Understanding Fibromyalgia & Central Sensitivity Syndromes

Recognizing Physiological Features, Changing Approach to Treatment

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An editorial review on central sensitivity syndromes (CSS) contains a lot of statements that those of us with fibromyalgia (FMS), chronic fatigue syndrome (ME/CFS), and related conditions love to hear. It's one you want to make sure all of your health-care providers have seen.

The review was authored by Muhammed B. Yunus, MD, a rheumatology professor at the University of Illinois, who's been associated with fibromyalgia research for more than 30 years.

CSS is an umbrella term that includes FMS/ME/CFS sister conditions such as irritable bowel syndrome, restless legs syndrome, and multiple chemical sensitivity – all of which share a certain amount of skepticism and stigma in the medical community. However, osteoarthritis and rheumatoid arthritis also involve pain from central sensitization, and they are far more accepted both in medicine and the general population.

All of these conditions are believed to involve central sensitization, which means that the central nervous system is hyper-sensitive to stimuli. It's important to note that it's the body that overreacts to things, not the person.

Physiological Features

Dr. Yunus points out several physiological features that are present in some CSS, including:

He emphasizes that central sensitization must be approached differently from structural pain. For example, anti-inflammatory drugs and joint replacements don't make the nervous system less sensitive, even though they may reduce or eliminate physical damage.

Approach to Treatment

Dr. Yunus cites advances in neuroimaging of pain, both provoked pain and pain while you're at rest, that may eventually help doctors better target treatments to the individual patient. (So far, the types of neuroimaging he describes are only used in research, not clinical practice.)  We've long known that we all need an individualized approach, but new brain-imaging techniques may provide a better guide than doctors have now.

Now for some of his statements that could make you cheer:

  1. The division between whats considered "functional" and "structural" pain should be abandoned because many of us have both. This means not treating symptoms caused by neuro chemistry as if they're psychological and therefore somehow less deserving of treatment than pain caused by damage to bones, joints, muscles and connective tissues.
  2. Psychobiology is also biology. This echoes the previous point, emphasizing that physiological factors are still physiological, even when they alter mood or behavior instead of something physical.
  3. Patient-blaming terms such as somatization, somatizer, and catastrophization should be avoided. The first two terms mean that physical symptoms are caused by psychological factors and the third essentially means the patient is making too big a deal of things. They have often been applied to people with FMS, ME/CFS and other illnesses of this type and have led some to be denied treatment, deemed ineligible for disability benefits, and even ridiculed and scorned by health-care workers.

    These are issues CSS patients have battled for decades. This review isn't likely to wipe them out, but it could influence attitudes and approaches of the people we depend on for proper treatment.

    The Importance of Spreading Information

    So much misinformation has been circulated about these illnesses – in the medical community, by media outlets, and by uninformed people – that it's important for us to share fact-based information like this review. If your health team isn't well informed, they need to see it. If your friends or family are skeptical, they need to see it. If you know someone with one or more of these conditions who doubts their own illness, they need to see it. A link to the abstract is sourced at the end of this article.

    We have more than enough evidence to say that our symptoms are real and are linked to abnormal physiology. Many health-care workers now understand this, but not all of them do. It's time for them to stop blaming and discounting us and focus instead on how to make us better.

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