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Fibromyalgia Is Not All In Your Head (Study)

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[quote][i]Originally posted by Dr. Zafirides[/i]
[br]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

------

[b] [size=3]Fibromyalgia Is Not All In Your Head, New Research Confirms [/size=3] [/b]

(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.�

[b]Nerve Endings Come In Many Forms[/b]

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.�

[b]A Thermostat for the Skin [/b]

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.�

[b]A role in regulating blood flow throughout the body.[/b]

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.
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Dr. Zafirides	Posted - 06/18/2013 : 21:59:34 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 ------ 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.
18 L A T E S T R E P L I E S (Newest First)
Peregrinus	Posted - 06/23/2013 : 07:22:37 quote: Originally posted by Dr. Zafirides I am more skeptical than you give me credit, my man. I will reject any - and every - theory that is meaningfully explained (and proven) by a better theory. NO theory, NO law is irrefutable. Isaac Newton knows this very well. -Dr. Z Dr. Z: As I recall the principle finding of the study were based on a qualitative assessment of a small tissue sample by a graduate student. Enough said. By the way, Isaac Newton, inventor of mathematical analysis, did not propose a �theory of gravitation� and in fact lamented that he was unable to do so. He proposed a mathematical model for gravitational force.
NextAdventure	Posted - 06/23/2013 : 06:41:34 My wife had her severe Raynaud's syndrome cured with biofeedback and meditation. At one point she had to wear gloves to take items out of the refrigerator and 70 degrees was painful When the body is stressed it reduces peripheral circulation
Dr. Zafirides	Posted - 06/22/2013 : 20:49:10 quote: Originally posted by pspa123 It is unlikely the prevailing approach will change, not only because most doctors are trained to think in a certain way and there is so much money in drugs, but also because patients in general strongly resent psychological explanations for their symptoms, as though it delegitimizes them. One sees this over and over on the CFS boards. I see it in treating TMS patients, pspa. The hardest thing in getting people better is to have them TRULY believe that a psychological basis for pain is both valid and not a measure of weakness. They can intellectually understand it and claim that they "believe" it, but they still go back to their doctors and get Medrol dose packs and trigger point injections. It can really be a challenge at times. -Dr. Z
Dr. Zafirides	Posted - 06/22/2013 : 20:46:10 quote: Originally posted by Peregrinus Dr. Z: Establishing a physical cause for fibromyalgia would be welcomed by the medical and drug industries. Such a discovery would mean more paitients, more drug sales, more doctor visits, more MRIs, etc. Now guess who funded the present study and who provided the convoluted interpretation of the results. Dr. Z, you should be more skeptical of your chosen field of endeavour: we don't want to hear that you are going to have an operation for spinal stenosis. Peregrinus, I appreciate your thoughts. I really do. But I think we have to look at all of the pain research. To automatically reject its validity because it suggests a non-TMS basis is essentially doing what the medical community has done to Sarno and TMS. They have rejected without as much as trying to understand it. We are all passionate about TMS, but we cannot allow our emotions to not objectively looking at the data and coming to a conclusion. If we truly believe in science and the scientific method, we must be willing to reject all previous theories - even TMS - if a more compelling and replicable understanding arises. This study shouldn't be so threatening.If anything, I was encourage by the conclusions that pain was thought to arise due to deep tissue ischemia. That is exactly what Sarno had said 4 decades before this study! I am more skeptical than you give me credit, my man. I will reject any - and every - theory that is meaningfully explained (and proven) by a better theory. NO theory, NO law is irrefutable. Isaac Newton knows this very well. -Dr. Z
Birdie78	Posted - 06/20/2013 : 00:57:42 Back2-it, great example with the Raynaud Syndrome! Kind regards from Germany sends Birdie
Back2-It	Posted - 06/19/2013 : 22:04:47 I offer Raynaud's syndrome, with vascular changes to the fingers and toes. What is the cause? Not known. In fact, I had this myself, until its minor symptoms were displaced by the extreme fear of the disk herniation and pain of unknown origin. Once I was occupied with "the Big One", the Raynaud's disappeared. I have known several Fibro patients, and they exhibit very typical symptoms of stress and fear of the fear of the pain. While interesting, I think it will continue to keep those who are searching for a pathology fixated on waiting for the cure for the pathogen, which exists, in my opinion, because of the cause of all pain: the brain. Meanwhile, their fear of the fear continues, as well as the symptoms. "Bridges Freeze Before Roads"
pspa123	Posted - 06/19/2013 : 20:12:32 It is unlikely the prevailing approach will change, not only because most doctors are trained to think in a certain way and there is so much money in drugs, but also because patients in general strongly resent psychological explanations for their symptoms, as though it delegitimizes them. One sees this over and over on the CFS boards.
chickenbone	Posted - 06/19/2013 : 20:03:31 I agree with all of the above. I think that medical science and Big Pharma is again confusing symptoms with causes. The symptoms of Fibromyalgia are physical, but the cause is psychological. When will they get with the program???
