Brain on Fire: Unraveling the Inflammatory Mystery of Fibromyalgia
- May 7, 2023
- 7 min read
Updated: Jun 30, 2023
Episode 18: Is Fibromyalgia an Inflammatory Disease?
What can a lay person take from all of the pivots in research on the origins of fibromyalgia? It's not this, it's not that, it is this, it could be that. But it is clearly understood by most medical professionals that fibromyalgia is not "all in your head". It is not a psychological malady.
However, just 6 months ago when I started being treated for fibromyalgia, I was told by one of my doctors that fibromyalgia was not an inflammatory disease and that it was not a factor in treating my disorder. But rather, fibromyalgia is a disorder in the way the brain processes pain. In a sense, it is all in my head.
Later, I was told that fibromyalgia was not caused by inflammation but that inflammation in the body could be a cause for an uptick in fibromyalgia pain. Along with this I was served the anti-inflammatory diet rhetoric and how this was the path to relieving many of my fibromyalgia symptoms. It is not in my head, but in my body.
Now, I am learning that it is possible that fibromyalgia could be caused by inflammation and that fibromyalgia is the result of inflammation in the brain and central nervous system. Recent, studies are showing that inflammation plays a central role in the root causes of fibromyalgia. Again, it is all in my head.
Which one is is? Or, is it all of the above? In this post, I look at all three positions and come to some semblance of an understanding.
Claim 1: Fibromyalgia is Not an Inflammatory Disease.
The claim that fibromyalgia is not an inflammatory disease is scientifically true. Under examination, a person with fibromyalgia will not present with inflammation like you see in rheumatoid arthritis, lupus, or gout. This is the position of the American College of Rhuematology. The ACR explains the causes of fibromyalgia by first clarify what it is not, "Fibromyalgia is not from an autoimmune, inflammation, joint, or muscle disorder." To illustrate this, Dorothy Folz of the AARP wrote, "Fibromyalgia does not involve inflammation or damage to joints"; as to what it is, she continues, "Brain imaging and studies have shown that fibromyalgia is a disorder of the central nervous system". Many medical experts agree that fibromyalgia has its origins in the brain and spinal cord. In 2015, at the annual scientific meeting of the American Pain Society, Daniel Clauw, M.D., professor of anesthesiology at the University of Michigan addressed the attendees and explained that fibromyalgia was a pain processing disorder in the brain.
What does this mean?
Well, what it means is that the "pain-sensing system is out of whack", as the Cleveland Clinic so graciously puts it. People living with fibromyalgia feel pain more intensely and from things that people without fibromyalgia would not feel pain such as heat and cold. So, things that hurt - hurt more, and things that shouldn't hurt - do.
In response to this, we get anti-convulsant medication that acts as an analgesic and reduces the brains pain signals to the body.
Claim 2: Diet! Diet! Diet! Food is the Problem.
As soon as I received my FM diagnosis I was bombarded with pamphlets and articles that ensured me that my diet was the key to successfully overcoming the symptoms of fibromyalgia. I was informed that many foods can increase inflammation which can exacerbate the intensity and frequency of fibro-flares. In fact, this is true. Many foods are known to cause inflammatory responses. Dr. Vijay Vad of Arthritis-Health notes, "Food can promote inflammation in the body, which makes the body's pain receptors more sensitive. In effect, the body is responding to these foods as it would to an injury. For people with fibromyalgia, who already have an enhanced sensitivity to pain, this makes a difficult situation worse". As I explained in my post "Sugary Suffering", inflammation presses on nerve endings causing a pain response that is only increased in people living with fibromyalgia.
What does this mean?
An anti-inflammatory diet can be limiting and frustrating. It seems at every turn there is something you can't eat: from oils, to sugars, to meats, to dairy, to grains, to alcohol - they can all increases inflammation in the body. Avoiding all the foods can be nearly impossible. However, as this relates to fibromyalgia, the American Pain Consortium asserts, "A diet that’s free of all inflammatory foods may be impractical, but limiting the intake of these foods could help lessen the intensity and frequency of fibromyalgia flare-ups and is better for overall health". Being careful to avoid these foods can, indeed, decrease the severity and recurrence of fibromyalgia flares.
In response to this we are advised follow a tailored diet that limits the intake of inflammatory foods.
Claim 3: New Evidence Says My Brain is Inflamed?
So, Inflammation does play a role in this disorder? It sure does. Recent studies show abnormal neuroinflammation in the brains of patients with fibromyalgia. Adrienne Dellwo, a journalist with expertise in fibromyalgia explains, "We're taking a second look at inflammation in this condition, thanks to a growing body of work suggesting it may play a role, after all". She continues explaining that the fascia, the thin tissue that encases organs, muscles, and nerve fibers may be inflamed causing fascial dysfunction and, "may be what leads to central sensitization, which is believed to be a core feature of the illness". Central sensitization causes individuals with fibromyalgia experience heightened intensity of pain along with other sensory experiences, such as sound and light.
What does this mean?
Well, it means that scientists are going beyond what you put in your body and the sensations your body feels as a result of this disorder. Researchers at The Cleveland Clinic explain, "Scientists are finding evidence that points to a likely suspect: neuroinflammation, or inflammation in the brain". Neuroinflammation is a response in the brain or spinal cord caused by stressors such as injury, disease, or physical and/or emotional trauma. This research is backed up by Geoffrey Littlejohn & Emma Guymer. In their work with the NIH they have found: "...evidence of neurogenically derived inflammatory mechanisms occurring in the peripheral tissues, spinal cord and brain in fibromyalgia." My brain is inflamed.
Clearly, it is not like I have this big old swollen head, but that the tissues surrounding my brain and spinal cord are possibly inflamed leading to an "explosive" response to pain.
Bringing it Home: It's In the Head, the food, and In the Body
As we know, fibromyalgia is a complex disorder; research shows that it involves maladaptations in the pain processing center, as well as neuroinflammation in the brain. Though there is disagreement among experts about whether fibromyalgia is an inflammatory disorder, emerging research suggests that neuroinflammation may play a role in the development of fibromyalgia. With this in mind, it is possible that an anti-inflammatory diet can play a role in pain relief and may help to reduce the severity of symptoms by reducing inflammation in the body.
In the meantime, as people living with fibromyalgia, we should work with our healthcare providers to develop a comprehensive treatment plan that may include a combination of medication, therapy, exercise, and lifestyle changes, including a healthy diet. While an anti-inflammatory diet may be a part of this plan, it should not be considered a cure-all for fibromyalgia.
My response to all of this? A multidisciplinary approach to treating fibromyalgia may be the most effective way to manage this complex condition.
If you enjoyed this post, share it with your friends and colleagues, and consider becoming a subscriber. If you have any tips or suggestions about how to better cope with chronic pain, leave a comment. I would love to hear from you!
Karen Palmen, EdD is a veteran educator in Saint Paul, Mn. She teaches Dance and English at Saint Paul Central High School. She has an active TikTok page that features humorous, political, mental health, and educational content (kickin it with karen). And a a dormant YOUTUBE channel with the same name, featuring fermented foods and other cooking oddities.
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