The feeling of pain
begins when outside stimulus, like stubbing your toe, activates nerve endings.
These nerve endings then send a message to the brain that activates sensory
signals producing the feeling of pain (Osterwise, M., Kleinman, A., &
Mechanic, D. 1987). However, what happens when these nerve endings are always
sending signals to your brain to produce the sensation of pain? This is what
occurs in Fibromyalgia, a condition that effects 2% of the US adult population,
including myself. Fibromyalgia is a
chronic disorder that causes widespread pain, fatigue, and emotional/mental
distress (Centers for Disease Control and Prevention 2020). Those with
Fibromyalgia have abnormal pain perception processing. This means that they are
more sensitive to pain or may even feel pain in situations that would not
normally promote pain (Centers for Disease Control and Prevention 2020). It is
as if your nervous system is on overdrive, or your foot is always on the gas.
Fibromyalgia symptoms include pain, fatigue, problems with memory and
concentration (Fibro Fog), as well as depression and anxiety. There is
currently no cure for Fibromyalgia and is treated via medication, physical
therapy, and stress management.
Fibromyalgia brings up an
interesting topic on pain sensation (Centers for Disease Control and
Prevention). There is a neurological cause to pain, but each person feels pain
differently (Osterwise, M., Kleinman, A., & Mechanic, D. 1987). The way I feel pain is not the way my
classmate would feel pain. For me, I feel pain 24/7 but have become used to the
sensation. My normal pain level is a 1 on my version of a pain scale but for
others it may be a 5 because they aren’t used to a daily sensation of pain.
Fibromyalgia has changed my perception of pain which has made me wonder how
others would feel if they experienced pain the same way I do.
Centers for Disease Control
and Prevention. (2020, January 6). Fibromyalgia. Centers for Disease
Control and Prevention. Retrieved October 2, 2022, from https://www.cdc.gov/arthritis/basics/fibromyalgia.htm#what
Osterwise, M., Kleinman,
A., & Mechanic, D. (1987). The anatomy and physiology of pain - NCBI
bookshelf. National Library of Medicine. Retrieved October 2, 2022, from
https://www.ncbi.nlm.nih.gov/books/NBK219252/
You allude to an interesting, complex, and tricky phenomenon to understand. Perception. From my experience in an Emergency Department we ask every patient to rate their pain on a scale of 1 to 10 and have to chart it as if it is an essential data point in diagnosing and treating patients. While it may give us some measurements on how to treat patients for pain, the scale of 1 to 10 seems arbitrary with minimal benefits, yet no risks. Do we need to have some exact standardized scale of pain? I don't believe we do. To treat a patient properly, in regards to pain, we need only their perceived scale of normalcy to excruciating pain. Even for larger studies, the change in perceived pain can be normalized and aggregated to draw larger conclusions on conditions, pain, and treatment.
ReplyDeleteFibromyalgia is a very complex and interesting disease and there are many ways to look at treatment options. The three major options are serotonin reuptake inhibitors (SSRI’s), neural anticonvulsants, or muscle relaxers. Let’s take the time to break them down and think about why they might curb symptoms.
ReplyDeleteSSRI’s are used for anxiety and depression mostly. This classification of drugs inhibits the reuptake of serotonin (Chu and Wadhwa 2022). In a study done by Walitt et al. in 2015 did a double blind where they tested the effects of the medication on pain and depression. The only symptom that was statistically improved was depression symptoms.
Anticonvulsants, or seizure medication can be used to depress overstimulation in patients that present, well, with overstimulation conditions. The drug works by enhancing the production of the neurotransmitter GABA, which is widely accepted as inhibitory for post-synaptic neurons (Taylor, 1997).
Lastly, muscle relaxers can be used to inhibit the functionality of Ach receptors. This classification works by declining tonic motor stimulations (Khan and Kahwaji, 2022).
Now this condition stems from prolonged sensation of pain. This sensation comes from the afferent system as it travels from receptors to the brain to be processed. The best medication would inhibit this signal to be transduced. How? We decrease the ability to generate an action potential… by inhibiting voltage gated sodium channels.
This could work… but there are many more clinical implications that could arise with treatment by this way that could hinder its ability to be a medication used to aid those who are struggling.
Chu A, Wadhwa R. Selective Serotonin Reuptake Inhibitors. [Updated 2022 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554406/
Taylor C. P. (1997). Mechanisms of action of gabapentin. Revue neurologique, 153 Suppl 1, S39–S45.
Walitt, B., Urrútia, G., Nishishinya, M. B., Cantrell, S. E., & Häuser, W. (2015). Selective serotonin reuptake inhibitors for fibromyalgia syndrome. The Cochrane database of systematic reviews, 2015(6), CD011735. https://doi.org/10.1002/14651858.CD011735