In the first two parts of “The Pain the Brain” series the concept of descending inhibition has been mentioned. This refers to a very elegant part of the central nervous system that originates in the brain and travels down the spinal cord to actual inhibit pain signals that have yet to be transmitted up into the brain—hence its name of “descending inhibition.” It has colloquially been referred to as “pain inhibits pain,” and its complete medical name is diffuse noxious inhibitory control (DNIC).
Part 1 of this series described the pain process in the central nervous system, primarily the phenomenon called windup and how it is created. Windup is the beginning of an important change in the central nervous system called central sensitization which is at the heart of the pain felt by patients with FMS. It was mentioned in Part 1 of this series that there is some bad news for FMS patients regarding windup. Here it is.
The International Association for the Study of Pain has defined pain as both an "unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage." There has been an extensive medical literature published on the multitude of mechanisms responsible for the primary complaint of FMS patients — pain.
Submitted by the Illinois Pain Institute
Sciatica and low back pain are leading complaints of pain and discomfort among adults. Typically, people associate such pain with a pinched nerve or bulging disc. Often times, some of the other common causes of low back pain are overlooked and subject patients to sometimes unnecessary, invasive, sometimes painful, and expensive diagnostic procedures. Common disorders, symptoms, and physical signs causing low back pain are listed below.
Myofascial Pain (Quadratus Lumborum Muscle)
Myofascial Pain (Gluteus Medius Muscle)
Myofascial Pain (Piriformis Muscle)
Advanced Pain Management: Facet Joint Syndrome. Advanced Pain Management Resource Guide, p. A4, 2010
Illinois Pain Institute: Diagnosis and Treatment of Back Pain. The Illinois Pain Institute Quarterly Vol. 1:1, 1995
Treatments for lower back pain and sciatica may include oral or topical medications, physical therapy, trigger point injections, transforaminal epidural injections, and other strategies tailored specifically to each individual patient.
Case Study I
A forty-one year old woman had been experiencing low back pain with leg pain for about a year. She stated that her back “went out” while cleaning. The original MRI showed a mild bulging of the lower three lumbar discs with a central disk herniation. Previous treatments, which were ineffective, included oral medication and therapy. Terri Dallas-Prunskis, M.D. of the Illinois Pain Institute provided an initial consultation. During subsequent office visits, transforaminal epidural steroid injections and sacroiliac joint injections were performed. After receiving these treatments, the patient felt excellent pain relief and was able to return to work.
Case Study II
A fifty-two year old male had been referred for treatment of back pain. He had been unsuccessfully treated elsewhere with epidural injections. After a complete history and physical examination, it was determined that his pain was a combination of myofascial pain, stemming from spinal muscle spasm, and facet arthropathy. John V. Prunskis, M.D. of the Illinois Pain Institute performed a site-specific, fluoroscopically guided facet joint injection and prescribed oral medication and physical therapy, which resulted in good pain relief for the patient.
Case Study III
A forty-four year old man had been suffering from chronic low back pain with leg pain and muscle pain from a work-related injury. He had spinal surgery years earlier in addition to previous treatments, which had limited effectiveness, including oral medications, physical therapy, and TENS/Ultrasound. Terri Dallas-Prunskis, M.D. of the Illinois Pain Institute provided an initial consultation. At the patient’s subsequent visit, transforaminal epidural steroid injections were performed; however, these treatments provided only short-term pain relief. The long-term treatment plan included: insertion of a spinal cord stimulator after a successful trial period, physical therapy, and aquatic therapy. After the long-term treatment plan, the patient felt excellent relief and pursued vocational training.
About the Illinois Pain Institute
The Illinois Pain Institute is the longest established, premier interventional pain management practice in the Chicago-area with locations in Barrington, Elgin, Itasca, Libertyville, and McHenry. The Illinois Pain Institute specialized in the diagnosis and treatment of neck pain, back pain, headaches, sciatica, and other painful conditions, and is co-directed by John V. Prunskis, MD, FIPP, five-time “Top Doctor” and Terri Dallas-Prunskis, MD, developer and former chairman of the University of Chicago academic and clinical pain program. They are joined by highly regarded Andrew J. Yu, MD; Shingo M. Yano, MD, FIPP; and Chadi I. Yaacoub, MD, along with the compassionate, caring Illinois Pain Institute team. For more information about back pain or the Illinois Pain Institute, visit www.illinoispain.com, call 847.289.8822, and follow ‘illinoispain’ on twitter and facebook.
Dysautonomia is a rather fancy medical term that refers to the autonomic nervous system (ANS). This is the unconscious or automatic part of the nervous system that regulates almost all the working parts of the body such as your heart rate, breathing, blood pressure, digestive system, temperature, and the way you sleep and wake up. The ANS has two components, the sympathetic and parasympathetic nervous systems. Without getting into too much detail, the sympathetic nervous (SNS) system tends to speed things up while the parasympathetic nervous system (PNS) tends to slow things down. For example, the SNS will increase your heart rate and blood pressure while the PNS will do the opposite – it will lower your heart rate and decrease your blood pressure. As another example, inappropriately regulated blood flow triggers nausea and abnormal bowel motility resulting in constipation or diarrhea.
Some people with Fibromyalgia Syndrome (FMS) may notice they tend to develop hives more frequently than other people. Hives is medically known as urticaria. Urticaria comes from the Latin word, "urere," which means, “to burn.” Usually, it’s a kind of skin rash that has a pale, itchy, red, raised area of the skin that usually has bumps. Hives is frequently caused by allergic reactions.
Cognitive abnormalities, colloquially known as “fibro fog” are another chief complaint of patients with fibromyalgia syndrome (FMS). The new term making its way into the FMS literature is “dyscognition,”which refers to both the experiences related by patients as well as measureable observations made by researchers. In two surveys, one by the National Fibromyalgia Association in 2006 and the second by the German Fibromyalgia Association in 2007, concentration related symptoms were rated the 5th most troublesome symptom, after pain, sleep, fatigue, and stiffness.
Before we talk about sleep and fibromyalgia syndrome (FMS) it is probably helpful to understand just how sleep researchers study sleep. People toss around terms like “REM” and “NREM” sleep and “alpha rhythms” but this really doesn’t give someone an understanding of the complexity of sleep cycles.
There are few words to describe the fatigue that often accompanies fibromyalgia syndrome (FMS). Many people will describe it as more disabling than pain.
There will be several short reports on this web site about pain in fibromyalgia syndrome (FMS): how the nervous system handles pain; how people with FMS have nervous systems that have changed because of the pain, and; especially how pain physicians can treat the pain of FMS. We’ll start off with a general discussion of the characteristics of FMS pain.
As a standard disclaimer, we always insist that you maintain contact with a medical care provider that is trained and qualified to diagnose and treat medical and painful disorders. We encourage an ongoing rapport with a physician to maintain continuity of care, which will enhance outcome and minimize complications. Under no circumstances should the advice on this website or by anyone within the Fibromyalgia.com community be followed without first discussing it with a qualified physician.