Dr. Zafirides Fibromyalgia Is Not All In Your Head? (Study)

Hi Everyone,

I thought you'd be interested in the latest scientific discovery with regards to fibromyalgia. This study was published in the journal, Pain Medicine. This was the actual headline of the article. We'll see where this finding leads...

Just FYI.

Kindly,
Dr. Z

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Fibromyalgia Is Not All In Your Head, New Research Confirms

(Researchers discover a rational biological source of pain in the skin of patients with fibromyalgia)


Fibromyalgia, a painful condition affecting approximately 10 million people in the U.S., is not imaginary after all, as some doctors have believed. A discovery, published this month in PAIN MEDICINE (the journal of the American Academy of Pain Medicine), clearly now demonstrates that fibromyalgia may have a rational biological basis located in the skin.

Fibromyalgia is a severely debilitating affliction characterized by widespread deep tissue pain, tenderness in the hands and feet, fatigue, sleep disorders, and cognitive decline. However, routine testing has been largely unable to detect a biological basis for fibromyalgia, and standard diagnosis is based upon subjective patient pain ratings, further raising questions about the true nature of the disease. For many years, the disorder was believed to be psychosomatic (“in the head”) and often attributed to patients’ imagination or even faking illness. Currently approved therapeutics that provide at least partial relief to some fibromyalgia patients are thought to act solely within the brain where imaging techniques have detected hyperactivity of unknown origin referred to as “central sensitization.” However, an underlying cause has not been determined, leaving many physicians still in doubt about the true origins or even the existence of the disorder.

Now, a breakthrough discovery by scientists at Integrated Tissue Dynamics LLC (Intidyn), as part of a fibromyalgia study based at Albany Medical College, has provided a biological rationale for this enigmatic disease. The small biotechnology research company, founded by neuroscientists Dr. Frank L. Rice and Dr. Phillip J. Albrecht, reports on a unique peripheral neurovascular pathology consistently present in the skin of female fibromyalgia patients which may be a driving source of the reported symptoms.

“Instead of being in the brain, the pathology consists of excessive sensory nerve fibers around specialized blood vessel structures located in the palms of the hands,” said Dr. Rice, President of Intidyn and the senior researcher on the study. “This discovery provides concrete evidence of a fibromyalgia-specific pathology which can now be used for diagnosing the disease, and as a novel starting point for developing more effective therapeutics.”

Nerve Endings Come In Many Forms

Three years ago, Intidyn scientists published the discovery of an unknown nervous system function among the blood vessels in the skin in the journal PAIN.

As Dr. Rice explained, “we analyzed the skin of a particularly interesting patient who lacked all the numerous varieties of sensory nerve endings in the skin that supposedly accounted for our highly sensitive and richly nuanced sense of touch. Interestingly however, this patient had surprisingly normal function in day to day tasks. But, the only sensory endings we detected in his skin were those around the blood vessels”. Dr. Rice continued, “We previously thought that these nerve endings were only involved in regulating blood flow at a subconscious level, yet here we had evidencs that the blood vessel endings could also contribute to our conscious sense of touch… and also pain.”

Now, in collaboration with renowned Albany Medical Center neurologist and pain specialist Dr. Charles E. Argoff, the study primary investigator, and his collaborators Dr. James Wymer also at Albany Medical College and Dr. James Storey of Upstate Clinical Research Associates in Albany, NY, clinical research proposals were funded by Forest Laboratories and Eli Lilly. Both pharmaceutical companies have developed FDA-approved medications with similar functions (Serotonin/Norepinephrine Reuptake Inhibitors, SNRI) that provide at least some degree of relief for many fibromyalgia patients.

“Knowing how these drugs were supposed to work on molecules in the brain,” Dr. Albrecht added, “we had evidence that similar molecules were involved in the function of nerve endings on the blood vessels. Therefore, we hypothesized that fibromyalgia might involve a pathology in that location”. As the results demonstrate, they were correct.

