Your Pain is Real

I'm Hans Hanson, medical doctor, and my interests are pain, addiction and depression. I’m boarded in pain and in addiction, and I treat situational depression and anxiety.

Invisible Pain

What is invisible pain? You can't see, touch, feel or measure invisible pain. The most reliable thing you have is somebody's self-report. 

As a medical provider, you need that self-report and you need to remember my five rules. 

From a compassionate standpoint, if you are someone suffering from pain, I want to get rid of all your pain. From a realistic standpoint, I want to improve your function and your quality of life. 

I want you to have all these things:

• A better range of motion 
• Ability to sit longer
• Ability to go to the grocery store
• Play with your grandchildren

Fibromyalgia

I’m going to talk about fibromyalgia. Fibromyalgia is that invisible pain. From my career's perspective, it's been thought of as neuropsychiatric, anxiety, symptom magnification, making it up, catastrophizing, and drama. 

In the early 1990s, I started calling it central sensitization. In other words, there's something going on in the nervous system. That muscle pain, migratory pain, is a central manifestation of pain that is showing up peripherally.

There's nothing wrong with the muscles. We beat up the muscles pretty good; we've done muscle biopsies and nerve conduction studies over and over. I’m going to put a little caveat on there: we may see a little neural hormonal stuff coming from the muscles. The reality is that  pain is “inside out” as opposed to “outside in”. The central nervous system is irritated.  

Central sensitization is neural inflammation. So this muscle pain is a peripheral, or outside, manifestation of a central nervous system problem. So, you're not crazy.

Yes, I do believe you're in pain. No, I can't see, touch, feel or measure it. I don't have a lab test. (But I don't know, there may be one coming, it's kind of in a gray area right now.)

I think that you do have neural inflammation. I'm not going to call it central sensitization, instead I'm going to call it neural inflammation.

Everybody believes headaches and migraines. You usually can't see, touch, feel or measure headaches. But everybody gets them. You take something, they go away. The reality is that fibromyalgia has every bit as much credibility as headaches.

We have to look at the central nervous system and see what's going on - neuroinflammation. 

Neuroinflammation is when the nervous system has irritability either from the structure, the elements of the structure, from chemicals (elaborated or retained) or from toxins that we take in.

I think in the world of fibromyalgia and interstitial cystitis people look at toxins as a root cause. You have to have the right diet, you must stay away from certain things. 

There's some truth to that, but remember taking fibromyalgia, interstitial cystitis or bladder pain, and extending that concept of “inside out”, as opposed to “outside in”, does it really matter what you take? Maybe. Certain things might be inflammatory to the central nervous system. I can see that. I can see that fibromyalgia can be improved with certain diets.

Glial Cells and Their Role in Pain

So what's going on? Well, there's these things called glial cells. “Glia” is latin for glue. It was noted in the 1850s or 1860s through the microscope, primitive as it was back then, that there were these little things we thought held neurons or nerve cells together. So they gave them the name glial cells.

Now we know that they're much more active. There are actually different types of glial cells. Glial cells cause trouble and they can clean up trouble. They can clean up toxins and they can stop toxins from getting into the brain. 

Glial cells can cause irritability where you wouldn't think they would. For example, if someone takes too many opioids, and they are hurting, that may be opioid induced hyperalgesia, a secondary event from glial cell irritability.

We also know that scientists have identified anti-inflammatory agents. I'll pick one, Interleukin 10 (IL-10). These are potentially a breakthrough to settle down that glial cell irritability, which may be neural inflammation.

Fibromyalgia can be explained in so many ways by thinking of “inside out” as opposed to “outside in”.  I think the neurophysiology is important. The more you know that explains your pain, for your own knowledge and for your family members, loved ones, your health care providers,  you know that you aren't crazy. Here is something that is progress and probably will explain a lot of your symptoms. It just makes you feel better doesn't it?

Ketamine and Fibromyalgia

In the 1950s, this was starting to get understood, and in the 60s/70s somebody used ketamine. You hear a lot about ketamine, and how the central nervous system is affected by ketamine and how ketamine can really help. It was seen that fibromyalgia is probably real because people that had a lot of pain from fibromyalgia got ketamine, and they felt a lot better. There may be a neuro inflammatory component that can be explained

It feels good to know that this pain is probably real and something that you can embrace. You can say that there is a real cause as to why you have symptoms like: 

• can't sleep
• can't retain anything in memory
• can't think during the day
• you want to do more but can't because you hurt so much and have no endurance

In an upcoming post, I will discuss some medications that may help you, such as Low Dose Naltrexone.