There may be new – but ancient – good news for individuals suffering from a mysterious and often extremely painful condition that, according to the National Institutes of Health, affects an estimated 5 million Americans ages 18 and older with most diagnosed during middle age.
Fibromyalgia overwhelmingly affects women between ages of 20 and 60 and it is not unusual for patients to consult as many as ten physicians over a five year period before being properly diagnosed and receiving appropriate treatments.
There is no known cure for fibromyalgia, a frequently disabling condition characterized by chronic, widespread musculoskeletal pain and symptoms such as fatigue, joint stiffness and sleep disturbance; available treatments are only partially effective. However, there are some indicators that acupuncture may affect the brain’s ability to regulate fibromyalgia pain and may provide some relief.
“Because fibromyalgia is so destructive of both the individual patient and his or her family, it’s important to explore every possible avenue, including safe non-traditional or alternative approaches,” notes Miami-based counselor, Francis J. Flynn, Psy. D., CAP. “And it is critical for fibromyalgia patients to be as up-to-date as possible regarding new research developments and to be as proactive as possible in planning their treatment,” said Flynn, president of the Brain Training Centers of Florida.
New research, including a report from researchers at Louisiana State University and appearing in The Journal of Pain (June 2209) indicating that reductions in gray matter in parts of the brain and resulting from alterations in levels of the neurotransmitter dopamine may explain some of the abnormal brain morphology associated with fibromyalgia.
In addition, LSU researchers reported in the February 2009 issue of The Journal of Pain that widespread body pain may be associated with specific brain metabolite abnormalities in the hippocampal region of the brain. Because the hippocampus is especially sensitive to the effects of stress, fibromyalgia is considered a stress-related disorder. Brain imaging studies have indicated that there are central nervous system disturbances that occur in response to pain stimulation. It appears that exposure to chronic stress produces increased hippocampal excitability that may play a role in the exaggerated sense of pain experienced by fibromyalgia patients. As a result, brain metabolite abnormalities in pre-menopausal women can disrupt the hippocampus region and inhibit brain activity required for modulating stress responses.
While research continues to provide increasing insight into the origins of this chronic pain syndrome, a University of Michigan study may provide new evidence that traditional Chinese acupuncture affects the brain’s long-term ability to regulate pain. Writing in the September 2009 edition of the Journal of NeuroImage, researchers at the University of Michigan Chronic Pain and Fatigue Research Center showed acupuncture increased the binding availability of mu-opioid receptors (MOR) in regions of the brain that process and dampen down pain signals – the cingulate, insula, caudate, thalamus, and amygdala.
It is believed that opioid painkillers – morphine, codeine, oxycodone and other medications – work by binding to these receptors in the brain and spinal cord and the increased binding availability of these receptors is associated with reductions in pain. As a result, patients with chronic pain – as in the case of fibromyalgia – treated with acupuncture may be more responsive to opioid medications because the receptors seem to have more binding availability.
However, it should noted that a January 2009 report on the British Medical Journal website indicated that the pain relieving effects of acupuncture compared with a placebo are small and seem to lack clinical relevance. Researchers at the Nordic Cochrance Centre in Copenhagen analyzed evidence from thirteen pain trials – over 3,000 patients – and compared the results for real acupuncture, “pretend” acupuncture or no acupuncture – for a wide range of conditions including knee osteoarthritis, migraine headaches, low back pain, and post-operative pain. While real acupuncture afforded a small analgesic effect when compared to placebo acupuncture – a reduction in pain levels of about 4mm on a 100mm pain scoring scale – the effects were not of clearly clinical significance. The researchers reported that their findings question both the traditional foundation of acupuncture and the prevailing theory that acupuncture has an important effect on pain in general.
Significantly for fibromyalgia patients, in an accompanying editorial Dr. Adrian White and Dr. Mike Cummings of the British Medical Acupuncture Society suggested that, although the overall effect of acupuncture in relation to usual care is not large, it may be clinically relevant for musculoskeletal conditions, especially when there are few or no effective treatment options; this may be especially true of fibromyalgia patients and should be considered in light of acupuncture’s long-standing safety record.
During 2009, the Brain Training Centers of Florida worked with 6 clients with fibromyalgia; and reported nearly 100% percent long-term relief of symptoms. “It is clear that the brain is the focal or central point of whatever is happening with fibromyalgia. For these patients, accomplishing a healthier distribution of the energy in their brains allowed them amazing relief,” noted Dr. Flynn. “The hope is that by extending these initial studies to a larger number of clients, we may be able to provide an important adjunct to the treatment of this disabling disorder.”