help us get out of bad situations. If you encounter a bear walking in the Tahoe woods, the stress response will help you to fight the bear or more likely flee by running as fast as you can. The stress hormones that are flooding your body during this survival response spread throughout your body and cause muscles to contract harder, cause the liver to release glucose for energy, and cause blood flow to reduce in your G.I. tract and go to the muscles so you have as much oxygen in them as possible. This is an okay response to have for 10 or 15 minutes, but not for a lifetime.

Well, most emotional trauma from sexual, verbal, physical abuse or general massive life stress (traumatic divorce, witnessing a shooting, etc.) are usually the original triggers of the above mentioned fight-or-flight responses when the stress response is chronic. Now if you’ve already developed central sensitization as de- scribed above, that patient is going to further over-experience pain even more as the stress hormones are flooding the person’s entire system and the hormone adrenaline further sensitizes the already sensitive nerve endings throughout the entire body, causing the pain nerves to send more pain signals to the brain creating a vicious cycle and then further overwhelming the entire pain filtering system. The adrenaline fight-or-flight response is like pouring lighter fluid on the fire in the fibromyalgia patient. And to be clear on this point, it’s not that the fibromyalgia patient is stressed or can’t handle stress or needs to “pull up their bootstraps,” it’s that they have a neurological stress response in their brain that never shuts off and helps to create the vicious cycle of pain that the fibromyalgia patient experiences. Thus, brain responses are at the core of the cause of the pain in the standard fibromyalgia patient.

Fibromyalgia is, as stated, a condition with five major components – the above central sensitization and flight syndrome, Hashimoto’s thyroid condition, intestinal dysfunction and peripheral neuropathy of the small fiber type. It is a multifactorial condition that requires its own unique therapeutic paradigm to dampen, reverse and manage – preferably without medication. In part two next month, we will cover the latter three legs of the condition and address some aspects of a successful approach for recovery and maintenance of this seemingly baffling condition.

For more information, call Power Health at 775-329-4402 or visit