To analyze the nerve endings, Drs. Rice, Albrecht, and postdoctoral researcher Dr. Quanzhi Hou, used their unique microscopic technology to study small skin biopsies (less than half the size of a pencil eraser) collected from the palms of fibromyalgia patients, who were being diagnosed and treated by Drs. Argoff, Wymer, and Storey. The study was limited to women, who have over twice the occurrence of fibromyalgia than men. What the team uncovered was an enormous increase in sensory nerve fibers at specific sites within the blood vessels of the skin. These critical sites are tiny muscular valves, called arteriole-venule (AV) shunts, which form a direct connection between arterioles and venules (see diagram).

As Dr. Rice describes their function, “We are all taught that oxygenated blood flows from arterioles to capillaries, which then convey the deoxygenated blood to the venules. The AV shunts in the hand are unique in that they create a bypass of the capillary bed for the major purpose of regulating body temperature.”

A Thermostat for the Skin

In humans, these types of shunts are unique to the palms of our hands and soles of our feet which work like the radiator in a car. Under warm conditions, the shunts close down to force blood into the capillaries at the surface of the skin in order to radiate heat from the body, and our hands get sweaty. Under cold conditions, the shunts open wide allowing blood to bypass the capillaries in order to conserve heat, and our hands get cold and put on gloves.

According to Dr. Albrecht, “the excess sensory innervation may itself explain why fibromyalgia patients typically have especially tender and painful hands. But, in addition, since the sensory fibers are responsible for opening the shunts, they would become particularly active under cold conditions, which are generally very bothersome to fibromyalgia patients.“

A role in regulating blood flow throughout the body.

Although they are mostly limited to the hands and feet, the shunts likely have another important function which could account for the widespread deep pain, achiness, and fatigue that occurs in fibromyalgia patients.

“In addition to involvement in temperature regulation, an enormous proportion of our blood flow normally goes to our hands and feet. Far more than is needed for their metabolism” noted Dr. Rice. “As such, the hands and the feet act as a reservoir from which blood flow can be diverted to other tissues of the body, such as muscles when we begin to exercise. Therefore, the pathology discovered among these shunts in the hands could be interfering with blood flow to the muscles throughout the body. This mismanaged blood flow could be the source of muscular pain and achiness, and the sense of fatigue which are thought to be due to a build-up of lactic acid and low levels of inflammation fibromyalgia patients. This, in turn, could contribute to the hyperactvity in the brain.”

Dr. Albrecht also points out that alterations of normal blood flow may underlie other fibromyalgia symptoms, such as non-restful sleep or cognitive dysfunctions. “The data do appear to fit with other published evidence demonstrating blood flow alterations to higher brain centers and the cerebral cortex of fibromyalgia patients” he stated.

Senior Research Chair of the Alan Edwards Center for Pain Research at McGill University, Dr. Gary Bennett, commented after seeing the results that “It is exciting that something has finally been found. We can hope that this new finding will lead to new treatments for fibromyalgia patients who now receive little or no relief from any medicine.”

This discovery of a distinct tissue pathology demonstrates that fibromyalgia is not “all in your head”, which should provide an enormous relief to fibromyalgia patients, while changing the clinical opinion of the disease and guiding future approaches for successful treatments.

 

I have been, in the past, diagnosed with Fibromyalgia. However, I strongly believe that, although it is highly possible that alterations in blood flow (and oxygen) likely happen in this ailment, the source of the problem is psychological. Medical Science, especially Big Pharma, is at their old tricks again, TREATING SYMPTOMS, NOT CAUSES. We certainly know that TMS causes real pain, so of course alterations in blood flow to muscles and nerves definitely happen and can probably be detected. However, the real, underlying cause of this ailment involves psychological factors. It also seems like most people with Fibro have a very similar psychological profile.

I am not completely cured of it, but I am working on it via the psychological approach and I have experienced a lot of progress and freedom from pain. I had it really bad, was able to make major progress toward recovery and I think others could too if medical science will just get with the program. I really don't like to see this sort of thing because this represents, to me, a giant NOCEBO.