NextAdventure	Posted - 06/19/2013 : 13:21:17 Yes Campylobacter bacteria can be the cause of stomach ulcers but only if their immune system is compromised. We all have the bacteria in out guts but only when stress and the immune system allow the mucosal barrier to break down do we get ulcers. Similarly the dreaded MERSA lives in all our noses but causes no problem unless the immune system is compromised. My wife gets colds and I have not had more than 2 in 65 years. HOWEVER once the changes are structural we have moved out of the realm of TMS. Stress causes structural changes in the hippocampus and the HPA axis that control the tension and pain expressions.
jegol71	Posted - 06/19/2013 : 12:14:29 This feels like the "molecule du jour" once again. How is this any different from finding elevated levels of Substance-P? If it can be framed to propose that these physical changes occur, by way of a stress/TMS mechanism, then of course that's a great boon to the field. Unfortunately it's not the field they're studying.
Dave	Posted - 06/19/2013 : 11:59:02 It is sad that researchers still cannot make the leap that physiological changes can be caused by the brain, even if they are not "all in your head." In fact these findings support Dr. Sarno's theory about oxygen deprivation. Yet, focus is on fixing the physiological changes with drugs rather than finding out what causes them in the first place. No doubt those who are looking for the cause will eventually find something under a microscope to blame, and we'll be even further from the acceptance that fibromyalgia is a psychologically based disorder. Oh well, maybe one day they'll get it right . . .
tennis tom	Posted - 06/19/2013 : 09:45:40 http://www.youtube.com/watch?v=N5rg39kz8bM Thanks Dr. Z, this is similar to the recent "scientific finding" about stomach ulcers, that they're caused by "bacteria" and NOT TMS/psychosomatic.
art	Posted - 06/19/2013 : 09:27:41 quote: Originally posted by NextAdventure The smoking gun is that fibro is comorbid with many other stress conditions: IBS � TMJ � CFS � dermatology symptoms � pelvic floor muscle dysfunction � anxiety � panic � PTSD. We know without question that people who grow up in stressful or overprotective families have permanently altered brains. The glutamate system is hair triggered which can overwhelm the GABA system that controls pain....and one you alter these two neurotransmitters the whole symphony changes. More simply put we are not as stress hardy as a person who grew up in an emotionally stable environment and allostatic load can more easily create physical expressions of stress. Here�s where the line gets fuzzy. Stress can and does cause changes in the body, including disease processes. Originating in the mind arguably, but no longer just �of� the mind. That�s an entirely different situation.
shawnsmith	Posted - 06/19/2013 : 09:19:30 The only f word we should be permitted to use on this forum is "f---k." ************************* �Living up to an image that you have of yourself or that other people have of you is inauthentic living � another unconscious role the ego�plays.� -- Ekhart Tolle
NextAdventure	Posted - 06/19/2013 : 07:04:22 The smoking gun is that fibro is comorbid with many other stress conditions: IBS � TMJ � CFS � dermatology symptoms � pelvic floor muscle dysfunction � anxiety � panic � PTSD. We know without question that people who grow up in stressful or overprotective families have permanently altered brains. The glutamate system is hair triggered which can overwhelm the GABA system that controls pain....and one you alter these two neurotransmitters the whole symphony changes. More simply put we are not as stress hardy as a person who grew up in an emotionally stable environment and allostatic load can more easily create physical expressions of stress.
Peregrinus	Posted - 06/19/2013 : 04:42:48 Dr. Z: Establishing a physical cause for fibromyalgia would be welcomed by the medical and drug industries. Such a discovery would mean more paitients, more drug sales, more doctor visits, more MRIs, etc. Now guess who funded the present study and who provided the convoluted interpretation of the results. Dr. Z, you should be more skeptical of your chosen field of endeavour: we don't want to hear that you are going to have an operation for spinal stenosis.
Birdie78	Posted - 06/19/2013 : 01:36:56 I never had any doubts that there occur changes in the structure of the tissues with fibromyalgia. Newest research at the university Wuerzburg (Germany) showed "damages" in the small nerve fibres in fibro-patients. BUT these remains (in my opinion) still the result. the cause is the brain which produces chemical changes and oxigen deprivation due to emotional factors/stress (didn't Dr. James A. mention in his book that the nerves are probably the tissue being most sensitive and "vulnerable" to oxygen deprivation.)? I find it devastating that now, when the fibro officially is "not only in the patients head", they try to fix it with lots of research creating a new wonder-drug (at least that was the tenor of the new findings published in Wuerzburg). And as we have seen on this forum - even if there may be some changes in the body - it's a reversible condition IF treated in the right way (and that means that "only" taking some ADs, exercicing a little bit and try to reduce the stress level may be not enough for a total cure, one really has to work on the emotional- and stressissues on a very deep lewel, knowing that there lie the main roots of this syndrome). And of course this will for most people take some time as fibro can be seen as a more severe form of TMS affecting the whole system. Kind regards from Germany sends Birdie
bryan3000	Posted - 06/18/2013 : 23:12:24 Interesting, but this sounds very downstream to me. The same way the old "chemical imbalance" theory came... and then went. If someone doesn't sleep well, their body is affected drastically, I would assume. (for instance.) Brain specs show heightened activity in anxiety patients. But, of course why wouldn't they. Hopefully this helps someone, like Dr. Z said. But, I don't think I've ever read a story of a normal, adjusted, non-anxious or depressed person having Fibro. In fact, it seems an overwhelming number are abuse victims of varying sorts. Seems a bit too coincidental.

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