tag:theconversation.com,2011:/us/topics/fibromyalgia-21731/articlesfibromyalgia – The Conversation2019-06-17T19:53:46Ztag:theconversation.com,2011:article/1167292019-06-17T19:53:46Z2019-06-17T19:53:46ZExplainer: what is fibromyalgia, the condition Lady Gaga lives with?<p>At least <a href="https://s3.amazonaws.com/rdcms-iasp/files/production/public/Content/ContentFolders/Publications2/PainClinicalUpdates/Archives/PCU03-2_1390265045864_38.pdf">one in ten</a> of us suffer some sort of troublesome, long-term (chronic) pain. But not all have fibromyalgia.</p>
<p>People with fibromyalgia have chronic widespread pain — including musculoskeletal aches, pain and stiffness, and soft tissue tenderness — <a href="https://arthritisaustralia.com.au/types-of-arthritis/fibromyalgia/">in many areas across the body</a>. </p>
<p>This affects other systems like the brain, impacting a person’s ability to concentrate and remember things. People who have fibromyalgia often refer to this as the “<a href="https://www.ncbi.nlm.nih.gov/books/NBK540974/">fibro fog</a>”. It can affect sleep patterns, emotions, and many other aspects of everyday living.</p>
<p>Fibromyalgia is a condition <a href="https://www.womansday.com/health-fitness/wellness/g3329/celebrities-with-fibromyalgia/">singers Lady Gaga and Sinead O'Connor</a>, and actor <a href="https://www.esquire.com/entertainment/movies/interviews/a14768/morgan-freeman-interview-0812/">Morgan Freeman</a> live with.</p>
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<p>So what causes fibromyalgia? How does it differ from other types of chronic pain? How is it diagnosed and treated?</p>
<h2>What causes fibromyalgia?</h2>
<p>When investigations can find no other cause for widespread chronic pain, it’s generally diagnosed as fibromyalgia. </p>
<p>We don’t know exactly what causes fibromyalgia, but <a href="https://www.ncbi.nlm.nih.gov/pubmed/30756137">genetics, environment, hormonal and neural (brain and central nervous system) factors</a> are all believed to play a role. Research indicates genes may be responsible for up to <a href="https://www.ncbi.nlm.nih.gov/pubmed/30486733">50% of susceptibility</a> to the condition. The latest research indicates the body’s <a href="https://www.ncbi.nlm.nih.gov/pubmed/30756137">immune system</a> is involved, too.</p>
<p>An <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6158621/">online survey</a> of 596 people with fibromyalgia found a few common causes reported by participants. Around two thirds of people could relate the start of their symptoms to a specific incident or event, such as a physical injury, a period of sickness that might have involved surgery, or a stressful life event.</p>
<p>Notably, many of those surveyed said they experienced negativity and stigma when trying to explain and authenticate their symptoms to professionals, their families, and their communities.</p>
<h2>Who is affected?</h2>
<p>Fibromyalgia affects <a href="https://www.ncbi.nlm.nih.gov/pubmed/28734619">around 2%</a> of the world’s population. A recent <a href="https://www.ncbi.nlm.nih.gov/pubmed/28743363">literature review</a> showed the frequency of fibromyalgia in the general population was between 0.2 and 6.6%. It’s often reported as <a href="https://www.ncbi.nlm.nih.gov/pubmed/23801009">higher in women</a>, at a ratio of three to one.</p>
<p>The <a href="https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/849253504">World Health Organisation</a> recognised fibromyalgia as a disease in 1994. Since then, doctors <a href="https://www.ncbi.nlm.nih.gov/pubmed/30724039">have debated</a> how fibromyalgia should be diagnosed and who should diagnose it, leading to the so-called “<a href="https://www.ncbi.nlm.nih.gov/pubmed/19342721">fibro wars</a>”. It continues to be controversial.</p>
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Read more:
<a href="https://theconversation.com/hidden-and-unexplained-feeling-the-pain-of-fibromyalgia-48319">Hidden and unexplained: feeling the pain of fibromyalgia</a>
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<p>The latest version of the <a href="https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/849253504">International Classification of Diseases</a> says for someone to be diagnosed with fibromyalgia, there needs to be pain in “at least 4 of 5 body regions and is associated with significant emotional distress”. </p>
<p>The <a href="https://www.ncbi.nlm.nih.gov/pubmed/2306288">American College of Rheumatology</a> devised a widely accepted test which looks for 11 points from <a href="https://www.mayoclinic.org/tender-points/img-20007586">18 potential tender points</a> of pain from areas across the body using what’s called the <a href="https://www.rheumatology.org/Portals/0/Files/2010%20Fibromyalgia%20Diagnostic%20Criteria_Excerpt.pdf">widespread pain index</a>. </p>
<h2>How is it treated?</h2>
<p>Everyone experiences treatments differently, and what works for one person <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6191958/">may not work for another</a>. But the main treatments focus <a href="https://www.who.int/medicines/areas/quality_safety/guide_on_pain/en/">on pain relief</a>.</p>
<p>The drugs <a href="https://darujps.biomedcentral.com/articles/10.1007/s40199-019-00257-4">pregabalin and duloxetine</a> work by altering the neurotransmitters in the brain (gamma amino butyric acid and serotonin), and are effective for many people.</p>
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Read more:
<a href="https://theconversation.com/how-support-groups-can-boost-your-health-and-make-chronic-conditions-easier-to-live-with-91756">How support groups can boost your health and make chronic conditions easier to live with</a>
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<p>There are many <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5662432/">other options</a> including medication specifically for pain (analgesics), muscle relaxants (benzodiazepines), or treatments to address nerve or spinal pain (neuropathic treatments).</p>
<p>Many of these medications can have <a href="https://www.ncbi.nlm.nih.gov/pubmed/18443635">side effects</a>, including constipation, or allergic reactions like digestive upset or inflammation. They can also be addictive. Always be honest with your GP about what painkillers you’re taking so they can help you safely manage your pain. </p>