 

Oh and another thing. I have detected, in myself, the sort of hyperactivity described in the article. I believe this to be the hyper-sensitization that comes with psychological trauma, unresolved conflict and generally "bad nerves". I believe it to have psychological origins. I have been trying to work on myself. Unfortunately, my husband and I retired to Panama, so I have no hope of seeing a mental health professional here, so I am doing my best on my own, using books and the internet.

 

I met a waitress in the Sierra last summer who reported this sequence of events surrounding how she developed fibromyalgia: 5 years ago she was involved in a car crash where she broke her jaw, dislocated her shoulder and fractured 3 ribs. Okay, after six months to a year she was all healed up. Then, 2 years ago she had an acrimonious breakup and divorce from a very controlling naval officer. Bango! Just after the divorce degree became final, she had an overwhelming attack of fibromyalgia. Later, as her ego mended and her sense of self-esteem came back, her fibro symptoms lessened and gradually went away.

This whole sequence sounds very much as if it followed the classic two trauma sequence that Peter Levine describes in Waking the Tiger. To grossly oversimplify the process, the physical pain of the first trauma (the car wreck) was re-triggered later on by the emotional trauma of the divorce, which resulted in a bout of fibromyalgia that luckily enough she was able to overcome on her own by rebuilding her shattered personality. The pathologies in the hands of fibro patients discovered by the studies underwritten by Forest Laboratories and Eli Lily are probably there. But are they the ultimate prime cause of the pain or only byproducts of the psycho-dynamics of trauma? Still sounds like a symptomatic cure that ignores the underlying psychological conditioning behind the appearance of a patient's fibromyalgia. Sure, take a pill and reduce the fibro pain. But if you don't address the underlying psychological issues it will just manifest somewhere else and with a different set of symptoms. I've just seen too many cases where an operation on a knee leads to an operation on a shoulder followed by total hip replacement surgery as TMS symptoms continue to migrate around the patient's body in an effort to express underlying unresolved psychological conflicts.

This sounds a whole lot like the same line of reasoning that blames lower lumbar pain or ulcers on a bacteria present in the lower spines of back patients or another bacteria present in the stomach lining of ulcer patients. In classical logic, you'd say that an epiphenomenon (the bacteria) is being mistaken for the prime cause of the condition (ulcer, fibro, back pain etc. etc.). It sounds to me as if it's just another way of evading the conclusion that emotional and mental states can change the biochemistry of both the body and the mind. One item of extreme interest in the case of those bacteria is that they are ubiquitous in all human beings. So what is it that causes them to "act up" and cause back pain or ulcers? Answer: States of consciousness caused by emotions.

 

Exactly right, Bruce, well put.

 

Interesting points Forest!

 

"deep tissue ischemia". That says it all, Forest!

 

Forest,


I thought the same thing as you when I read the article. This study certainly points to thinking in line with Dr. Sarno's original assertion with TMS - namely, that emotions lead to decreased blood flow that leads to pain.

I absolutely believe in TMS/PPD. I was cured of my back pain back in 2000-2001 thanks to Dr. Sarno and Dr. Schectder.

Despite our loyalties and beliefs, I think we have to consider all the research on pain and make a thoughtful choice as to whether the information merits further consideration.

I do like the fact it has generated some meaningful discussion, though. Great points all around!!

-Peter

 

I agree with Forest & Peter Zafirides. It really looks this study is confirming the Sarno ideas. It gives a physical link between the function of blood flow alteration causing pain and the proliferation of people with fibromyalgia. It would be interesting to see if there is a correlation with other forms of TMS - people with unexplained migraine - or unexplained pain in just one part of the body. I hope those scientists have got plenty of time to follow all this up...

 

Ha! It is about time we hear back from Dr. Z. I had a feeling he posted it tongue-in cheek!!

Excellent post Forest, really spells it out. I also thought that the ischemia findings were interesting. I think Dr. Sarno hit the nail right on the head! Brilliant!!