FM/CFS/ME RESOURCES - Types of Fibromyalgia Pain


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Those of us with fibromyalgia (FM) experience several kinds of chronic pain, usually all at the same time. Only a few of the fibromyalgia pain types have medical names. But just as Eskimos have several words for snow, I have several ways to define and categorize our pain.

Here are some categories based on my own experiences. Knowing the medical terms will help you 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.

Types of Fibromyalgia Pain

The first 3 types of fibromyalgia pain are medically defined:

The next 4 types are obvious by their names. I wouldn't use these terms in a doctor's office, they might think you're crazy!

  • Knife in the Voodoo Doll
  • Randomly Roving Pain
  • Sparkler Burns
  • Rattled Nerves

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 migraines.

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.

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:

  1. Tactile, which is pain from touch or gentle pressure
  2. Mechanical, which is from something moving across your skin
  3. 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.

Other 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 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 makes it hurt to breathe. It usually goes away as fast as it comes. I have no idea how to prevent this type of pain, other than by pacing myself.

* 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

Remember when you were a kid and you hung onto a sparkler for too long? The sparks hit my hand causingtiny pin-pricks of pain? I have almost the same sensations today. 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 people with FM 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, screaming kids)
  • 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.

Pain From Head To Toe

How can you hurt from heat to toe? Research shows the pain control system in the skin, spinal cord, and brain of fibromyalgia patients is overloaded and offers a reason for why you ache all over.

Your central nervous system (brain and spinal cord) is believed to be a major player in causing your FM pain, but it's not the only one. The skin appears to be contributing to your pain as well. Seong-Ho Kim, M.D., and colleagues in South Korea, took tiny biopsies of this peripheral tissue from a group of FM patients and compared the results to healthy controls.1

Most of the FM patients, but none of the controls, showed enlarged or ballooned Schwann cells surrounding the nerve fibers. Schwann cells are part of your immune system and encase all fibers extending from your spinal cord to your peripheral tissues, such as your skin. These nerve fibers relay information from your tissues to your spinal cord, and vice versa.

Under normal situations, Schwann cells provide nutritional support and protection for your nerves. But keep in mind they are part of your immune system, always surveying the nearby environment to make sure nothing occurs that might be threatening to your body. These cells are geared to respond quickly to anything that is not quite right.

Enlarged Schwann cells represent an activated state usually triggered by infections and tissue injury. When activated, they pour out pain-promoting substances, called cytokines, to clean up the debris from the tissue injury. Yet, obvious tissue injury is not apparent in FM. However, cytokine levels in the skin of FM patients have been shown to be elevated when examined under the high-power magnification of an electron microscope.2 These chemicals can cause painful skin irritation.

Ordinarily, the central nervous system (particularly the spinal cord) is suppose to filter out the number of signals traveling to the tiny nerves in the skin. But this pain filtering system in the cord is not working well in people with FM.

Kim's research team suspect that too many signals are traveling to the tiny nerves in the skin, causing the fibers to become overstimulated. The Schwann cells attempt to keep pace by clearing out the waste products and providing nutrients to the nerve fibers, and in the process, they become enlarged.

But the real question is, how do the ballooned Schwann cells relate to your pain? They secrete pain-promoting cytokine substances that irritate nearby nerve fibers. As a result, you are left with burning, itching skin, even though it looks normal. Your irritated nerve fibers in the skin start relaying signals back to your spinal cord, saying, "Ouch … help me out!" but this just makes matters worse in the cord.

Spinal Cord Opioids

When experiencing fibro pain, you would think the neurons in your spinal cord and brain would release lots of opioid-like pain-killing substances to get your symptoms under control. Operating under this assumption, James Baraniuk, M.D., of Georgetown University, and Daniel Clauw, M.D., of the University of Michigan in Ann Arbor, measured the levels of enkephalins in the spinal fluid of fibromyalgia patients. Enkephalins are naturally produced endorphins, similar to opioids. The results in the fibro group were compared to low back pain patients (regional pain) and healthy pain-free controls.3

The concentration of enkephalins in the fibromyalgia group was almost fourfold greater than the controls and threefold higher than the regional low back pain patients. This means your spinal cord is pouring out natural opioid-like substances in a valid attempt to contain your pain, but it is just not enough.

Opioid Receptors in Brain

You may wonder if the high concentration of opioid-like substances in the spinal fluid (which bathes the brain) are not properly activating the pain-relieving centers in your brain. After all, given the high concentrations of spinal opioids, you should not be in any pain whatsoever.

Clauw's team measured the number of receptor sites in the brain that opioid-like substances target to put out the pain. He compared a group of fibromyalgia patients to a group of healthy controls using a brain imaging technique called positron emission tomography (PET).4

The opioid receptors in the brain were almost completely occupied in the FM patients, particularly in the areas known to regulate pain. So the higher amount of enkephalins (opioid-like substances) in the spinal fluid appear to be properly working on the brain's receptors to control your pain.

Why Do You Hurt?

If you are producing plenty of opioid-like enkephalins and they are activating the pain-relieving receptors in your brain, why do you still hurt all over? Researcher don't know all the details, but the foregoing findings offer important clues.

Studies in the skin implicate it as a potential source of continuous pain transmissions traveling to your spinal cord and the cytokines produced by the enlarged Schwann cells cause local irritation. Substantial elevations of the opioid-like enkephalins in your spinal fluid could be doing more than hitting the centers in your brain to provide analgesia. They might also be activating your immune cells to produce pain-promoting cytokines. A recent study looking at cytokine levels in the spinal fluid of fibromyalgia patients supports this theory. One pain-producing cytokine was found to be increased fourfold.5

Your body is working overtime to put out your pain, and there is no question you hurt from head to toe, including your skin. However, too many pain-promoting cytokines appear to be produced by the opioid-related process. This means your body's attempts to ease discomfort backfires (e.g., the pain-promoting cytokines win out over the opioids), leading to more rather than less pain.

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  • 1. Kim SH, et al. Clin Rheumatol 27:407-11, 2008.
  • 2. Salemi S, et al. J Rheumatol 30:146-50, 2003.
  • 3. Baraniuk JN, et al. BMC Musculoskel Dis 5:48-54, 2004.
  • 4. Harris RE, et al. J Neurosci 27:1000-6, 2007.
  • 5. Kadetoff D, et al. [epub ahead of print] Nov. 27, 2011.
  • From the Skin Tissue to the Brain, Fibromyalgia Network, 2012.
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