Cause of the Effect
This is one of the most searched questions about fibromyalgia. How did I get this? The short answer is you didn't get anything. Fibro is a syndrome, a collection of problems, it is not a disease state. It is a diagnosis, but maybe not that either. The internet is replete with declaratives about what fibro really is and a fix at the ready.
Here's a few.
Microtrauma, sensitized nerves (whatever that is), infection (many variations), leaky gut, thyroid imbalance, hormone imbalance, chemical imbalance (make one up), and on and on. I actually believe in a sensitized central nervous system and I published a book about it many years ago. Pain Bugs. It made sense that fibro was a complex interaction between the brain and the peripheral tissues – inside out, not outside in. I thought a certain exposure to a trigger (bug) started a cascade of central nervous system events culminating in an irritable central nervous system and manifesting peripheral events throughout. Enter fibro five. This theme will come up again.
There actually is some. Fibromyalgia yields a very characteristic footprint on a functional MRI scan of the brain. Fibro symptoms are significantly diminished when a drug called ketamine is used. Ketamine is an interesting agent and will be discussed after a few words. Coming.
Years of literature suggest only one real conclusion. A cause is yet to be found. Hints and cues, theory and suggestion. The most widely promoted cause to date is "irritable nerves" leading to "widespread pain" –"talk it over with your doctor." Discuss a receiver unknown with the uninterested. The real answers remain elusive. Start with what caused the irritated nerve. Once again, peripheral event(s) manifested by a central nervous system problem. Let's find the problem. Here are some ideas ...
Neurobiology - Not the Scary Stuff
Neuro - nerves, nervous tissues, nervous system.
Biology - the interrelationship of action at a target site or system.
The nervous system consists of nerves, spinal cord (nerves), sub-brain (more nerves) and brain. Yes, they're all nerves. It also consists of surrounding structures and fluid to make it work. Within the nerves, spinal cord and brain exist with pathways and partitions that are being studied and discussed at our ever accelerated rate of understanding. Read something 10 years old, and it's dated, obsolete, or rewarded. Technology has enabled interested researchers and teachers advice for the receivers benefit. Include fibromyalgia as a recipient of this positive knowledge momentum. Note the word knowledge, not cure. The micro environments of the brain will inevitably yield answers how we better manage fibromyalgia and it's parts. I doubt it will be a targeted drug, but maybe. More likely fibromyalgia symptoms will improve when we fracture the crosstalk between the Fibro 5 that promotes decline in function and quality of life. Pain relief should follow.
The Rat's Brain
Like it or not, we have a lot in common with rats. Researchers that work with rats will tell you, they are very smart, and nice. And their brain looks like ours (at least certain parts). Take a sagittal section of the rat brain, and look at our primitive section (the old part of our brain behind the ears) and we have a very close look and feel. This is why we torment our friendly rodents. They yield a tremendous wealth of useful bench services for science. They are treated ethically and humanely, and I thank them all. Rats help us develop drugs and all sorts of health system responses and reactions - good and bad. Here's how I see our friends help us with fibromyalgia.
The primitive part of our brain behind the ear, with it's inner relationship to the paleospinothalamic, neospinothalamic (newer) part of the spinal cord system, is that pain has a way of talking to us. I said, "Pain is talking to us, and not our nervous system." With fibromyalgia an overactive nervous system is suspected. What is an overactive nervous system? Makes no sense. What makes sense is the fact that you have a perception of pain. As we stated in the five rules, pain is a perception, it is a description, it is not a real entity. It can't be seen, felt, touched, or measured, it is a described sensation. Therefore widespread pain, is a description. It is not necessarily an entity. So where are we going with this?
Where we're going is to, hopefully, a better chance of improving function and quality of life. This starts with a progressive understanding of what fibromyalgia is and we turn to our friends that have taught us so much, the rat.
The rats have shown us that there's certain types of problems that are enhanced when we either reward or disincentivize the primitive part of the brain. We know of a reward circuitry, and the rat has shown us in well-developed studies that good things get more. In other words, if the rat is rewarded with a chemical, such as morphine or cocaine, by pressing a bar, it will continue to press the bar. There is a point where there is extinction. The rat quits pressing the bar because the reward isn't worth it. For morphine, it's one in whatever, with cocaine,it's never. The rat will continue to press the bar until it dies. So the rat has taught us that getting to our best place, our best feeling, our best position, is dependent on a circumstance, and in this case a chemical. This is where we are at with fibromyalgia. Certain things make us feel better and worse, and it is all driven by reinforcement of the positive. Think of it that way, the more you get active, the better you feel, and therefore the more you want to continue to do. Sounds simple, but let me put it another way. You heard it here first.
