“Research shows that fibromyalgia has low credibility in healthcare, leading to poor treatment, lack of knowledge and disinterest from medical professionals.”[
This statement will come as no surprise to many fibromyalgia sufferers, who frequently feel as though they are being fobbed off by doctors, with scepticism and disregard for the seriousness of their illness. Considering that this condition affects up to 6.6% of the population, it is time that this changed.
Lack of Treatment Options Having finally been given a diagnosis to explain their symptoms of widespread pain, fatigue, brain fog, sleep disturbances and more, patients are then subjected to the news that there is no cure for this condition, and very few treatment options to relieve their suffering. A 2021 change to the NICE guidelines even means that painkilling medication is no longer routinely offered, further reducing the available help.
A New Approach Fibromyalgia is notoriously difficult to detect, with blood tests and other examinations often failing to show any abnormalities. However, advances in brain imaging led to the discovery that the areas of the brain responsible for processing sensory information from the body, including pain, were overactive in people with the condition[].
This is where Transcranial Magnetic Stimulation (TMS) comes in.
TMS has been used for over 20 years to treat a variety of mental health issues. It works by either stimulating or inhibiting specific regions of the brain, helping to return the activity levels of these areas back to normal[. At TMS London, they use this technology to target the overactive pain-processing region of people with fibromyalgia, and reduce this activity back to healthy levels, enabling them to help their patients to feel less pain, and have an improved quality of life[].
Non-invasive and Medication Free The best part about this new treatment; it requires no medication or anaesthetic, it is incredibly safe[5], and many of their patients even report the sessions to be relaxing and enjoyable. Their team of experts love nothing more than talking about all things TMS and fibromyalgia, so please get in contact with them if you would like to hear more about this revolutionary new approach.
The King’s-led study, in collaboration with University of Liverpool and the Karolinska Institute, shows that many of the symptoms in fibromyalgia syndrome are caused by antibodies increasing the activity of pain-sensing nerves
New research from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London, in collaboration with the University of Liverpool and the Karolinska Institute, has shown that many of the symptoms in fibromyalgia syndrome (FMS) are caused by antibodies that increase the activity of pain-sensing nerves throughout the body.
The results show that fibromyalgia is a disease of the immune system, rather than the currently held view that it originates in the brain.
The study, published today in the Journal of Clinical Investigation, demonstrates that the increased pain sensitivity, muscle weakness, reduced movement, and reduced number of small nerve-fibres in the skin that are typical of FMS, are all a consequence of patient antibodies.
The implications of this study are profound. Establishing that fibromyalgia is an autoimmune disorder will transform how we view the condition and should pave the way for more effective treatments for the millions of people affected. Our work has uncovered a whole new area of therapeutic options and should give real hope to fibromyalgia patients. Previous exploration of therapies has been hampered by our limited understanding of the illness. This should now change. Treatment for FMS is focussed on gentle aerobic exercises, as well as drug and psychological therapies designed to manage pain, although these have proven ineffective in most patients and have left behind an enormous unmet clinical need– Dr David Andersson, study primary investigator, King’s College London
The researchers injected mice with antibodies from people living with FMS and observed that the mice rapidly developed an increased sensitivity to pressure and cold, as well as displaying reduced movement grip strength. In contrast, mice that were injected with antibodies from healthy people were unaffected, demonstrating that patient antibodies cause, or at least are a major contributor to the disease.
Furthermore, the mice injected with fibromyalgia antibodies recovered after a few weeks, when antibodies had been cleared from their system. This finding strongly suggests that therapies which reduce antibody levels in patients are likely to be effective treatments. Such therapies are already available and are used to treat other disorders that are caused by autoantibodies.
Current estimates suggest that at least 1 in 40 people are affected by FMS worldwide (80% of which are women) and is commonly characterised by widespread pain throughout the body, as well as fatigue (often referred to as ‘fibro fog’) and emotional distress. It most commonly develops between the ages of 25 and 55, although children can also get it.
Dr Andreas Goebel, the study’s principle clinical investigator from the University of Liverpool said, “When I initiated this study in the UK, I expected that some fibromyalgia cases may be autoimmune. But David’s team have discovered pain-causing antibodies in each recruited patient. The results offer amazing hope that the invisible, devastating symptoms of fibromyalgia will become treatable.”
Professor Camilla Svensson, the study’s primary investigator from Karolinska Institute said, “Antibodies from people with FMS living in two different countries, the UK and Sweden, gave similar results, which adds enormous strength to our findings. The next step will be to identify what factors the symptom-inducing antibodies bind to. This will help us not only in terms of developing novel treatment strategies for FMS, but also of blood-based tests for diagnosis, which are missing today.
