Invisible Pain

My rule number two for treating pain is that I must have a diagnosis. The question is, how can I get a diagnosis if I can't see, touch, feel or measure pain?

Pain is a personal experience. It has to do with the central nervous system, and it has a lot to do with “inside out” as opposed to “outside in”.

People think of pain as a broken bone. True, but what about that abdominal pain. It doesn't always have characteristics that are very definitive. You stick your finger on a pin, and the pain is right there. Or you put your hand on a hot plate, the pain is right there. 

But pain such as abdominal pain, cramping, and aching, those types of pain can be really hard to characterize. Also the fibromyalgia pain, the interstitial cystitis, you have a bladder that hurts, or muscle that hurts, but is it really a bladder problem or a muscle problem?  It might be.

Fibromyalgia Vaccine

We can get deeper into that with fibromyalgia. In reality, fibromyalgia really doesn't have a test - there are some people out there that say they have a test that looks at certain inflammatory markers. It's expensive, and they look at genetic markers. They believe there's a “vaccine” that's possible for fibromyalgia. Well, I don't know everything, but I’m a wait-and-see guy. Let's see the science. 

I do believe in a few other things that are invisible, for example, a central nervous system pain that is “inside out”, not “outside in”. This can be what you can't see, touch, feel or measure, which are so many of the common pain complaints. 

Take for example headaches. Everybody believes in headaches, because most everybody has had one!

On the other hand, people don't always believe in fibromyalgia because they don't understand what fibromyalgia is. Likewise interstitial cystitis, chronic fatigue, irritable bowel, and fibromyalgia with headache.

Glial Cells and Pain

The newer stuff neurobiologically and newer sciences talk about glial cells. Glial cells are support cells for the central nervous system and neurons. Their activation and the process of neural inflammation is really coming to the forefront of understanding of what chronic pain is all about. 

Chronic pain happens acutely, and acute pain happens chronically

There is a very gray distinction between chronic pain and acute pain.

In fact, studies have now shown that you can almost tell, with a very high level of confidence, who is going to have chronic pain from the time of injury, such as low back pain. 

This is through functional magnetic resonance imaging. FMRI. There is a footprint. There is also a footprint with fibromyalgia. There is also a footprint with other types of pain. In the brain there are actually neurological changes.

Central Nervous System and Pain

What does all that mean?

It means that the central nervous system is actively involved in what you feel. 

Don’t discount the central nervous system. “Inside out” as opposed to “outside in”. If it's muscle pain, then it must be fibromyalgia - not necessarily.  There are some biomarkers that look like the muscles may have a neural hormonal effect. Traditionally we can't put nerve conduction studies into the muscle or do a muscle biopsy and see anything. You just can't do it, it's just not there.

So what gets discounted? Rule number two, the diagnosis. You can't see, touch, feel or measure the pain. You have to believe in something you can't put a diagnosis on and that. you don't have a test for. 

What happens?

Most folks, and I'm talking across the board from family and friends, all the way to health care providers, don't necessarily believe in fibromyalgia. They don’t believe in invisible pain.

This is step one in that process of walking that journey and understanding pain. It has to do with age, genetics, and even your personal experiences  - that all plays into it.

But the reality is that sometimes this process of neural inflammation is a big part of treating you.

Pain Medications for Fibromyalgia

We treat you with rule number four, know thy meds. Know five medications in each of the five categories. One of my categories is gabapentinoids. Gabapentin, which is brand name Neurontin, and pregabalin which has a brand name of Lyrica. These work in the central nervous system, “inside out”. 

There is also ketamine, low-dose naltrexone, and other things that help a lot, and in fact check a lot of boxes for Fibromyalgia. Low-dose naltrexone fills a lot of buckets.

I will continue the invisible pain discussion with the understanding that it's one step at a time but they add up.

This is not to overwhelm you, it's to give information, not necessarily earth-shattering information, real information.

It's about participation between you and your healthcare provider and with the folks around you. It’s also knowing that pain is a difficult thing to understand for everybody.