Fibromyalgia Pain Isn’t All In Patients’ Heads, New Brain Study Finds
A new brain-scan study confirms scientifically what fibromyalgia patients have been telling a skeptical medical community for years: They’re really in pain.
In fact, the study finds, people with fibromyalgia say they feel severe pain, and have measurable pain signals in their brains, from a gentle finger squeeze that barely feels unpleasant to people without the disease. The squeeze’s force must be doubled to cause healthy people to feel the same level of pain — and their pain signals show up in different brain areas.
The results, published in the current issue of Arthritis & Rheumatism, the journal of the American College of Rheumatology, may offer the proof of fibromyalgia’s physical roots that many doubtful physicians have sought.
As one of the first psychiatrists to pay attention to the then-new entity of fibromyalgia, I wrote and taught about it from two perspectives — both the importance of recognizing the reality of mysterious mind-body complaints and the suffering they cause, as this study points out; and the nondiscriminating way these diagnoses become fads and are applied broadly by clinicians jumping on a bandwagon and by patients invested in the diagnoses as explanations of their vague malaise. Fibromyalgia is one of the more recent entities to occupy what is a perennial niche for controversial syndromes at the interstices of various medical specialties. Some go on to be dismissed as passing fads, others go on to gain scientific veracity, and others linger for quite a long time in a never-never land between those two extremes. So, while the present study makes sense — if the fibromyalgia patients are carefully selected to be a homogeneously, rigidly-defined sample, there will be some objective findings — I would also assert that this probably applies only to a very small subset of patients diagnosed with fibromyalgia in the ‘real world’, and should not be used to legitimize the indiscriminate, ever-broadening application of the label to patients whose suffering should more properly be understood in different (psychological, usually) terms.
Hal Rager, of the weblog blivet, wrote to point out to me that he was a fibromyalgia sufferer. Here’s his take on the same research report:
I was extremely ill six years ago, and fibromyalgia was one of the constellation of things I was diagnosed with. I accept that there may well be a psychosomatic component to fibromyalgia, but I resented like hell the implications by some that my pain was fabricated. If the brain is registering pain, it’s pain. It may be being caused by problems with brain chemistry, but the pain was as real as pain gets.
By the way, there are far broader implications of this study. The assessment of subjective complaints of pain against some objective standard has long been a Holy Grail across disciplines of clinical medicine, for obvious reasons. Longtime FmH readers will know how excited I have been with the developments we’re seeing with functional brain imaging such as fMRI. If it finally allows us to verify and perhaps grade pain experiences (by watching brain regions involved with noxious experiences), we may yet drink from the Grail. Not only could this give guidance to the bitter problems of both the overmedication and undermedication of pain, but might we more readily empathize with neurological analogues to fMRI patterns that indubitably entail pain in humans when we see them in non-human species? On the other hand, how brightly a signal lights up on some objective scale on an fMRI reading doesn’t tell the whole story. By a sort of physiological “Peter Principle’, the subjective experience of pain probably expands to fill every bit of the space allocated for it, and is that any less real?