Fibromyalgia affects millions of people in the UK and can have a devastating impact on quality of life. It causes pain all over the body, fatigue, disturbed sleep and regular flare-ups where symptoms get even worse. Fibromyalgia is a particularly difficult condition to diagnose and manage because its causes are unknown. This research shows that antibodies found in human blood can cause fibromyalgia-like symptoms in mice, suggesting that these antibodies play a crucial role in the condition. Further research is needed but this offers hope to the millions of people with fibromyalgia that an effective treatment could be found in the relatively near future– Dr Craig Bullock, Research Discovery and Innovations Lead at Versus Arthritis
This study was possible thanks to funding from the Medical Research Council (UK), Versus Arthritis, the Liverpool Pain Relief Foundation, the Swedish Research Council, the Knut and Alice Wallenberg Foundation, a donation from the Lundblad Family for clinical pain research at Karolinska Institute, and other agencies.
The feeling of fatigueness, low mood, and trouble sleeping can be caused by many things. But when accompanied by widespread pain and tenderness, you may want to get tested for Fibromyalgia and treated accordingly. Find out what are the symptoms of Fibromyalgia, the cause, the diagnosis and the treatment of the condition in this 4 minutes animation.
People with fibromyalgia show variations in microbiome composition
Bacterial species which were found in greater quantities in individuals with fibromyalgia (left) versus species which were found in greater quantities in healthy individuals (right).CREDIT Dr. Amir Minerbi
Scientists have found a correlation between a disease involving chronic pain and alterations in the gut microbiome.
Fibromyalgia affects 2-4 percent of the population and has no known cure. Symptoms include fatigue, impaired sleep and cognitive difficulties, but the disease is most clearly characterized by widespread chronic pain. In a paper published today in the journal Pain, a Montreal-based research team has shown, for the first time, that there are alterations in the bacteria in the gastrointestinal tracts of people with fibromyalgia. Approximately 20 different species of bacteria were found in either greater or are lesser quantities in the microbiomes of participants suffering from the disease than in the healthy control group.
Greater presence or absence of certain species of bacteria
Human gut microbiome composition shows an enormous richness. Each circle represents a bacterial species, while the different colours mark different bacterial phyla. CREDIT Dr. Amir Minerbi
“We used a range of techniques, including Artificial Intelligence, to confirm that the changes we saw in the microbiomes of fibromyalgia patients were not caused by factors such as diet, medication, physical activity, age, and so on, which are known to affect the microbiome,” says Dr. Amir Minerbi, from the Alan Edwards Pain Management Unit at the McGill University Health Centre (MUHC), and first author on the paper. The team also included researchers from McGill University and Université de Montréal as well as others from the Research Institute of the MUHC.
Dr. Minerbi adds, “We found that fibromyalgia and the symptoms of fibromyalgia – pain, fatigue and cognitive difficulties – contribute more than any of the other factors to the variations we see in the microbiomes of those with the disease. We also saw that the severity of a patient’s symptoms was directly correlated with an increased presence or a more pronounced absence of certain bacteria – something which has never been reported before.”
Are bacteria simply the markers of the disease?
At this point, it’s not clear whether the changes in gut bacteria seen in patients with fibromyalgia are simply markers of the disease or whether they play a role in causing it. Because the disease involves a cluster of symptoms, and not simply pain, the next step in the research will be to investigate whether there are similar changes in the gut microbiome in other conditions involving chronic pain, such as lower back pain, headaches and neuropathic pain.
The researchers are also interested in exploring whether bacteria play a causal role in the development of pain and fibromyalgia. And whether their presence could, eventually, help in finding a cure, as well as speed up the process of diagnosis.
Confirming a diagnosis and next steps towards finding a cure
Fibromyalgia is a disease that has proved difficult to diagnose. Patients can wait as long as 4 to 5 years to get a final diagnosis. But this may be about to change.
“We sorted through large amounts of data, identifying 19 species that were either increased or decreased in individuals with fibromyalgia,” says Emmanuel Gonzalez, from the Canadian Center for Computational Genomics and the Department of Human Genetics at McGill University. “By using machine learning, our computer was able to make a diagnosis of fibromyalgia, based only on the composition of the microbiome, with an accuracy of 87 per cent. As we build on this first discovery with more research, we hope to improve upon this accuracy, potentially creating a step-change in diagnosis.”
Dr. Amir Minerbi, first author on the paper, along with his colleagues, have found a correlation between a disease involving chronic pain and alterations in the gut microbiome. CREDIT McGill University Health Centre
“People with fibromyalgia suffer not only from the symptoms of their disease but also from the difficulty of family, friends and medical teams to comprehend their symptoms,” says Yoram Shir, the senior author on the paper who is the Director of the Alan Edwards Pain Management Unit at the MUHC and an Associate Investigator from the BRaiN Program of the RI-MUHC. “As pain physicians, we are frustrated by our inability to help, and this frustration is a good fuel for research. This is the first evidence, at least in humans, that the microbiome could have an effect on diffuse pain, and we really need new ways to look at chronic pain.”
How the research was done
The research was based on a cohort of 156 individuals in the Montreal area, 77 of whom suffer from fibromyalgia. Participants in the study were interviewed and gave stool, blood, saliva and urine samples, which were then compared with those of healthy control subjects, some of whom lived in the same house as the fibromyalgia patients or were their parents, offspring or siblings.
The researchers’ next steps will be to see whether they get similar results in another cohort, perhaps in a different part of the world, and to do studies in animals to discover whether changes in bacteria play a role in the development of the disease.
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