<p>Another common treatment is using a <a href="https://www.nhs.uk/conditions/transcutaneous-electrical-nerve-stimulation-tens/">TENS machine</a> (transcutaneous electrical nerve stimulation). This involves applying pads around the area of pain, or the nerves that might be sending the pain message, and interfering with these using small electrical pulses.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/279486/original/file-20190614-158931-184ree5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/279486/original/file-20190614-158931-184ree5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/279486/original/file-20190614-158931-184ree5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/279486/original/file-20190614-158931-184ree5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/279486/original/file-20190614-158931-184ree5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/279486/original/file-20190614-158931-184ree5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/279486/original/file-20190614-158931-184ree5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/279486/original/file-20190614-158931-184ree5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Some patients find therapy with a TENS machine helpful, where pads are placed on the body and electrical pulses applied.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/tens-treatment-physical-therapy-young-man-1151290940?src=vqVpG8b_6LG_S9lZMe7Q6g-1-19&studio=1">from www.shutterstock.com</a></span>
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<p>This <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4186747/">effective</a> treatment is thought to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4186747/">increase levels of endorphins</a> produced by the brain and spinal cord to provide pain relief. But the effects may weaken with ongoing use. </p>
<p>It’s important to check with your doctor if TENS treatment is appropriate because it might affect pacemakers or people with epilepsy. </p>
<p>Fibromyalgia can also be treated with physical interventions such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6191958/">heat therapy</a>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/29389485">massage</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/28637133">vibration therapy</a>. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6365227/">Acupuncture</a> and <a href="https://arthritisaustralia.com.au/wordpress/wp-content/uploads/2017/12/ArthAus_Fibromyalgia_1705.pdf">treatment from a psychologist</a> are other options.</p>
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<em>
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Read more:
<a href="https://theconversation.com/pain-drain-the-economic-and-social-costs-of-chronic-pain-49666">Pain drain: the economic and social costs of chronic pain</a>
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</em>
</p>
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<h2>How about the future?</h2>
<p>In time, we might be able to look for diagnostic <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0198625">immune markers</a> for fibromyalgia in our genetic material to help find who might be at risk of developing the condition, and take preventative action. </p>
<p>Many of the symptoms of fibromyalgia can be found in people who have a condition known as <a href="https://www.ncbi.nlm.nih.gov/pubmed/30795933">myalgic encephalomyelitis</a>, or chronic fatigue syndrome. Our research is currently looking at the blood of people with fibromyalgia and chronic fatigue syndrome to see if there are specific inflammatory markers that may help us understand how these illnesses develop.</p>
<p>If we can understand the interaction of the immune system with pain and inflammation, then we can begin to target treatments more effectively for people living with fibromyalgia.</p>
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<p><em>If you or someone you know has fibromyalgia, resources and support are available from <a href="https://arthritisaustralia.com.au/wordpress/wp-content/uploads/2017/12/ArthAus_Fibromyalgia_1705.pdf">Arthritis Australia</a> and the US <a href="http://www.fmaware.org/wp-content/uploads/2018/04/10-Things-FM-Patients-Need-to-Know.pdf">National Fibromyalgia Association</a>.</em></p><img src="https://counter.theconversation.com/content/116729/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tiffany Gill is affiliated with Arthritis SA. </span></em></p><p class="fine-print"><em><span>Michael Musker does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>People with fibromyalgia live with chronic pain all over their body. And not all treatments work for everyone.Michael Musker, Senior Research Fellow, South Australian Health & Medical Research InstituteTiffany Gill, Senior Research Fellow, University of AdelaideLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1029462018-09-14T10:51:54Z2018-09-14T10:51:54ZFibromyalgia: researchers trying to fathom the causes of this painful condition<figure><img src="https://images.theconversation.com/files/236219/original/file-20180913-177968-f3qvel.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/1174861399?src=RTT5kUUUgpk3StAuc_cV_Q-1-83&size=medium_jpg">TierneyMJ/Shutterstock.com</a></span></figcaption></figure><p>Fibromyalgia is something of a mystery. It can’t be detected with scans or blood tests, yet it causes lifelong pain for millions of people. </p>
<p>The disease mainly affects women (about 75-90% of cases), causing pain all over the body. Because not all healthcare professionals are adept at identifying and diagnosing fibromyalgia, reported rates of the condition <a href="https://www.researchgate.net/publication/242016982/download">vary greatly from country to country</a>. In China, it affects only 0.8% of people, in France around 1.5%, in Canada 3.3%, and in Turkey 8.8%. Estimates in the US range from 2.2% to 6.4%, and in Russia, about 2% of the population is affected. </p>
<p>People with the condition are often diagnosed if they have longstanding muscle pain, bone or joint pain and fatigue. Fibromyalgia can also cause insomnia, “brain fog”, some symptoms of depression or anxiety, as well as a range of other complaints, including irritable bowel syndrome and headache. Many patients are also hypermobile (“double-jointed”), and there is some overlap with chronic fatigue syndrome (also known as ME). </p>
