The cause of fibromyalgia, a common syndrome characterized by severe fatigue and heightened sensitivity to muscle and tissue pain, has evaded easy explanation. Now University of Florida researchers will use $1.2 million in federal grant money to try to pinpoint the biological basis of the chronic disorder, which primarily afflicts women.
Two five-year studies are planned. In one, scientists will take magnetic resonance images of the brains in patients with fibromyalgia and in those without to determine which regions activate when pain occurs. In the other, patients with fibromyalgia will be evaluated to see how strenuous muscle activity affects their pain. The project is an attempt to clarify how the body processes pain in people with the disorder, said Roland Staud, M.D., director of the Musculoskeletal Pain Research Center at UF and the studies’ principal investigator.Whereas chronic, widespread pain is very preventable in patients with arthritis or in those with systemic lupus or inflammatory bowel disease, fibromyalgia is assumed to develop over many years, and the question is to understand the mechanisms that lead patients from being just sensitive to pain, dysfunction and suffering,” said Staud, also an associate professor of medicine in the division of rheumatology and clinical immunology at UF’s College of Medicine. “We know this is something that happens over time — the evidence that is currently available shows it probably takes years — nevertheless, it’s unknown to this day what the decisive factors are. The psychological hallmark of all this is many of these patients are distressed, which is understandable. When you have chronic pain and nobody seems to understand why you have chronic pain, you become distressed and depressed and anxious, and so on.”
Fibromyalgia syndrome afflicts up to 30 million people in the United States, mostly women in their 30s and 40s. The often disabling medical condition, characterized by widespread body aches and pains and uncontrollable fatigue, is difficult to treat. It is often accompanied by other problems, such as headaches, sleep disorders, cognitive impairments and an irritable bowel.
Traditional treatments don’t adequately manage chronic pain in patients with the disease. Meanwhile, typical blood tests and body imaging fail to reveal the root cause of fibromyalgia’s typical symptoms.
“The intrinsic question is what factors drive pain in fibromyalgia?” Staud said. “What makes this pain better, what makes that pain worse? We only have very anecdotal evidence, that is, patients who say ‘When I overdo things I have more pain.’ The exercise testing we’ll use, for example, is a precisely defined activity that may be related to increases in pain. We’ll also be able to see whether rest decreases fibromyalgia pain sensations and changes patients’ spinal pain processing.”
Meanwhile, related research already under way at UF will continue, Staud said. In particular, UF researchers seek to learn more about what triggers fibromyalgia’s hallmark symptom: sudden and debilitating pain flares, which frequently interfere with patients’ ability to work or enjoy normal day-to-day activities. As part of the study, they will take blood samples, then hunt for abnormalities in chemical messengers in the brain and assess whether proteins known as cytokines, certain metabolic processes, or abnormal immune system functioning play a role in the occurrence of pain flares.
Ultimately, scientists hope to use the findings to identify new treatments for fibromyalgia patients and for other chronic pain sufferers, Staud said.
“Health-care providers would really like to understand the biology of chronic pain,” he said. “We’re looking particularly at inflammatory mediators that may be related to increases in pain sensation. So I think at the end we hope to better understand how to prevent and treat these pain flares and suffering and disability in this particular patient population.”