The best treatment for fibromyalgia might be hard to find if you’re just looking to fight the symptoms. In this video, Dr. Bill Rawls explains how to treat the problem to stop the pain, instead.
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Painful intercourse in women improved with fibromyalgia drug
Gloria Bachamann was the lead author in this study, which was the first to analyze sexual function in women with vulva pain treated with Gabapentin. Photo by John O’Boyle
Women with chronic pain or discomfort around the vulva showed improved sexual function with an oral nerve pain medication used to treat pain caused by a previous herpes infection as well as fibromyalgia, according to a Rutgers study.
The study, which was the first to analyze sexual function in women with vulva pain treated with Gabapentin, appeared in the American Journal of Obstetrics and Gynecology.
The women in the study were diagnosed with provoked vulvodynia, a chronic pain syndrome that is characterized by symptoms such as stinging, burning, irritation or itching at the entry to the vagina. The pain usually occurs with contact, such as from tampon insertion or intercourse, which can lead to sexual dysfunction.
“Previous studies have suggested Gabapentin reduces the pain of fibromyalgia, a chronic condition that includes widespread pain in various parts of the body. Our theory was that reducing pelvic floor muscle pain might reduce vulvodynia pain overall and thus improve sexual function,” said lead author Gloria Bachmann, director of the Women’s Health Institute at Rutgers Robert Wood Johnson Medical School.
The researchers found that the 230 women studied, who had an average age of 37 and, for most, had the condition for more than five years, experienced less pain and improved sexual desire, arousal and satisfaction after using the oral medication. However, their overall sexual function remained lower than women without this pain disorder.
“We found that women with greater muscle pain responded better in terms of pain and improved arousal than those with less pain, which suggests that Gabapentin be considered for treatment in women who have significant muscle tightness and spasm in the pelvic region,” said Bachmann.
Pain: Perception and motor impulses arise in brain independently of one another
Laura Tiemann, first author of the new study about pain perception, prepares together with Markus Ploner, Heisenberg Professor for Human Pain Research, a volunteer for the EEG-measurements. Kurt Bauer / Technical University of Munich
Pain is a negative feeling that we want to get rid of as soon as possible. In order to protect our bodies, we react for example by withdrawing the hand. This action is usually understood as the consequence of the perception of pain. A team from the Technical University of Munich (TUM) has now shown that perception, the impulse to act and provision of energy to do so take place in the brain simultaneously and not, as was expected, one after the other.
Led by Markus Ploner, Heisenberg Professor for Human Pain Research, scientists from the Department of Neurology of the university hospital TUM Klinikum rechts der Isar investigated in detail how a painful event is processed in the brain. For the first time they were able to show that the brain yields at least three different responses to a painful stimulus, and that these responses are simultaneous and independent of one another. The results may have fundamental repercussions for the understanding of pain and treatment of pain patients.
Pain embodies at least three factors: Perception of pain, an action such as withdrawing the hand from a hot stove, and a response of the autonomic nervous system which provides the necessary energy for the action. The autonomic nervous system controls essential functions such as heart rate, breathing, digestion and metabolism.
Combination of behavioral and EEG measurements
In their experiments, the researchers applied short pain stimuli of varying strengths to the back of the hand of healthy volunteers. The perception of pain was determined based on the participants evaluation of the stimulus on a rating scale. The team, led by Markus Ploner, investigated the action component based on the reaction time the subjects needed to withdraw their fingers in response to the stimulus. Moreover, to determine the response of the autonomic nervous system, the team measured the sweat production at the interior surface of the hand.
For the entire duration of the experiment, brain activity was measured using electroencephalography (EEG). This method provides highly precise information on when and how nerve cells react to pain stimuli.
Pain components arise independently of one another
Ploner and his team applied a statistical method known as mediation analysis to the data. The method has been well established in the social sciences for some time now; however, this was its first application to EEG data. The team was thus able to find out which brain responses serve the three pain components, and when exactly they take place.