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<img alt="" src="https://images.theconversation.com/files/236418/original/file-20180914-177953-1k88o1s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/236418/original/file-20180914-177953-1k88o1s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=566&fit=crop&dpr=1 600w, https://images.theconversation.com/files/236418/original/file-20180914-177953-1k88o1s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=566&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/236418/original/file-20180914-177953-1k88o1s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=566&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/236418/original/file-20180914-177953-1k88o1s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=711&fit=crop&dpr=1 754w, https://images.theconversation.com/files/236418/original/file-20180914-177953-1k88o1s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=711&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/236418/original/file-20180914-177953-1k88o1s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=711&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Many people with fibromyalgia are hypermobile (</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/w/index.php?curid=17256369">MatthewThomasWxm/Wikimedia Commons</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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<p><a href="https://acrabstracts.org/abstract/2016-revisions-to-the-20102011-fibromyalgia-diagnostic-criteria/">Guidelines</a> from the American College of Rheumatology make it clear that the diagnosis should be made using defined criteria based on the “widespread pain index” (which scores the number of painful regions out of 19) coupled with a symptom severity scale. The diagnosis also takes fatigue, generalised pain, unrefreshing sleep and cognitive symptoms into account. It doesn’t matter if the patient has another rheumatic disease, they can still be diagnosed with fibromyalgia. </p>
<p>The scoring system, recommended by the American College of Rheumatology, is often used in clinical trials, but in the clinic, most doctors rely on detecting tender points in specific places and on excluding other medical conditions, including rheumatic conditions. Unlike say, rheumatoid arthritis or lupus, the tests do not show clear evidence of inflammation or autoimmunity (when the body’s immune system attacks itself) and scans are normal.</p>
<p>The lack of inflammation or structural abnormality in muscles or joints – aside from making diagnosis difficult – is the main reason there are no widely accepted or effective treatments. In rheumatic diseases, where we understand the mechanisms that underlie the condition, we have the most effective treatments. In rheumatoid arthritis, for example, we know that much of the inflammation is caused by a cell-signalling protein (cytokine) called tumour necrosis factor and that blocking the activity of this protein switches off the disease in most patients. </p>
<p>A number of possible mechanisms have been proposed in fibromyalgia, including abnormal muscle metabolism, reduced levels of steroid hormones such as cortisol, or abnormal small nerve fibres. But these abnormalities aren’t found in all patients with the condition. As such, they can’t be used as part of a diagnostic test, nor can they help develop treatments. </p>
<p>Some experts have suggested that fibromyalgia may be related to abnormalities in the autonomic nervous system – the part of the nervous system that controls bodily functions, such as heart rate and blood pressure – and how the brain responds to pain signals and reacts to external stressors (such as infections). But there is currently no hard evidence to back up this theory.</p>
<h2>Looking for clues</h2>
<p>To fill in some of the gaps in our knowledge about this devastating condition, our research team at Brighton and Sussex Medical School is investigating the potential role of the autonomic nervous system and inflammation in fibromyalgia and chronic fatigue syndrome.</p>
<p>For our study, we have two groups of patients: one with pain as the main symptom and the other with fatigue as the main symptom. We also have matched controls – people without the disease, but otherwise similar characteristics – to make meaningful comparisons. </p>
<p>The study is in two parts. First, we will test the patients’ autonomic nervous system using a tilt-table. This involves tilting the person head downwards to see how well their body adapts to this change in posture by changing heart rate and blood pressure (both of which are monitored during the test). </p>
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<img alt="" src="https://images.theconversation.com/files/236419/original/file-20180914-177962-111d3o8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/236419/original/file-20180914-177962-111d3o8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=922&fit=crop&dpr=1 600w, https://images.theconversation.com/files/236419/original/file-20180914-177962-111d3o8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=922&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/236419/original/file-20180914-177962-111d3o8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=922&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/236419/original/file-20180914-177962-111d3o8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1158&fit=crop&dpr=1 754w, https://images.theconversation.com/files/236419/original/file-20180914-177962-111d3o8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1158&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/236419/original/file-20180914-177962-111d3o8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1158&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">A tilt-table test.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/332960090?src=uQY-b5YXXPiRVOiA_XMXmg-1-0&size=huge_jpg">Blamb/Shutterstock.com</a></span>
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<p>Second, we will stimulate patients’ immune systems with a typhoid vaccine (the normal type used in travellers) and perform magnetic resonance brain scans to look for changes in blood flow and also measure the levels of “inflammatory mediators” (the chemicals the body produces in response to stimuli of this type), to see whether these are higher in the fibromyalgia patients.</p>
