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Dec. 11, 2009
You hear a lot about "fibromyalgia pain," but really those of us with fibromyalgia (FM)
experience several kinds of chronic pain.
Medically speaking, only a few of the fibromyalgia-pain types I talk about here have
actual names and definitions. But just as Eskimos have several words for snow, I feel like
we need to have several ways to name, define and categorize our pain. I've created some of
my own categories, based on my own experience and on conversations I've had with other
fibromites. My hope is that understanding the medical terms will help us communicate
better with doctors and other healthcare providers, while my categories will help you
understand your illness and let you know you're not alone in feeling these things.
Types of Fibromyalgia Pain
The first 3 types of fibromyalgia pain are medically defined:
The next 4 types are my own creation, which will be obvious by their names. I don't
recommend using these terms in a doctor's office (unless you want to be seen as crazy),
but these labels may help you get to know your body's quirks, triggers, patterns, etc.:
- Knife in the Voodoo Doll
- Randomly Roving Pain
- Sparkler Burns
- Rattled Nerves
Hyperalgesia & Fibromyalgia
"Hyper" means excess and "algesia" means pain. Hyperalgesia is the medical term for pain
amplification in FM. Our brains appear to take normal pain signals and "turn up the
volume," making them more severe than they would normally be.
Most of the drugs used for managing FM pain are aimed, at least in part, at reducing
hyperalgesia.
Allodynia & Fibromyalgia
A symptom that perplexes a lot of us, especially when it's new, is allodynia. That's what
it's called when your skin hurts to the touch, and when mild pressure from clothing or
gentle massage causes pain. A lot people describe allodynia as similar to a bad sunburn.
Allodynia is a fairly rare type of pain - other than FM, it's only associated with a
handful of conditions, including neuropathy, postherpetic neuralgia (shingles) and
migraine. Allodynia is believed to be a hypersensitive reaction that may result from the
central sensitization associated with FM. The pain signals originate with specialized
nerves, called nociceptors, that sense information about things like temperature and
painful stimuli right from the skin.
Allodynia comes in 3 forms:
- Tactile, which is pain from touch or gentle pressure
- Mechanical, which is from something moving across your skin
- Thermal, which is pain from heat or cold that's not severe enough to damage tissues
Some drugs that work for some people with allodynia include:
Some people also get relief from topical pain creams (capsaicin, Tiger Balm,
Aspercreme, BioFreeze). Paying close attention to the way you dress can help alleviate
allodynia as well.
If you have allodynia, massage therapy may make it worse. If you feel other aspects of
your health would benefit from massage, be sure to discuss allodynia with your doctor and
massage therapist and keep track of how treatments impact this symptom.
Paresthesia & Fibromyalgia
Paresthesias are odd nerve sensations that can feel like crawling, tingling, burning,
itching or numbness. Sometimes, these sensations can be painful. Paresthsias are also
associated with peripheral neuropathy, chemotherapy drugs, multiple sclerosis and migraine.
Many common FM treatments can help alleviate paresthesia-related pain, including selective
serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors
(SNRIs). Some people also have good luck with vitamin B12, capsaicin cream, massage and
acupuncture.
My Own Fibromyalgia Pain Categories
Once again, the following categories are not medically recognized - they're things I came
up with to fill a gap in how we classify different types of pain. They're intended to help
you track symptoms, gauge effectiveness of treatments, and to let you know you're not
alone.
Knife in the Voodoo Doll
Sometimes, out of nowhere, I'll get an intense stabbing pain that seems to cut through my
body. I've also described this as a fireplace poker in the ribs or being impaled on a
spear.
For me, the voodoo doll pain is often my body's early warning system - it tells me that I
need to stop what I'm doing and rest. Other times, I have no idea why it strikes. I
generally get this pain in my chest or abdomen, but some people say they get it in other
parts of the body. It can be so intense that it can double me over and make it hurt to
breathe. It usually goes away as after a few minutes. I have no idea how to prevent this
type of pain, other than by pacing myself. (If only I could find that darned doll)
Randomly Roving Pain
This is one of those things that reminds you FM just doesn't make a lot of sense. A lot of
us get pain that migrates around the body, sometimes moving between certain places,
sometimes striking in new areas. If you also have myofascial pain syndrome, it can be
especially hard to tell randomly roving pain from the referred pain caused by trigger
points. For me, this pain responds to treatments about the same as hyperalgesia.
Sparkler Burns
One 4th of July, when I was young, I hung onto a sparkler for too long and some sparks hit
my hand. They caused tiny pin-pricks of pain almost identical to sensations I now get
regularly. They make me jump, and scratching them triggers tactile allodynia. These
sensations usually just last a few seconds. I have no idea what triggers them or how to
prevent them.
Rattled Nerves
Most people won't understand why I call this a type of pain, but I'm sure most fibromites
will get it. Certain things tend to get my whole body on edge, jumpy, and feeling rattled.
It makes me ache all over, and sometimes I get nauseous, dizzy and anxious. Things that
rattle my nerves generally involve sensory or emotional overload, such as:
- Certain sounds (repetitive, loud, shrill, grating)
- Visual chaos (crowds, flashing lights, busy patterns)
- Stressful situations (busy traffic, confrontations, fibro-fog induced confusion or
disorientation)
When my nerves are rattled, I try to get out of the situation as quickly as possible and
relax, preferably somewhere quiet.
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