Types of Fibromyalgia Pain
There are three types of fibromyalgia pain. There are treatment options for each, including medications and exercise. Exercise is one of the best ways to combat the different types of fibromyalgia pain.
Because fibromyalgia is a pain syndrome, it is not characterized by a single type of pain, but rather three. The types of fibromyalgia pain can be divided into three broad categories: hyperalgesia, allodynia, and paresthesia.
Hyperalgesia is an increased sensitivity to pain. That is to say, it is the experience of pain that is greater than would be expected for the level of stimulus. Consider this example. If you are pricked by a needle and experience pain that is a three out of 10 in severity then that is your baseline pain. If the next time you receive the same needle prick you report the pain as a seven out of 10, then you have experienced hyperalgesia because the same stimulus causes more pain that it did previously.
Hyperalgesia can include local, regional, or diffuse pain. Many fibromyalgia patients suffer from all three types of hyperalgesia. They have enhanced pain response to injury, but they also experience increased pain in undamaged tissue. Thus, a typical injury such as a pulled muscle is more painful for a person with fibromyalgia and affects a great area than it would in an average person.
Hyperalgesia is one of the most difficult types of fibromyalgia pain to treat because it is the result of changes in the chemical signals in the brain and spinal cord. Therefore, treatment must target the central nervous system. SSRIs and tricyclic antidepressants are most commonly used to treat pain that originates from chemical imbalances in the central nervous system. In addition, glucocorticoids and anti -seizure medications can be used.
Beyond medications, hyperalgesia is highly responsive to exercise. Part of the reason that exercise is effective has to do with endorphins, which are natural painkillers manufactured by the body. Endorphins provide better pain relief because they are released directly into the CNS rather than having to go through the GI tract like oral medications or the blood stream like injected medications. They also have fewer side effects than prescription and over the counter medications.
Allodynia is a painful response to stimuli that would otherwise be non-painful. For example, if a gentle touch with a cotton swab causes pain, then you suffer from allodynia. Allodynia is thought to result from injury and reorganization of pain receptors in the spinal cord. Basically, wires get crossed and things that were never painful before become painful.
Allodynia is exceptionally difficult to treat, especially if it affects large areas of the body. Fortunately for most people who have fibromyalgia, allodynia is rare and when it does occur it is transient. For those who suffer from prolonged allodynia, such as is seen in vulvodynia, treatment can include anti-seizure medications and nerve blocking agents like lidocaine. Both classes of medication reduce the ability of nerves to transmit pain and prevent pain signals from reaching the spine.
Paresthesia is the sensation of tingling, prickling, or numbness in a person’s skin that has no apparent physical cause. It is often described as a “pins and needles” feeling not that dissimilar from a when a limb “falls asleep” and is considered one of the most irritating types of fibromyalgia pain.
The exact cause chronic paresthesia is unknown, but seems to result from the indirect irritation of nerves. Patients suffering from fibromyalgia often report paresthesias in the form of the restless legs syndrome. In this condition, the legs tingle, ache, and fell as though they are “crawling with bugs.” The symptoms are more severe at night or when sitting still. Restless legs syndrome and many paresthesias are treated with drugs like Lyrica, which calm the nerves and decrease their ability to transmit signals to the brain and spinal cord.
There are several types of fibromyalgia pain, all of which are amenable to similar treatments and have origins in the central nervous system. Of the three types of fibromyalgia pain, hyperalgesia is the most common and severe.