<p>Our study should, for the first time, help us to address the question of whether there really is an abnormal brain response to inflammation or infection in these patient groups and enable us to explore the relationship between the abnormal functioning of the autonomic nervous system and fibromyalgia and chronic fatigue syndrome. </p>
<p>Fibromyalgia rarely goes away and treatment options are limited. Only by developing a proper understanding of the disease processes underlying this condition will doctors be able to make a clear, positive diagnosis, and most importantly, offer effective therapy.</p><img src="https://counter.theconversation.com/content/102946/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kevin Davies receives funding from AR-UK. </span></em></p><p class="fine-print"><em><span>Jessica Eccles receives funding from Academy of Medical Sciences, National Institute of Health Research, MQ</span></em></p><p class="fine-print"><em><span>Neil Harrison receives funding from the Wellcome Trust, Medical Research Council (MRC), Arthritis Research UK, and Janssen Pharmaceuticals.</span></em></p>A new study offers hope.Kevin Davies, Professor of Medicine, Brighton and Sussex Medical SchoolJessica Eccles, NIHR Clinical Lecturer, Brighton and Sussex Medical SchoolNeil Harrison, Reader in Neuropsychiatry, Brighton and Sussex Medical SchoolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/829422017-08-31T10:36:29Z2017-08-31T10:36:29ZMind games: new research shows the brain can be tricked into feeling pain relief<figure><img src="https://images.theconversation.com/files/184028/original/file-20170830-24286-116pts0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Shifting mindsets.</span> <span class="attribution"><span class="source">shutterstock</span></span></figcaption></figure><p>Pain is never a nice thing to experience, but it is one of the most useful bodily signals we have. It acts like an alarm system – sending an immediate message for highly harmful and potentially fatal conditions – so you know that when you touch that boiling hot pan, you should take your hand away very quickly. </p>
<p>Pain is also a highly subjective experience – people can experience <a href="http://www.ibtimes.com/why-do-some-people-tolerate-pain-better-others-new-study-links-pain-sensitivity-grey-matter-brain">different levels of pain</a> in the same situation. So while some people tend to have a very low pain threshold – for example, needing anaesthetic when having dental cavities fixed – others seem to have no problem when they have teeth removed. </p>
<p>These individual differences seem to have a <a href="http://www.sciencemag.org/news/2010/03/pains-genes">genetic basis</a>, but there are also things that can help to “manipulate” the mind and change the way we feel pain – such as a sudden distraction. This could be as simple as making someone laugh, as this shifts attention away from the pain, helping to reduce its perceived intensity and unpleasantness.</p>
<p>And <a href="http://www.jpain.org/article/S1526-5900(17)30558-8/abstract">new research</a> shows that as well as tricking the mind into feeling distracted from pain, the brain also seems to be able to be tricked into experiencing pain relief.</p>
<h2>The power of pain</h2>
<p>On a brain scan, the areas that light up when pain is felt are in the frontal brain regions. These are the areas of the brain that regulate the intensity and quality of the pain experience. They are also the brain areas that are responsible for setting expectations – which is no coincidence. Expectation plays a big part in how we <a href="http://www.pnas.org/content/97/16/9281.full.pdf">perceive pain</a> and the intensity with which it is felt.</p>
<p>So if you are waiting for an injection that you are told will be really painful, you are likely to experience it in this way. And on the flip side, if something painful happens unexpectedly – such as stubbing your toe – it might take a bit of time before you realise the actual intensity of the pain.</p>
<p>In this way, the now somewhat famous “<a href="https://www.researchgate.net/profile/Marcello_Costantini/publication/6489408_The_rubber_hand_illusion_Sensitivity_and_reference_frame_for_body_ownership/links/0c96052277367e5203000000.pdf">rubber hand illusion</a>” reveals the powerful connection between what we see and what we feel. Using a fake rubber hand, psychologists found they could convince people an artificial arm was part of their body. For this to happen, the participants had to hide their real arm from view (under a piece of cloth) and then both their real arm and fake arm were simultaneously stroked. </p>
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<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/19323139">A few studies</a> have also <a href="http://www.pnas.org/content/104/23/9828.short">suggested</a> that pain – not just touch – can be perceived by the rubber hand illusion. And there are countless <a href="https://www.google.co.uk/search?q=rubber+hand+illusion&source=lnms&tbm=vid&sa=X&ved=0ahUKEwimwfXzj4HWAhWrKsAKHUpQBYkQ_AUICygC&biw=1360&bih=573">YouTube videos</a> of people cringing as the rubber hand is threatened by a hammer or pricked with a needle. </p>
<h2>Mind over matter</h2>
<p><a href="http://www.jpain.org/article/S1526-5900(17)30558-8/abstract">New research</a> now shows how as well as being tricked into experiencing pain, the brain can also be fooled into experiencing pain relief. <a href="http://www.jpain.org/article/S1526-5900(17)30558-8/abstract">The recent study</a> involved researchers carrying out the rubber hand illusion, and then using a thermode to deliver intense pain stimulation on selected sites of the real arm. This was done while a visible mock thermode was attached to the exact same sites of the rubber arm, which then lit up during the stimulation. </p>
