Another Theory: Childhood Trauma

Probably the most agreed upon aspect of fibromyalgia is the variety of experiences people with fibromyalgia have, which makes fibro very difficult to pin down in terms of diagnosis, management, treatment, and possibly above all, pinpointing the trigger or mechanism that causes fibromyalgia.  I’m not sure, but I think the trigger has to be identified before an ultimate treatment can be developed.  There are common threads, but not a lot and the only one I’ve found that came in at 100% of patients in a study was an abundance of mast cells (another page coming someday).  However, another common experience which has been highlighted a lot is early childhood trauma or stress.  Not everyone who has been exposed to trauma as a child develops fibro, and not everyone who has fibro has undergone early childhood stress.  It’s not even close to 100%, but the percentage is relatively high (I’ll find the estimate somewhere).

Most often when I’m reading about early childhood trauma the focus is on abuse and neglect, such as sexual abuse in female fibro patients.  However, apparently physical problems as a newborn is also a possible cause, in particular premature babies who undergo surgeries or hospitalizations.

Unfortunately, this possible connection can be used to reinforce a psychological rather than a physiological cause, which seems like it would limit the possibility of coming up with viable solutions in terms of treatment and prevention of fibromyalgia.  It’s too limited.

However, emotional and physical trauma in early childhood results not just in psychological trauma but also alters the way the pain processing system develops, thus possibly paving the way for the development of fibromyalgia later in life.  I suspect that there is a combination of at least two elements for this possible trigger – early life trauma, which causes  a genetic predisposition plus a genetic predisposition.  Burke et al relate genetics, early-life stress, inflammation, and altered brain structure to the development of fibromyalgia.

Burke et al, “Psychological Stress in Early Life as a Predisoposing Factor for the Development of Chronic Pain: Clinical and Preclincal Evidence and Neurobiological Mechanisms”review different studies (primarily rat studies) that look at the physiological effects of childhood stress/trauma.  Please see the library for full citation.  A few notes from the article:

First, stress is not stress is not stress is not stress.  The baby rats that were experimented on were subjected to a wide variety of stress.  The three main types of stress were maternal separation, maternal deprivation, and neonatal limited bedding.  Both maternal deprivation and neonatal limited bedding mimicked parental neglect of a young one. Maternal separation was when the babies were separated from the mommies, not necessarily permanently but for periods of time.  There were a lot of nuances in the degrees of deprivation and separation, and they were mixed occasionally with pain stress along with the psychological/emotional stress.  What’s remarkable is that for each of the different scenarios, there are different physiological outcomes.  MS victims do not have the same outcomes as MD or NLB victims.

Second, female and male rats do NOT have the same outcomes in the same scenarios. There are distinct differences in the way female pain processing systems develop under stress and the way male pain processing systems develop under the same stress.  It’s remarkable.  It is possible, with the results they discuss, that male rats need more stress to affect their development than females do.  However, there are still scenarios that affect male rats more than female rats, so it’s not a matter of male rats being “tougher.”

Third, it seems established by the studies they are reviewing, there is a difference between how the body reacts to sudden and short-lived stress and how it reacts to long term stress.  For acute stress, sudden and intense, short term stress, the body shuts down the pain processing system so it can react unencumbered by pain.  This is what allows people to perform superhuman feats to rescue or protect loved ones in times of danger or crisis.  At the opposite end of the spectrum, chronic pain actually physically increases the pain receptors in the body, so when the system becomes sensitized, it’s not “all in your head,” it has actually changed your pain processing system.

There are several parts of the brain whose development is altered by the physical stress of childhood trauma:

  • The amygdala is affected and then affects the production of “endogenous opioid dynorphins and enkephalan.”  In short, the body’s natural pain killers.  The hypothalamus, substantia nigra, and periaqueductal gray are also altered, which results in further inhibition of these natural pain killers.  In men, a disruption to genetics of the hippocampus can also increase this possibility.
  • The nucleus accumbens and dorsal raphe nucleus in which serotonin and serotonin metabolites are increased.  The amygdala connects to the limbic system and dopamine, which is another possible contributor or mechanism for fibromyalgia.
  • The subgenual cingulate cortex is affected in females (primarily those also affected by IBS).  Early childhood stress causes the cortex to be thinned.  There are also changes in the frontal cortex not necessarily only affecting females.

Besides brain structure changes, inflammation markers and the immune system are also apparently affected, and people who are subjected to early life stress can be susceptible to inflammatory disease, such as arthritis.  This reinforces the need to look beyond stress as creating a psychological storm that then triggers fibro, which then becomes “all in your head.”  No one has ever told people with arthritis the pain was all in their heads.  In essence early childhood trauma sort of “primes” the immune system, which (I think) then causes the over-development of the pain processing system.  It would be interesting to see what connection there is to early-life stress and autoimmune disorders.

Early life stress also affects genetics, note the opioid, immune, and cannabinoid systems mentioned above.  But it also causes a change in phenotypes.  This goes over my head (again), but a change in phenotypes means that the way cells “read” genes (presumably what the function of the gene is) is altered.  This reminds me of the connection of mitochondrial changes that have been pointed out in fibro patients (I have to find the reference – it’s in the library).

Finally, yes, the psychological.  Stress/trauma in early life definitely affects psychological development, pulling in the tendency to depression and anxiety in chronic pain/fibromyalgia patients.

Looking at early-life trauma as the trigger for fibromyalgia really actually pulls a lot of the disparate research on fibromyalgia together.  Furthermore, the pieces that don’t directly interconnect with childhood stress/trauma may connect together like dominoes.  The finger that starts the dominoes falling is trauma/stress, which changes the development of the pain processing system, which affects the way different chemicals/hormones are released, which then causes other symptoms, etc etc.  Since there are different physiological consequences of stress/trauma in developing systems depending on the stress/trauma situation, it’s easy to imagine a myriad of domino mazes, some small, some gargantuan, depending on the severity and symptoms, hence the enormous diversity in symptoms, management techniques, and possible treatment options.

Personal reflections on my childhood – do I fit this mold?  On the whole I had a comfortable childhood with loving parents, a safe environment, and all the necessities.  I don’t remember it, but when I was a baby, I wore casts on my legs – I’ve seen pictures.  So I was learning to crawl and walk with casts.  The reason was because of being pigeon-toed, and it straightened my feet and legs.  I think that was probably the only physical hardship I had.  Is that enough to have altered the development of my pain processing system?  I don’t know.  I’ve mentioned what I believe is a genetic tendency in my family for chronic pain as well.

A few questions: When is the pain processing system fully developed?  Is it possible that it can be altered later in life if there is a long term, constant severe stress for an adult?