The results of the evaluations surprised the researchers: “For the first time we were able to see that the brain responses to the pain components did not take place one after the other, but rather in part simultaneously. This means that the preparation for action and the provision of energy are not entirely dependent on the perception of pain; instead they are in part triggered independently of one another,” explains Laura Tiemann, the study’s lead author.
Comprehensive pain therapy for chronic pain patients
Although at first rather abstract, these findings could be of great importance to patients suffering from chronic pain. Ploner recommends considering all three components of pain in comprehensive pain therapy: “For chronic pain patients, it is possible that not only the perception of pain, but also the preparation and performance of actions against pain and the provision of the energy to do so are changed. Our findings are thus a biological argument for holistic pain therapy approaches that take different pain components into account. Such approaches would include psychotherapy and drug therapy as well as physiotherapy,” Ploner says. This kind of therapy, referred to as Multimodal Pain Therapy, is already being offered at the TUM Interdisciplinary Center for Pain Medicine.
How To Treat Brain Fog, Body Pain and Seizures
How To Treat Brain Fog, Body Pain and Seizures
Study finds evidence of nerve damage in around half of fibromyalgia patients
Neurons and nerve pain
Small study could lead to identification of treatable diseases for some with chronic pain syndrome
About half of a small group of patients with fibromyalgia – a common syndrome that causes chronic pain and other symptoms – was found to have damage to nerve fibers in their skin and other evidence of a disease called small-fiber polyneuropathy (SFPN). Unlike fibromyalgia, which has had no known causes and few effective treatments, SFPN has a clear pathology and is known to be caused by specific medical conditions, some of which can be treated and sometimes cured. The study from Massachusetts General Hospital (MGH) researchers will appear in the journal Pain and has been released online.
“This provides some of the first objective evidence of a mechanism behind some cases of fibromyalgia, and identifying an underlying cause is the first step towards finding better treatments,” says Anne Louise Oaklander, MD, PhD, director of the Nerve Injury Unit in the MGH Department of Neurology and corresponding author of the Pain paper.
The term fibromyalgia describes a set of symptoms – including chronic widespread pain, increased sensitivity to pressure, and fatigue – that is believed to affect 1 to 5 percent of individuals in Western countries, more frequently women. While a diagnosis of fibromyalgia has been recognized by the National Institutes of Health and the American College of Rheumatology, its biologic basis has remained unknown. Fibromyalgia shares many symptoms with SFPN, a recognized cause of chronic widespread pain for which there are accepted, objective tests.
Designed to investigate possible connections between the two conditions, the current study enrolled 27 adult patients with fibromyalgia diagnoses and 30 healthy volunteers. Participants went through a battery of tests used to diagnose SFPN, including assessments of neuropathy based on a physical examination and responses to a questionnaire, skin biopsies to evaluate the number of nerve fibers in their lower legs, and tests of autonomic functions such as heart rate, blood pressure and sweating.
The questionnaires, exam assessments, and skin biopsies all found significant levels of neuropathy in the fibromyalgia patients but not in the control group. Of the 27 fibromyalgia patients, 13 had a marked reduction in nerve fiber density, abnormal autonomic function tests or both, indicating the presence of SFPN. Participants who met criteria for SFPN also underwent blood tests for known causes of the disorder, and while none of them had results suggestive of diabetes, a common cause of SFPN, two were found to have hepatitis C virus infection, which can be successfully treated, and more than half had evidence of some type of immune system dysfunction.
“Until now, there has been no good idea about what causes fibromyalgia, but now we have evidence for some but not all patients. Fibromyalgia is too complex for a ‘one size fits all’ explanation,” says Oaklander, an associate professor of Neurology at Harvard Medical School. “The next step of independent confirmation of our findings from other laboratories is already happening, and we also need to follow those patients who didn’t meet SFPN criteria to see if we can find other causes. Helping any of these people receive definitive diagnoses and better treatment would be a great accomplishment.”