<p>It was discovered that a large number of participants reported experiencing the pain as if it was coming from the rubber arm. The researchers then used a fake pain relieving cream – in other words a placebo – on the “painful site” of the rubber arm. This time round, people who experienced the rubber hand illusion also reported a decrease in pain intensity. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/184178/original/file-20170831-22586-dlsbf4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/184178/original/file-20170831-22586-dlsbf4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/184178/original/file-20170831-22586-dlsbf4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/184178/original/file-20170831-22586-dlsbf4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/184178/original/file-20170831-22586-dlsbf4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/184178/original/file-20170831-22586-dlsbf4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/184178/original/file-20170831-22586-dlsbf4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">‘Is this my hand I see before me?’</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>What this shows is that people’s minds can be tricked into experiencing both pain and pain relief on a fake hand, where of course no pain stimulation, or any pain relief, were applied. </p>
<p>But the rubber hand illusion is more than just a great party trick, it also reveals one of the most important ideas in brain science. It shows how multi-sensory perception can influence how we see our own body. It also reveals how what we know to be true can be overridden by the brain. </p>
<p>In the experiment, the brain is changing to accommodate the new rubber hand – which is called <a href="https://theconversation.com/what-is-brain-plasticity-and-why-is-it-so-important-55967">neuroplasticity</a>. This is the idea that the brain can change in response to experience. </p>
<p>And in practical terms, these findings could present viable treatment and pain relief in conditions for people with chronic pain – such as <a href="http://thejns.org/doi/abs/10.3171/jns.1945.2.3.0251?journalCode=jns">phantom limb syndrome</a>, where pain is experienced as if coming from an nonexistent limb. It could even be used in other chronic pain conditions such as <a href="https://theconversation.com/hidden-and-unexplained-feeling-the-pain-of-fibromyalgia-48319">fibromyalgia</a> or <a href="https://theconversation.com/chronic-pain-isnt-all-in-the-brain-which-is-good-news-for-sufferers-34632">complex regional pain syndrome</a>, potentially offering hope to thousands of people whose lives are blighted by real pain on a daily basis.</p><img src="https://counter.theconversation.com/content/82942/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Giuliana Mazzoni receives funding from ESRC, British Academy, SSHRC, Portuguese Research Council. </span></em></p>People’s minds can be fooled into experiencing both pain and pain relief.Giuliana Mazzoni, Professor of Psychology, University of HullLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/748902017-03-23T01:06:02Z2017-03-23T01:06:02ZHow a study about Chronic Fatigue Syndrome was doctored, adding to pain and stigma<figure><img src="https://images.theconversation.com/files/161665/original/image-20170320-9132-rd2gxr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Dr. Ellen Wright Clayton, who has worked with those who have Chronic Fatigue Syndrome, spoke to an open committee at the Institute of Medicine in February 2015 about the biomedical nature of CFS. </span> <span class="attribution"><span class="source">Susan Walsh/AP</span></span></figcaption></figure><p>The public relies on scientists to report their findings accurately and completely, but that does not always happen. Too often, researchers announce only their most favorable outcomes, while keeping more disappointing results <a href="http://www.chronicle.com/article/Spoiled-Science/239529">well out of sight</a>. </p>
<p>This phenomenon, first identified by the psychologist <a href="http://psycnet.apa.org/journals/bul/86/3/638">Robert Rosenthal</a> in 1979, is called the “file drawer problem.” Although it is widely recognized – affecting <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1257776/">drug trials</a>, <a href="http://www.psychfiledrawer.org/TheFiledrawerProblem.php">psychology</a> experiments and most other fields – it has seldom been documented, for obvious reasons. Suppressed results are, well, suppressed, and they are usually discovered only by chance.</p>
<p>It was therefore almost unprecedented when a group of patients, at the end of last year, successfully <a href="https://www.statnews.com/2016/09/21/chronic-fatigue-syndrome-pace-trial/">unmasked the skewed data</a> behind an <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60096-2/abstract">influential British study</a>, first published in Lancet in 2011, of the devastating disease known as Chronic Fatigue Syndrome (sometimes called myalgic encephalomyelitis or ME/CFS). </p>
<p>My interest in this issue is both professional and personal. As a law professor, I have devoted much of my career to the study of judicial ethics, including the problem of implicit biases that can undermine the reliability of both <a href="http://journals.sagepub.com/doi/full/10.1177/1359105317697324">court trials and clinical trials</a>. </p>
<p>I have also been living with ME/CFS for over a decade, so I am acutely attuned to the need for responsible and transparent research on the illness. Unfortunately, the most extensive study of ME/CFS – called the <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60096-2/abstract">PACE trial</a> – was deeply flawed from its inception, in ways that the principal investigators have yet to acknowledge. </p>
<h2>‘Dysfunctional’ beliefs all too real for those in pain</h2>
<p>The story began in 2005, when a group of psychiatrists set out to test their theory that ME/CFS is primarily a psychosocial illness, characterized by patients’ <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60096-2/abstract">“unhelpful cognitions”</a> and their <a href="http://www.virology.ws/2015/10/21/trial-by-error-i/">“dysfunctional”</a> beliefs that their symptoms are caused by an organic disease. </p>
<p>Under this assumption, they recruited over 600 ME/CFS patients for the PACE trial and randomly divided them into four categories. One group was treated with cognitive behavior therapy (CBT), a form of psychotherapy that addresses patients’ “false perceptions” of their illness, and a second group received graded exercise therapy (GET), which consisted of supervised increases in their activity levels. The other two groups were essentially controls, receiving neither of the treatments under study. </p>
