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For Dr. P, a question about migraine research and FM link
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sadecakes posted:
Hi Dr P, I heard on a radio broadcast regarding migraine research that the brain is permanenty altered thru time as the individual experiences more migraines. The brain is physiologically changed. They also see that more woman have migraines than men and have contributed this to hormonal changes as women age. I believe they also indicated that there is an increase in migraines as women age.

Have you seen any research indicating that the brain changes, that FM increases as women age and that hormonal changes (estrogene is what they indicated) contribute to FM? Also is the brain changed by FM is a similar way to the war it's changed by migraines? is it changed by the reoccurrence of pain?

Thank you, Susan
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Mark Pellegrino, MD responded:
Hi Susan,

Very interesting questions! Research has shown that our brains change in fibro, It appears that other chronic pain conditions including migraines can cause similar brain changes like fibro.

The brain is quite dynamic and always changes in response to chronic illnesses, stress, and pain. I like to say that the brain rewires itself in response to fibro's chronic neural bombardment with pain signals, dysfunctional autonomics, and hormone changes. The brain rewiring, in the case of fibro, is creating a "better" way for the brain to accomodate and signal all the extra amplified pain signals it receives from the spinal cord and peripheral nerves. In other words, fibro turns our brains into "lean, mean pain-signalling machines!"

Once our brains become rewired in fibro, the typical central pain we experience becomes the new norm. Theoretically, our brains could be rewired back to the previous "normal." The problem with fibro, or any chronically painful condition, is that we haven't figured out how to change it back to normal....yet.

More women than men have these chronically painful condition such as fibro and migraines. A lot has to do with how women's nervous systems have slight differences compared to men's. Women tend to experience pain more globally with the entire brain compared to more focal or one-sided brain pain experiences in men. (Yes, men are more half-brained!) Some of the reasons likely include: larger corpus callosum in women which connects the 2 brain halves, higher estrogen & lower testosterone in women, and genetic differences in pain processing.

One genetic difference studied has to do with how we normally block chronic pain signals with a specialized nerve pathway in our spinal cord. People (with and without fibro) are continuously being bombarded with potentially chronically painful signals, but these specialized nerve pathways function as a wall to block any chronic pain condition from breaching it. As normal aging occurs, this wall develops some cracks and starts allowing more pain signals through. The deterioration is faster in women than men, so this may be another reason why woman get more chronic pain conditions over time compared to men.

This difference may also explain how it may take years for fibro pain to develop, even though we may have inherited the fibro susceptibility. It takes time for the "wall" to deteriorate to the point where fibro signals are finally able to "break through" and establish a "foothold." Once that happens, the rest of the nervous system changes occur leading to full blown fibro. And this occurs more readily in women due to the aging differences in the specialized blocking nerves as mentioned.

Hope this info helps answer your questions. I reread my answer and I half confused myself...perhaps only half my brain is working right this morning! Let me know if you'd like any additional clarification, Susan.

Dr. P
 
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sadecakes replied to Mark Pellegrino, MD's response:
Yes, that was a very good explanation of what happens due to FM. I do have a couple of questions as a follow up.

Would it then follow that once the wall has been breached, then there's no turning back and not only is FM chronic but can worsen. It possibly will level out or hit a ceiling but it can and will worsen until it hits this ceiling. There's not much out there on prognosis of FM but after reading your reply and also reading the posts on this site, it does worsen. It can even be debilitating. Everyone's experience is different, so one person my be able to function and another may become disabled. Once the wall is breeched, there is a serge of pain and worsening symptoms that are different for each person. Am I understanding this correctly? My pain is much worse and I'm attempting to understand the progression of the illness.

Regarding exercise, where is that happy place between exercise and overdoing it? When are you strengthening and conditioning and when are you doing more than tolerable? And what's the difference between exercise (ie improving one's health) and getting active? Everyone has had a strain caused by movements they're not used to (shoveling the driveway, walking too far, or even lifting too much weight at the gym) but as an FM-er, what limits do we have? What is the cause of the flares when we're trying to maintain a level of fitness, agility, flexibility and strength? It seems like a catch 22. The less movement, the worse the pain and the worse the pain the less movement. When are you preventing vs causing and how do I go about exercising as I deal with this illness?

One more question: is there a point when the pain overtakes the effectiveness of the meds? Is it that the pain is that much stronger? Has the body adapted to the meds and thus rendered the meds ineffective? Or is the dosage too low and is not effective against the pain for that reason? I take Lyrica plus an NSAID, diuretic and a small dose of an antidepressant. The Lyrica helps but doesn't eliminate the pain as it used to. So, I'm wondering is it time for an increase in the dosage or change to a new med? I want to know what ask my doc for at my next visit in early May.

This has been incredibly helpful to me. I appreciate your patience as I increase my knowledge regarding my experience with FM.

Thank you,
Susan


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