An article titled “Inflammatory Fibromyalgia: Is It Real?” by Metyas et al (see library) took me completely by surprise.  At first I read it because I had a flashback to a certain doctor’s reaction to seeing the fibromyalgia diagnosis on my chart.  His eyes went blank and his whole demeanor yawned.  He no longer took me seriously nor did he intend to.  I was in his office because I couldn’t catch my breath, was having sharp shooting pains in my rib cage, and going downhill quickly.  He wasn’t too interested in the first place – I was his last patient of the day.  But he agreed to do an EKG and take an x-ray of my lungs, neither of which would pick up the massive pulmonary emboli I had in my lungs – blood clots in both lungs, all lobes.  Five days later, I woke up on the bathroom floor, spent a night in the ICU with a clot-buster, then five days in hospital, and a year on warfarin.  The diagnosis on my chart stopped him in his tracks from regarding me as anything but a psychosomatic whiner.  This is what I thought this article was going to be about, the validity of a fibromyalgia diagnosis.  My own defense mechanisms were up high enough that it took a little while for me to realize I wasn’t reading an article like that at all.

Metyas et al look at the possibility of a subset of fibromyalgia patients, a fairly substantial subset, actually.  Some fibromyalgia patients have elevated inflammatory markers, in particular ESR and CRP, and positive ANA and RF.  Yeah, I had to Google… ESR=erythrocyte sedimentation rate; CRP=C-Reactive Protein; ANA=antinuclear antibodies; RF=rheumatoid factor.

One of the major points Metyas et al make is that if there is a substantial subset of patients with abnormal inflammatory markers, then the American College of Rheumatology may need to amend its guidelines for fibromyalgia treatment, since it does not take into account any problems with inflammation.

And here’s where I realize, huh.  It never occurred to me that inflammation was NOT a part of the fibromyalgia process.  Ever since I can remember, pain was accompanied by inflammation.  When my joints hurt the worst, they are stiff and visibly swollen.  I can see inflammation in the soft tissue of my hands and feet in particular, again corresponding with the peak pain times.  I had no idea it wasn’t considered part of the fibromyalgia experience.

Live and learn!  For what it’s worth – I concur wholeheartedly that YES the American College of Rheumatology absolutely needs to take into account inflammation markers, and yes, doctors please consider these as a potential way of treating fibromyalgia.  I’ve asked more than one doctor if there was a way to reduce fluids in the joints to ease up pain: steroids, diuretics, etc.  None have taken me up on it – with my propensity to side effects, that’s probably good, but it’s still an unanswered question in my head.  If I wasn’t so swollen, would I have less pain?

A friend forwarded an article about the connection between arteriole-venous shunts and fibromyalgia (see “Fibromyalgia is not all in your head…” in library).  And I thought – of course! Silly me!  Why didn’t I think of that?  Essentially what the article is talking about is how people with fibromyalgia have more sensory fibers around the arteriole-venous shunts in the palm of the hand.  The arteriole-venous shunts are the little guys that connect arterioles (carrying oxygenated blood) and venules (carrying deoxygenated blood).  With more sensory fibers around the shunts, they malfunction and blood flow is disrupted.  This in turn, after a domino effect, contributes to the hyperactivity of the brain, which stimulates pain mechanisms needlessly.

At first glance it seemed the researchers were saying that the cause of fibromyalgia was in the palm of our hands, but those were just the shunts that they had studied. Other articles about the same research were clear that shunts throughout the body were probably malfunctioning the same as the ones in the hand.

I have to look further, but after a cursory review I’m not finding anything but a brief mention of this potential cause of fibromyalgia in 2014.  There is a strong connection between the study and financial support by medical industry, and the study essentially justifies the use of medications produced by these industry partners.  This does not necessarily make the study suspect or this potential cause out of the realm of possibility, but my eyebrows raise.  The meds that these industry partners produce do not cure fibromyalgia, they relieve the symptoms, so there is a strong conflict of interest.  Of course with the exception of the virus/infection theory, very few of the theories (including this one) seem to have any possibility of cure.  Symptom relief may be the best chance.  And inevitably, one of the meds that is mentioned is one I can’t take.  I haven’t tried the other one…

Last night was another Nanos workout.  We were working on core strength, so there were a bunch of sit-ups and dumbbell planks (not named for the intellectual capacity of the person doing this move).  However, we also jumped rope quite a bit, which is where the actual aerobic portion of the workout came in and, by my own theory, where the fibromyalgia pain fighting starts.

Make no mistake, aerobic conditioning will not cure fibromyalgia (I don’t think), but there are benefits to it that makes it an effective management strategy, and it all boils down to the four main foci for management:

1.  Movement.  Obviously.  You’re moving.  A lot.  It’s not something a lot of people with fibro can do.  However, the more you move, the more you CAN move.
2. Sleep.  Aerobic conditioning helps you sleep.  It would be interesting to look at the role of hormones in terms of sleep post-exercise.  Does releasing hormones during a workout enable the body to release sleep hormones better during sleep?  That may not have made sense…
3. Stress.  A workout absolutely helps release stress, not only mentally but physically too.  In some ways it’s kind of like hitting your head on a wall when you have a headache.  Your focus changes from the headache to the pain of hitting your head on the wall instead.  As warped as it is, you’ve CHOSEN to hit your head on the wall.  Pain/stress you choose is much easier to manage than pain/stress you have no say over.  (I do not advocate hitting your head against the wall).
4. Diet.  Reason would say the more you move the more you need to eat.  Really – no.  I think it’s because the body becomes more efficient with exercise.  Furthermore, there’s something about exercise that dampens cravings.  I’m not saying you’ll never indulge in comfort eating again, but it helps.

So in terms of my current fibro attack, I slept much better last night after the workout, but still woke up tired and wanting to sleep more.  This weekend I’ll work on catching up on sleep and doing some mild at-home exercises.  Fibro sometimes requires a quiet couple of days to recuperate.  That’s what snuggly cats are for, and movies, and a comfy couch….