<p>In a 2013 article in <a href="https://www.ncbi.nlm.nih.gov/pubmed/23363640">Psychological Medicine</a>, the PACE team announced its most striking results. This follow-up article claimed that the therapy arms of the study – CBT and GET – had achieved impressive 22 percent recovery rates – not just improvement rates – as opposed to only seven or eight percent in the control arms. </p>
<p>The result was <a href="http://www.sciencemediacentre.org/expert-reaction-to-new-research-into-therapies-for-chronic-fatigue-syndromeme/">enthusiastically promoted</a> in the press, but many patients were suspicious, especially of the GET outcomes, which contradicted their experience of debilitating crashes following the simple movements of daily life.</p>
<p>ME/CFS patients have consistently explained that <a href="http://www.slate.com/articles/health_and_science/medical_examiner/2015/11/chronic_fatigue_pace_trial_is_flawed_should_be_reanalyzed.html">exertion exacerbates</a> their worst symptoms. For many, even moderate exercise can result in a days-long crash, in which they are nearly immobilized by muscle weakness and joint pain. In the U.S., post-exertional relapse has been recognized as the <a href="https://www.ncbi.nlm.nih.gov/pubmed/25695122">defining characteristic</a> of the illness by the Centers for Disease Control, the National Institutes of Health and the Institute of Medicine. </p>
<p>For the PACE investigators, however, the announced recovery results validated their conviction that psychotherapy and exercise provided the key to reversing ME/CFS. </p>
<p>There was just one problem. A <a href="http://www.virology.ws/2015/10/21/trial-by-error-i/">subsequent investigation</a> found that the PACE investigators had <a href="https://www.nytimes.com/2017/03/18/opinion/sunday/getting-it-wrong-on-chronic-fatigue-syndrome.html?_r=0">changed</a> the standard for recovery midstream, weakening one of the key criteria to the point that a subject could actually have gotten worse in the course of the trial and yet still count as “recovered” following supervised GET. </p>
<h2>Unraveling the mystery</h2>
<p>Here is how it worked, as shown by the investigation: At the outset of the trial, patients were recruited who scored at 65 or lower on a measure called the physical function score, and recovery was defined as achieving a subsequent score of 85 or higher, which indicates a relatively healthy person. </p>
<p>Before the unblinded trial was completed, however, the definition of recovery was <a href="http://journals.sagepub.com/doi/full/10.1177/1359105316675213">reduced to a score of 60</a>, which was below the level that qualified research subjects in the first place. </p>
<p>It was the change in this outcome measure <a href="http://www.senseaboutscienceusa.org/pace-research-sparked-patient-rebellion-challenged-medicine/">(and several others)</a> that allowed the PACE researchers to declare their favorable outcome for GET. The unimpressive results under the original protocol went <a href="https://theconversation.com/tribunal-was-right-to-order-release-of-chronic-fatigue-trial-data-64255">unpublished</a>, as though they had been stuck in a a figurative file drawer. </p>
<p>When the Psychological Medicine article was published in 2013, members of the patient community immediately pointed out the discrepancy. Because the study had been publicly funded, they sought the underlying data under the U.K.’s Freedom of Information law. The PACE investigators refused to release any of the raw results.</p>
<p>In October 2015, David Tuller of the University of California at Berkeley published a lengthy <a href="http://www.virology.ws/2015/10/21/trial-by-error-i/">expose</a> of the PACE trial, pointing out the jiggered outcome measure, as detailed above, and many other flaws. His report attracted the attention of numerous American scientists who joined an <a href="http://www.virology.ws/2016/09/06/open-letter-to-queen-mary-university-london-about-pace/">open letter</a> seeking an independent review of the PACE data. </p>
<p>Finally, in summer 2016, a British Freedom of Information tribunal <a href="https://theconversation.com/tribunal-was-right-to-order-release-of-chronic-fatigue-trial-data-64255">ordered</a> the PACE team to unlock the file drawer and disclose their raw data. A revelation followed. </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/161903/original/image-20170321-5397-srcg1i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/161903/original/image-20170321-5397-srcg1i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=429&fit=crop&dpr=1 600w, https://images.theconversation.com/files/161903/original/image-20170321-5397-srcg1i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=429&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/161903/original/image-20170321-5397-srcg1i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=429&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/161903/original/image-20170321-5397-srcg1i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=539&fit=crop&dpr=1 754w, https://images.theconversation.com/files/161903/original/image-20170321-5397-srcg1i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=539&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/161903/original/image-20170321-5397-srcg1i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=539&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/archives-magnifier-3d-557199121?src=oyv2P5wFiTaNIEWuemcUZA-1-1">From www.shutterstock.com</a></span>
</figcaption>
</figure>
<h2>Exaggerated recovery claims</h2>
<p>A group of patients and scholars reanalyzed the PACE data according to the original determinants and, as suspected, the “recoveries” under CBT and GET all but disappeared. As they reported last December in a peer-reviewed <a href="http://www.tandfonline.com/doi/full/10.1080/21641846.2017.1259724">medical journal</a>, the recovery rate for CBT fell to seven percent and the rate for GET fell to four percent, which were statistically indistinguishable from the three percent rate for the untreated controls. </p>
<p>Thus, the PACE investigators proved nothing more than a familiar adage among statisticians: If you torture the data, they will confess anything. </p>