As I don't want to get too far into the weeds, a process that enhances what we'll call synaptogenesis, or development of certain parts of the brain, raises BDNF, brain-derived neurotrophic factor. As that rises, mood is enhanced. When mood is enhanced, the brain operates better. It has more numerous connections to the positive, and less to the negative. Those with chronic disease states, such as Alzheimer's, diabetes, obesity, and yes, fibromyalgia, have decreased connection between nerve cells and less available BDNF. As we increase our activity, BDNF rises. So what we call runner's high (after exercise, people just feel better) is not because of enkephalins or dynorphins, the commonly perceived opioids that live inside of you, it is because of enhanced BDNF, and therefore improving mood. We can actually see increases in brain size when we increase BDNF, and decreases in brain size as disease processes progress. So I can block enkephalins and dynorphins- these naturally occurring painkikillers (endogenous enkephalins) and
is commonly discussed- and misunderstood. BDNF improves brain health. It is therefore, our friend the rat that has taught us the more we do, the more we can do. Stay active, stay engaged, entertain a hobby and socialize. These are all things that help fibromyalgia, and are a direct reflection of strong science to support this.
Fibromyalgia is not fibro-junk. It is a very real condition. Studies that go back years and years have shown us a drug called ketamine, diminished the fibromyalgia symptoms. Guess what ketamine also does? It rapidly increases brain neurotrophic factor (BDNF), to the tune of 12 to 24 hours, enhancing mood and quality of life indices. We will continue to beat down this path, as I know it is a difficult one to grasp and requires more than one sessions of interpreting this diatribe to best understand it. We are aware of this, but it is so important. This is not fibro-junk, this is real. This is stuff that we don't find by scouring the internet. What most people don't realize when they go to major websites is that hired writers are producing much of the pages, and not necessarily medical professionals, or those in the know. Don't be skeptical, but again, verify.
Title: Peaceful Command and the Special Senses
Primitive part of our brain has circuitry and is like a highway.
This is the cross-sectional sagittal part of the brain behind the ear. Information is fed by the spinal cord, through the limbic system, processed, and fed to this highway. Once the primitive brain is done processing information, it is sent to higher-functioning brain areas that think, interpret, react, respond. The brain reacts to defined chemicals when the chemical finds a receptor. Depending where, the chemical stimulus initiates a specific response, and in effect your fence needs more white paint. A paintbrush (receptor) takes paint from a bucket, and with a few strokes effects a response to the appearance of the fence, interpreted by our eye. In the brain, dopamine (paint), lands a receptor (paintbrush), effects a change at the cellular level (prompts a transcription), and the fence is now refreshed with white (desired result). Repeat ... until the bucket runs dry. No transcription, no event. The system is disrupted. Normal processing is interrupted in peaceful control erodes rapidly.
The special senses emerge in the from of emotion, pain, loss and craving for normalcy. The commonality of pain, addiction, and oppression is realized. PAD (pain, addiction and depression), suggests that the phylogenetically older parts of the brain are vitally important to knowledge, a starting point to effect change in the fibro five. There are many receptors, and neurotransmitters, and they're all important for peaceful command to dominate. Here exists CB1, CB2, cannabinoid receptors, and others. Right, marijuana has entered the discussion and to be continued.
Are We Treating One Drug For Another?
It is not treating one drug for another, as commonly believed. Buprenorphine transforms lives, and the data is there. Those incarcerated that use, heroin most commonly, lost their underlying tolerance. When released, they went back to their "regular" dose. No tolerance, overdose, death. Get them buprenorphine, get them back into society.
Craving controlled, and desired substances, is a return to heroin, and should be extinguished. Another study separated opioid addicts into two groups in treatment. Both had good psychosocial support. One group was treated without buprenorphine, but also had receieved outpatient therapy, and they went head to head without patient support therapy and buprenorphine. Result - buprenorphine-free group started dropping out in a week. Their tolerance was diminished or gone. All dropped out eventually. The buprenorphine group however stayed in treatment. And this robust trend occurred over a year. With no way to prevent cravings, the group that receieved outpatient therapy developed and only thought of "heroin" and is a lesson. If plan A doesn't work and is a failure, cross over quickly, particularly in the world of addiction. The buprenorphine-free group had four deaths when they left. The message is this. With pharmaceuticals, forces of reason don't always match need.
The federal government acknowledges a severe opioid epidemic (it's really a fentanyl heroin epidemic, the prescription pill problem is that, but look at fentanyl heroin). The claim that more people die from prescription drug overdoses than from car accidents is a fallacy of generalization. More on this later. A healthcare provider can write (prescribe) and historically encourage too, indefinite doses of opioids. On the other side of treating this self-defined epidemic, physicians are limited to a small number of patients that may rec lifesaving buprenorphine, and must be approved to do so. A complete logic failure. Most prescription opioid addicts were prescribed by a provider with no pain training, and scant knowledge regarding opioid management. I believe that non-steroidal anti-inflammatory agents may eventually share a common fate. These drugs are taken from our armamentaria because the fallacy of false generalization, once again, is reinforced by bad information.