It’s not a disease of tissues, however, but a disorder of the central nervous system, brain and spinal cord “masquerading” as something musculoskeletal, Wood said, explaining that fibromyalgia patients suffer from an imbalance in neurotransmitter brain chemicals that affect their pain sensitivity. In work published this February, Wood and colleagues conducted brain-scan studies involving dopamine, a neurotransmitter that when released into the brain, can control the pain experience. (Dopamine has been found to play a role in schizophrenia and Parkinson’s disease.) The researches used the brain scans to look at the differences between fibromyalgia patients and healthy subjects when given a painful stimulus. The results showed the healthy subjects releasing dopamine but not the fibromyalgia patients, who experienced more pain than their dopamine-releasing counterparts—“evidence that [they] have an abnormal dopamine response to pain,” according to the study. In another new study featuring brain scans (published in March by the American College of Rheumatology), Michigan’s Clauw and colleagues looked at the pain interaction of another powerhouse neurotransmitter, glutamate. They did brain scans that examined glutamate levels in FMS patients before and after pain-reduction treatments that didn’t involve drugs. After four weeks of treatment, the participants’ pain levels and their brain glutamate levels both went down. Patients with greater reductions in pain also showed corresponding greater reductions in glutamate. Such brain scans prove that “patients are telling the truth” about their symptoms, Clauw argued, adding that the notion of fibromyalgia as a psychological disease “is not supported by imaging studies.” Moreover, studies have revealed interesting differences in gender when it comes to pain response, which may underline fibromyalgia’s strong presence among women. A 2002 study published in the Journal of Neuroscience looked at the body’s built-in opioid or “natural high” endorphin system, examining individual differences in pain response. In a brain-scan study of 14 men and 14 women who received the same painful stimulus, the women reported more intense pain and more negative emotions than the men. All of the women were studied at a time in their menstrual cycle when levels of estrogen were low. When women with high estrogen levels were exposed to the painful stimulus, they released more endorphins and became better at damping down their pain, resembling the pain responses of their male counterparts. This gender difference in pain response made sense in light of what is already known about women and pain, according to Dr. Jon-Kar Zubieta, a University of Michigan neuroscientist who led the study. “Women experience chronic pain syndromes more frequently, often in tandem with stress-related mood disorders, and they are also more sensitive to the effects of opiate drugs,” he explained. In 2003, University of Michigan researchers summarized their estrogen-pain findings at a meeting of the American Association for the Advancement of Science. They said brain scans demonstrated that variations in women’s estrogen levels can affect the brain’s “natural high” chemicals, the endorphins, and thus alter the body’s natural ability to suppress pain, with low estrogen levels resulting in less effective pain control. In addition to breaking down bias, all of these studies could open the door to new treatments for patients. Glutamate, for instance, could be a new target drug for fibromyalgia and pain control. Wood of the National Fibromyalgia Association noted that three fibromyalgia drugs currently in the pipeline and likely to be approved for patient use in the near future either raise the levels of neurotransmitters that normally stop the spread of pain, or lower the levels that increase pain’s spread. With evidence like this piling up, most researchers now accept FMS as a distinct medical syndrome. “There’s a consensus,” said Richard E. Harris, a colleague of Clauw’s at the University of Michigan Medical School, although Harris admitted that there remains a group of clinicians “reluctant to embrace it,” estimating that they make up about a quarter of all practicing physicians. After the Diagnosis “Getting a diagnosis doesn’t have to ruin your life,” Matallana said. “It will change it, but having a positive attitude and partnering with a good health care provider can be helpful, as can, especially in the beginning, a good support group.” Experts say that the kind of physician you see as a fibromyalgia patient is less important than whether or not that doctor is up to date, empathetic, and willing to work with you on what can be a complicated course of treatment. “What you really have to do is find an empathetic and caring physician who believes your symptoms are real,” Clauw said. Primary care physicians, family doctors, internal medicine specialists, rheumatologists and pain specialists can all offer valuable help. Other kinds of caregivers such as physical therapists, massage therapists, acupuncture experts and exercise specialists such yoga instructors are also recommended as possibilities, depending on the patient. Then, after dealing with the disease to the best of your ability, you need to “move beyond it,” Matallana advised. “Don’t let it be who you are.” Carolyn Cosmos is a contributing writer for The Washington Diplomat. Resources National Fibromyalgia Association: www.fmaware.org Pain Connection Chronic Pain Outreach Center: www.pain-connection.org Fibromyalgia online tutorial from the National Institutes of Health: www.nlm.nih.gov/medlineplus/tutorials/fibromyalgia/htm/index.htm The Food and Drug Administration’s consumer Web site on living with fibromyalgia: www.fda.gov/consumer/updates/fibromyalgia062107.html Angler Biomedical Technologies, LLC, the Web site of Dr. Patrick Wood, medical advisor to the National Fibromyalgia Association: www.lifebeyondpain.com “The Complete Idiot’s Guide to Fibromyalgia” co-authored by Lynne Matallana: available at area bookstores and www.amazon.com

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