<p>Researchers in the U.S. and Australia have recently made great progress toward <a href="https://www.healthrising.org/blog/2017/02/28/biomarker-aussies-chronic-fatigue-syndrome/">identifying biomarkers </a>for ME/CFS, which may lead to an effective medical intervention. Over 100 prominent researchers, clinicians and organizations have called on Psychological Medicine <a href="https://www.statnews.com/2016/09/21/chronic-fatigue-syndrome-pace-trial/">to retract </a>the PACE article, although the journal has not yet publicly responded. </p>
<p>Thanks to the original PACE announcement, however, graded exercise is still routinely prescribed throughout the U.S. and the U.K. despite reports that the treatments can cause intolerable pain and relapse. Those who question GET are often told that they must simply exercise more, no matter how badly they crash afterward. </p>
<p>It is bad enough to torture the data, but it is indefensible to torture patients based on manipulated results.</p><img src="https://counter.theconversation.com/content/74890/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Steven Lubet does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A study that suggested Chronic Fatigue Syndrome was more psychological than physical has been debunked. How did the data get doctored?Steven Lubet, Williams Memorial Professor of Law, Northwestern UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/483192015-12-17T00:40:54Z2015-12-17T00:40:54ZHidden and unexplained: feeling the pain of fibromyalgia<figure><img src="https://images.theconversation.com/files/98795/original/image-20151019-7780-tl94to.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Fibromyalgia can be made more difficult when the pain doesn't seem to have a visible cause</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/shitsuren/4904341484/in/photolist-8to2RN-4X7hMc-bUKXf9-7Y1isf-6yEpBk-ce2LSm-dtEpX2-dveXaK-xe9cn5-c2B6h5-66McvJ-qnAtkg-8svFP7-6VpBou-jbFPK1-3ufH6f-8fs4o8-7WZfgM-9WBGsu-mDPKmX-9muCe5-wtbz54-e9Cgqt-6cHmaC-9BwjCn-9WBGuo-7Ej7ZR-asbJv-duCLzk-duCLvx-4mnysH-dCFk4u-5Nhvo-dbu6y-cs3kb1-w45C7b-vfkWGM-9pttue-wk2LMG-w45DX7-4MwSo5-bcFxaD-4emb3T-txbGq6-tx3NMm-djEJ7P-CkP9f-2zEhNw-66CQtU-bXpF8E">Silvia Sala/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>For some people, waking up every day means the start of persistent pain that affects their mood, thinking and relationships. This experience is more difficult when the pain doesn’t seem to have a cause; at least not a visible one. </p>
<p>That’s the reality for people with <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394355/">fibromyalgia</a>, a chronic disorder characterised by pain and muscle tenderness throughout the body where even the slightest touch can be sensitive. Sufferers often <a href="http://www.ncbi.nlm.nih.gov/pubmed/2306288">have other health issues</a>, including sleep difficulties and fatigue. </p>
<p>For a long time, fibromyalgia was thought of as a medical mystery. Technological advancement has allowed us to look closer. Today, it is a recognised disorder, part of a group of chronic pain syndromes described as <a href="http://americanpainsociety.org/about-us/press-room/fibromyalgia-clauw">central nervous system disorders</a>. </p>
<p>The condition affects more than four times as many women as it does men. With <a href="http://www.ncbi.nlm.nih.gov/pubmed/7818567">as many as 2-5% of the developed world</a> living with fibromyalgia, it is far from uncommon. Yet targeted and effective treatment options aren’t available for the condition. And compared to fibromyalgia’s impact, this area of research remains highly underfunded.</p>
<h2>Chicken or egg?</h2>
<p>Fibromyalgia has a long history of stigma. Some explanations even pinned it <a href="http://scopeblog.stanford.edu/2013/08/13/fibromyalgia-living-with-a-controversial-chronic-disease/">down to being psychosomatic</a>, “made up” and “all in your head”, as well as a condition people needed to “just get over”. </p>
<p>There may be some truth in saying fibromyalgia is “all in your head”, but more as a reflection of associated brain changes than a figment of the imagination. An <a href="http://www.hindawi.com/journals/prt/2012/585419/">explosion of recent research</a> has shown <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3258006/">brains</a> of fibromyalgia sufferers are made up differently. There are variations, for instance, <a href="http://www.jneurosci.org/content/27/15/4004.full">in regions key to how we think and feel</a>.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/100125/original/image-20151029-15322-b3eoqm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/100125/original/image-20151029-15322-b3eoqm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=441&fit=crop&dpr=1 600w, https://images.theconversation.com/files/100125/original/image-20151029-15322-b3eoqm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=441&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/100125/original/image-20151029-15322-b3eoqm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=441&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/100125/original/image-20151029-15322-b3eoqm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=555&fit=crop&dpr=1 754w, https://images.theconversation.com/files/100125/original/image-20151029-15322-b3eoqm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=555&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/100125/original/image-20151029-15322-b3eoqm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=555&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Even the slightest touch can be sensitive for fibromyalgia sufferers.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/vaxzine/2642346629/in/photolist-52uHAv-pp7YBE-goCmpj-2kjSVv-gjn8K4-4QTDnm-veQ41f-zeen7c-5JywNQ-hgrWBb-pb9vUY-zDuRPi-9pn552-wN61eQ-pLM4Fq-aWz48r-5V3DUx-vpTg1L-6L12vv-h6bNVm-aeZNE2-zwVBuA-bnCWMZ-hkyUXn-aexdvy-bjSowZ-6vYLeq-gwXzyC-apcXUo-6yYVAK-6L4xdj-KzR53-gRVQ5S-8nEmvz-nxjKe1-6noCBP-5JsNAa-6CWBgP-6mdMbb-dwLgYp-5G9Ycs-pEPUfR-8yYFSu-bRXyo8-8HYk6L-7EnZAj-duCLte-5qPk8m-k4pFrn-jNYM1">vaXzine/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Although our understanding has taken a dramatic leap in the last few decades, we can’t shut the book on fibromyalgia’s exact cause or causes. The reported brain changes pose a real chicken and egg scenario: are these brain changes causing fibromyalgia, or is fibromyalgia causing the brain changes? </p>
