Episode 1: Where is the fibromyalgia pain coming from?

In this first episode, I explain the difference between acute and chronic pain, or in in other words between the "regular" pain and "neuroplastic" or "brain" pain. The pain is always real, but it differs of where it comes from.

Hello there!

I am super excited to introduce you to my first Podcast ever called Winning At Fibromyalgia!

Episode #1: Where does the pain of fibromyalgia come from?

My name is Dr. Martina Ziegenbein, I am a board-certified Rheumatologist. For those of you who are wondering and do not know, Rheumatology is a field of Medicine that deals with all kinds of arthritis but also autoimmune conditions like lupus, vasculitis, myositis.

It is October 15th 2021 at the time of the recording. The reason I am excited about this podcast, is because I believe a solution for women with pain from ibromyalgia IS available! And I want to share it with every woman who suffers with fibro. But first let me explain a little bit.

Fibromyalgia is NOT considered an inflammatory condition at the time of the recording. It has many definitions in literature. It can be most simply described as “pain all over” that is often accompanied by slew of other symptoms including, but not limited to: brain fog, overwhelming fatigue, irritability, inability to concentrate, headaches, jaw or TMJ pain, IBS, vaginal or bladder pain (sometimes also referred to as interstitial cystitis). Many times patients with fibromyalgia also describe weird tingling or burning sensations in their hands or feet. Fatigue and pain are the most overwhelming symptoms and literally rule the life and make it miserable for many women who are unfortunate to suffer from it. Women are more often affected than men, and in summary, no one is really sure what is causing it. Genetic reasons, prior trauma (whether physical, emotional, or psychological) are all suspected causes. At the time of this recording, autoimmune origin was raised as a possibility in one recent research study but for the purposes of this podcast and discussion about fibromyalgia in general, the origin of the fibromyalgia pain is not believed to be autoimmune.

Rheumatologists usually see a patient with fibromyalgia for the initial consultation, to confirm the diagnosis and then generally the patient is returned to the primary care doctor with recommendations on what to implement in treatment plan.

I have been fascinated by fibromyalgia for a long time. I have been avoiding following these women regularly in my clinic initially, to give you a full disclosure. Reasons were several but mostly – the solution to pain felt too elusive and out of reach. Many times no matter what I tried for these patients, the pain would not remit or not remit consistently. Plus, I was reasoning, patients with Rheumatoid arthritis, psoriatic arthritis, gout and all the other diagnoses that also cause pain and suffering needed me more.

This has changed recently. I moved from Wi to Cape Cod in March 2021. I have been re-evaluating my career and I realized that I truly, really, want to steer toward helping women with fibromyalgia. I studied more materials, immersed myself in all things fibromyalgia and I am happy to report that I think solution IS AVAILABLE. Which is the reason for my excitement to start this podcast and share with all the women with fibro 

So the rest of this first episode is focused on the origins of the pain. What is causing the pain? First of all – PAIN IS REAL. In the past, many women felt not believed or dismissed because the pain was referred to as “psychosomatic” which for some reason meant that it was not real. Let me tell you – the pain IS REAL. You feel the pain, it hurts – the pain is real. However, the pain is not believed to be coming from the injured tissue or body – but rather from the brain or central nervous system! Let me explain.

When we sprain our ankle or burn our hand on the stove – the pain is referred to as acute. The pain recetors in the tissues that are injured communicate the information through neurons into spinal cord and from spinal cord the information goes into the brain. Brain tells us to stop doing whatever we were doing that injured us. We limp for a while, we have a burn on our hand, we heal and the pain resolves. I will refer to that pain as “plain” pain or “regular” pain. There is nothing exciting about it. It is a survival mechanism and was meant to alert us to danger. So far so good? Acute pain = plain or regular pain

Fibromyalgia pain on the other hand, is chronic, happening on daily basis and fluctuating in severity. It is a juicy and very exciting topic. There is nothing regular about it. Through rigorous and extensive research studying functional MRIs of the brain of patients with pain, it was discovered without any doubt that the chronic pain of fibromyalgia is basically a conglomerate of misfiring neurons. It is a mistake of the brain who is mis-interpreting regular signals from the body as “danger”. I just mentioned above that brain interprets pain as danger and that it is a survival mechanism. We are wired to interpret pain as danger. Danger is meant to put us on high alert. High alert means augmentation of our senses which can lead to (or even create) more pain. More pain leads in turn to more danger signals – which leads to more high alert messages to the brain which leads to more pain. It is referred to as NEUROPLASTIC or BRAIN PAIN. Chronic pain – neuroplastic pain. That means the fibromyalgia pain is brain pain, it comes from the pain.

I feel it is important to stress again that the pain IS REAL. There is nothing imaginary about the pain. But the origin of the pain is basically brain centers that are full of misfiring neurons that are dealing with faulty information.

As a side note, there are cases when chronic pain is NOT neuroplastic, for example patients with cancer or patients with severe damage to tissues that cannot heal – these patients have chronic pain that is not neuroplastic. OR they have a combination of acute and neuroplastic pain.

One other way (though not a perfect way) to distinguish between acute and chronic pain is response of the patients to usual medical interventions or surgeries. Acute pain tends to respond well to meds. Chronic neuroplastic pain usually does not.

The most exciting feature of the chronic pain is that it CAN Be made better. Our brains are adaptable. Neuroplasticity means that the brain pain pathways that are misfiring, CAN be rewired. And that Is why I am excited to start bringing this knowledge to all the women with fibromyalgia who have not been able yet to improve their pain consistently. It can be done and I will show you how.

So in summary, in this episode we covered the difference between acute or plan/regular pain and chronic pain of fibromyalgia that is also referred to as “neuroplastic pain” or brain pain. Stay tuned for next episode where I discuss how it comes to be. 