When you think about Fibromyalgia related pain you have to consider CNS (Central Nervous System) involvement. And that in it-self predicts lasting pain and treatment of that pain. This is an interesting read that explains just a little bit of the basics of what is going on with FM. That it is the brain and its dialed up pain and no longer any actual injury in any specific location in the body, if there ever was on to begin with. Not to mention the more involvement there is, the less responsive to certain treatments a person can be.

Thinking of the CNS as an amplifier of pain signals helps to explain why people with similar levels of inflammation and/or tissue damage from injury or disease may have very different pain levels—the strength of the amplifier differs. When the amplifier is dialed up too high, the result is centralized pain.

Patients who show changes in the CNS have pain that differs from the pain typically caused by injury in that it is more extensive and can spread from one part of the body to another. In fact, it has recently been shown that some regions of the brain that process sensory input from the body can increase in size as pain becomes more widespread…

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Perhaps the most important reason to describe the level of CNS involvement in pain is to figure out effective treatment strategies. For example, Clauw said that physicians are often taught that knee pain comes from the knee. However, pain that is more centralized may not respond to typical knee pain treatments such as ibuprofen or opioids. In fact, drugs for epilepsy or depression do a better job of working in the CNS and have more positive effects in centralized pain states, even at very low doses.

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Non-drug therapies are also important to manage centralized pain. Treatment plans including yoga, tai chi, meditation, cognitive behavioral therapy, and mild voluntary exercise regimens may be much better for these patients than drugs. These approaches may ultimately be more successful at treating the lingering or widespread pain occurring after the initial course of treatment is complete. Although putting a broken arm in a sling or replacing an arthritic knee may be important for managing pain, they are not the whole story. It is critical, then, to understand how much the CNS is involved—how strong is the amplifier? Using the idea of “FM-ness” might give physicians a better handle on how to approach chronic pain—not just in FM but in a variety of painful conditions—and allow for the most effective course of treatment.

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