<p>The condition may have multiple causes. Some suggest biological factors, including a <a href="http://www.ncbi.nlm.nih.gov/pubmed/17187510">genetic basis</a> for the disorder. Other research shows a history of <a href="http://www.ncbi.nlm.nih.gov/pubmed/20722042">sexual, emotional and physical abuse</a> among sufferers. <a href="http://www.arthritis-research.com/content/6/3/98">Psychological factors</a>, including responses to chronic stress, have also been shown to contribute to its cause. </p>
<p>None of these are likely to be independent of each other.</p>
<h2>Links to mood disorders</h2>
<p>Further complicating explanations of fibromyalgia include its <a href="http://www.hindawi.com/journals/prt/2012/486590/">link to other illnesses</a>, such as mood disorders like depression. This relationship likely reflects the fact they share some of the same biological processes, such as inflammation. </p>
<p>Inflammation occurs when injury or infection triggers the production of messenger molecules that flood to the site of injury as part of an immune response. <a href="http://www.nature.com/nrn/journal/v9/n1/full/nrn2297.html">It is now believed </a> that, like injury to the body, psychological adversity and mental illness can trigger the same immune response affecting the brain.</p>
<p>And recent research suggests the <a href="http://www.researchgate.net/publication/279299589_Bidirectional_Association_Between_Depression_and_Fibromyalgia_Syndrome_A_Nationwide_Longitudinal_Study">occurrence of fibromyalgia or depression may increase the likelihood</a> of the other. Regardless of what came first, though, the presence of mood disorders in fibromyalgia is <a href="http://www.researchgate.net/publication/45439877_Fibromyalgia_syndrome_and_depressive_symptoms_Comorbidity_and_clinical_correlates">linked to more pain</a> and reduced quality of life.</p>
<p>It comes as no surprise, then, that if medical professionals and scientists can’t explain what causes fibromyalgia, it is even harder for the person living with the condition. In fact, those diagnosed have <a href="http://www.ncbi.nlm.nih.gov/pubmed/22820966">a significantly harder time</a> understanding or explaining their pain to people with other disorders, like arthritis for instance.</p>
<h2>Treatment options</h2>
<p>It can take years to receive a fibromyalgia diagnosis, and some may have been misdiagnosed with one or more other conditions beforehand. This can be very frustrating for the patient as well as their doctor. </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/100126/original/image-20151029-15355-114v0a9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/100126/original/image-20151029-15355-114v0a9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/100126/original/image-20151029-15355-114v0a9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/100126/original/image-20151029-15355-114v0a9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/100126/original/image-20151029-15355-114v0a9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/100126/original/image-20151029-15355-114v0a9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/100126/original/image-20151029-15355-114v0a9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Despite the poor response rate, pharmaceutical methods are the main treatment option for fibromyalgia.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/fatmandy/125282049/in/photolist-c56Zk-65PyUt-7bcRAo-7b93mX-7bcSbd-aiJisn-a4Np1S-7bcTtj-7b942v-7b91Lt-7b977K-7bcSNb-7bcPoY-r7nCL-7bcPPu-4moWD6-4qzzzv-8ZpNUe-7Dsout-NsGJW-9ZYKte-bqCnhN-66xQyU-f1Vmj-89jusq-ebNVM8-nsnjck-dgA1YX-nAcUbq-e5PSvZ-Gj9AL-5f3ocG-qVvXtf-qgicVF-qg5Wtd-tJtjct-68UMtV-tJkbky-t4U6RW-7rhB2d-7b6fb7-6gnfen-AeS5k9-8ZiU7L-7qU1Bc-q2oo56-ceYBEy-pgHs4Z-cFe563-cy5SLS">Chris Frewin/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>Currently, the <a href="http://www.ncbi.nlm.nih.gov/pubmed/2306288">best method</a> of diagnosis is classification-based. Physicians assess the number of possible body areas where someone experienced pain in the last two weeks, and the severity of other symptoms, including fatigue and cognitive function. </p>
<p>Following diagnosis, there is no universally effective treatment plan. It usually includes a multi-method pain management regime from a team of health care providers. But <a href="http://annals.org/article.aspx?articleid=713152">responses to treatments</a> can be no better than chance, regardless of whether these are pharmacological or others such as acupuncture or hypnotherapy.</p>
<p>Despite the poor response rate, pharmaceutical methods are the main treatment option. <a href="http://www.sciencedirect.com/science/article/pii/S014067369904088X">Prescriptions are commonly</a> made out for non-steroidal anti-inflammatory drugs (such as ibuprofen), opioid analgesics (such as codeine), antidepressants, or anticonvulsants (drugs used to control seizures that also affect pain signals). </p>
<p>Because there is no clear treatment target for fibromyalgia, drug doses needed to manage symptoms have significant side effects. These include problems with thinking, drowsiness and the risk of drug dependency. </p>
<p>We don’t know exactly what causes fibromyalgia, but treatments need to be developed based on what we do know. For instance, we know there are brain changes. One promising treatment may therefore be brain stimulation techniques like <a href="http://www.maprc.org.au/dr-bernadette-fitzgibbon">Transcranial Magnetic Stimulation</a> (rTMS); a non-invasive technique that can change the activity of neurons in the brain.</p>
<p>There is a clearly an urgent need to provide targeted and effective treatment options for fibromyalgia sufferers. Considering how far we have come in explaining the unexplained pain of the condition, there is real hope for the future.</p>
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<p><em>This article is part of a series focusing on Pain. Read other articles in the series <a href="https://theconversation.com/au/topics/pain-series">here</a>.</em></p><img src="https://counter.theconversation.com/content/48319/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bernadette Fitzgibbon receives funding from National Health and Medical Research Council and Arthritis Australia. </span></em></p>Unexplained, chronic pain known as fibromyalgia affects up to 5% of the population. Yet there are no effective treatment options for the millions for whom each day begins with persistent pain.Bernadette Fitzgibbon, Neuroscientist, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.