Why Chronic Pain and Fibromyalgia Challenge Pain Specialists

19 07 2012

Sticky Tongue to Ice Can Be Painful

Chronic Pain Syndrome (CPS) is a poorly defined condition “and somewhat” similar to fibromyalgia as a chronic pain experience.  CPS is where a neurologically based pain has not resolved, or finding the exact cause of pain may have not been identified.  We’ve all experienced pain at one time or the other, e.g., a broken bone, or speck of dirt in the eye, a bruised, or strained muscle, or maybe you’ve been unfortunate enough to experience a passing kidney stone.  These painful experiences are considered temporary or acute pain conditions.  If the injury heals then the acute pain will typically resolve itself within a 30 day window.  The difference between chronic and the acute pain, you healed and are no longer in pain, or that pain is triggered infrequently when aggravated.

If a pain condition has not healed significantly after 30 days, or you still experience significant pain for a 3-6 month time period, this is a chronic pain condition.  Those diagnosed with CPS can appear to experience pain all over and at any point of the neurological body.  This is much akin to those that experience frequent phantom pain anywhere at any time throughout the body.  You hurt and the pain varies in frequency and intensity throughout each day.  Nevertheless, your body always seems to be in pain.  For those with this type of chronic pain it is much harder for medical specialists to explain what is causing it, especially when a pain origin is not obvious.  Understanding and treating a CPS is certainly a challenge for the medical professional.

The most mysterious thing about CPS is that the chronic pain conditions can occur without evident exasperation, or aggravation of past injury, illness or disease.  And on the other hand, chronic pain can be a substantiated medical pain origin finding caused from illness and disease, i.e., cancer, immune disorders, rheumatoid arthritis, migraines, back condition(s), past injuries and other radiating neuropathies that affect and cause pain.  CPS is typically a complex treatment pain story “often” without an origin of pain and/or lacks medically substantiated cause of injury or disease.

Regardless of pain origin or cause, or lack thereof, chronic pain patients will require a pain management specialist or team of various resources to treat a complex pain etiology, especially if the cause is unclear.  Those resources might include acupuncture, electroneuro-stimulation, hot/cold modalities, exercise, physical therapy, specialized diet, supplements, pharmaceuticals, or deep muscle massage, etc.

If you’re a pain patient with unexplainable pain and you’ve not been diagnosed with fibromyalgia or some other form of immune disorder for example, you may likely be diagnosed with CPS.  What is the difference between the two diagnoses?  Fibromyalgia is a neurosensory disorder where one feels widespread pain throughout the body, but most specifically; joint and muscle stiffness and pain with fatigue.

During the early years of fibromyalgia diagnosis, it was thought this type of pain originated from the brain and where chemical imbalance may be connected somehow to the cause of muscle and joint pain.  In other words, at one time a great portion of the medical community believed it possible to think the pain and from the psychosomatic (brain-body) connection, the pain manifested itself into chronic pain.  Although this is partially true, it is not the whole truth.

The American College of Rheumatology diagnosis criteria has proven that the origin of pain does not solely stem from a brain signal that produces the pain.  Instead a physiological chemical shortfall is present in many pain patient cases that prevent the patient from completely alleviating pain.  In my mind, this would be the equivalent of a person whose immune system is down, gets a cold and can never completely get rid of the cold.  So you always feel under the weather sort of speak and where it does not take much physical activity or stress to aggravate low-sensory acute pain to a high chronic pain condition.

Another difference between fibromyalgia versus CPS appears to be three primary symptoms for those that suffer with fibromyalgia:  Muscle tenderness, aches and joint pain, which produce stiffness and fatigue and/or emotional stress that can continue for years.  There also appears to be a chemical identifier in the way fibromyalgia pain origins present pain symptoms.  That’s where the neurosensory pain connection between the brain and spinal cord are now known to be chemically interlinked.

People with Fibromyalgia tend to have a low chemical P substance, and low levels of neurotransmitter chemical production of dopamine, serotonin and norepinephrine.  It appears pain patients with a low P substance condition are more sensitive to acute low sensory pain perceived by the brain and spinal cord.  So it can be stated, if our bodies are low on P substance and neurotransmitters, anyone of us would be susceptible to low-acute to chronic pain conditions by lacking the ability to immunological and physiologically low stress environmental aggravation we’d not experience otherwise.

If our ability to produce natural pain alleviating chemicals is compromised than it is reasonable to deduce this makes pain patients more likely to be sensitive to daily stress.  And this everyday stress pain could be amplified 10-fold from the way anyone else would experience it given the same environment.

So the stress most of us experience daily is likely shielded chemically by normal levels of P substance and natural neurotransmitters in the body.  If pain protection is not chemically balanced to shield the body from the mental to physical pain, then those that lack this protection will experience more pain.  In time this can chronically fatigue a person into manifesting itself into illness-disease and painful medical condition.

Patients now diagnosed with fibromyalgia are taken much more serious as a real chronic pain condition where chemical deficiency and immune systems are likely compromised.  I suspect there are many hormonal and chemical imbalances within the brain-body barrier that creates an unshielded pain recipient experience.  It is amazing to realize that ~35% of all Americans have some form, or have experienced chronic pain.  And some 50 million have experienced partial to full disability due to chronic pain.

Many patients that experience CPS also experience the same internalizing and rationalizing effect of fibromyalgia depression for lack of ability to provide help for self and family.  This depression stress is often brought about by the obvious… Chronic unrelenting pain and addiction to pain alleviation drug use, anxiety, fatigue, reduced activities including sexual desire, and maybe simultaneous experience of other disabilities that are secondary to the primary cause of pain and medications.

This vicious cycle of internalizing and inability to control the pain becomes exhausting and to the point where it is difficult to get a good night sleep.  If this exhaustion cycle is not alleviated the calamity of suffering, sleeplessness and sadness can have a demoralizing impact on self and family.

CPS, fibromyalgia and chronic fatigue pain patients are typically treated as outpatients and require a variety of pain alleviation drugs and other clinical resources to help manage their pain.

If you experience chronic pain, and/or pain depression and anxiety and are experiencing a complex pain condition and need help, be sure to seek medical referrals to a pain management specialist, rheumatologist, immunologist, or physiatrist through your primary care physician to get the treatment you need.


The Free Dictionary, by Farlex.  Fibromyalgia.  http://medical-dictionary.thefreedictionary.com/fibromyalgia

Dellwo, Adrienne. About.com. Fibromyalgia and Chronic Fatigue.  July 2, 2012.  http://chronicfatigue.about.com/b/2012/07/02/sound-off-about-symptoms-fibromyalgia-chronic-fatigue-syndrome.htm

Wikipedia.  Chronic Pain.  http://en.wikipedia.org/wiki/Chronic_pain

Health Encyclopedia – Diseases and Conditions.  http://www.healthscout.com/ency/1/629/main.html

Singh, Manish K. Chronic Pain Syndrome.  Medscape. http://emedicine.medscape.com/article/310834-overview

Woodamarc.  Pain Depression Origins.  Hubpages.com. http://woodamarc.hubpages.com/_sigsinmula/hub/Pain-Depression-Origins

Marc T. Woodard, MBA, BS Exercise Science, USA Medical Services Officer, CPT, RET.  2012 Copyright, All rights reserved, Mirror Athlete Publishing @: http://www.mirrorathlete.com,  Sign up for your Free eNewsletter.



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