Fibromyalgia, how the brain intensifies pain

Maladie who was able to reconnect in France, fibromyalgia was honored in the healthy emission of Figaro Live «Toc Toc Docteur».

The  Fibromyalgia  is manifested by  widespread pain , including muscle (some abnormally painful specifics under moderate pressure have been identified), which extend for months or years (chronic pain) and are associated with severe fatigue, impaired sleep, and often other symptoms such as mood disorders (anxiety, depression). Although fibromyalgia has been included in the WHO International Classification of Diseases since 1992, France has always refused to consider it as such, without denying  the existence of a syndrome  (set of symptoms).

The difficulty is that there is no  indisputable examination to affirm  the diagnosis of fibromyalgia  and that the cause of its appearance is unknown. This complicates the recognition of the suffering of the sick, especially in the world of work. Moreover, the examinations (radiology, blood tests, etc.) that are carried out are not made to make the diagnosis of fibromyalgia but to rule out other pathologies requiring specific treatment. the discovery of another pathology can sometimes explain the symptoms but it can also be simply associated.

Fibromyalgia is still a diagnosis by default, when nothing else is found, which seems very reductive today since researchers, imaging support, have highlighted disturbances in the brain modulation of the brain. pain that explains the symptoms. Current expertise at the National Institute of Health and Medical Research (Inserm) on fibromyalgia should allow to see more clearly. The conclusions are expected mid 2018. Why is it complicated?

The pain is invisible

The pain, everyone knows what it is. However, for science, this remains a complex notion. Pain is above all a personal experience with an affective and cognitive dimension (memory, concentration, attention) for which there is no indisputable marker. It has been thought possible to turn to  modern brain imaging  (functional MRI and other Pet-Scan), to “see from the outside” the pain felt by an individual, but scientists have had to shrug off their claims. In fact, not all pain is visible in medical imaging and when it does, it is not felt in the same way by two people.

Nevertheless, the many studies conducted over the last twenty years thanks to brain imaging have confirmed what everyone knows intuitively: Context and its psychological impact can modulate pain in one direction and the other. Neuroscientists speak of ascending nerve pathways, for the nociceptive signal that goes up from a place of the body maltreated (by a painful stimulus), and of descending routes for those who leave the brain (thoughts, emotions, memory etc.) to come modulate pain. As if the two impulses met to decide the intensity and the more or less unpleasant character of the sensory message sent by the body. That’s why, in a way, the pain really only exists in the brain.

The brain modulates pain

A modulation of the brain that can therefore amplify or attenuate the pain. To mitigate it, when one anticipates for example the benefits of a deep massage. Amplify it when you are suffering from chronic pain, as is the case in fibromyalgia. Moreover, even in the absence of any painful stimulus, areas of pain can be activated in the brain, in case of fibromyalgia. It is important to be careful because the pain has a very large effect on the brain, beyond these specific areas. Here again, it suffices to have trouble somewhere to know that the brain’s ability to mobilize on any task is seriously compromised.

What is interesting about this better understanding of brain modulation of pain is that it can be used for the benefit of the person who is suffering. Many non-drug therapies rely on the modulation of the brain circuits of pain, either based on physical relaxation or directly targeting the brain: cognitive behavioral therapies, emotional management. This last approach has just shown some very interesting results for fibromyalgia in an American study.

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