What is Fibromyalgia?
Fibromyalgia is a chronic pain disorder characterized by dull ache-like pain and stiffness in the joints and muscles. It’s usually widespread across the body, on the left and right side, above and below the waist. It tends to last a very long time, and sometimes never goes away for some unlucky people. Whether from the pain itself or from whatever caused the fibromyalgia, there are usually mental symptoms as well. Fatigue, depression, insomnia, and even mental cloudiness (“brain fog”) or difficulty with thinking are all common among people with the condition. This is hardly surprising with a chronic pain syndrome that for many, never lets up or goes away.
Fibromyalgia is also widespread, considered by some research to be one of the most common chronic pain conditions. Around 5% of the world population, or 280 million adults, has this chronic pain problem. In the United states, it’s estimated that nearly 10 million adults have fibromyalgia. Unfortunately, this disorder is also far more prevalent in women, with at least 80% of fibromyalgia patients being female.
As if that wasn’t enough, it’s also difficult to understand and diagnose. A common diagnostic method is to poke and prod at 18 different "tender points” on the body and, if enough of them hurt, boom! You’ve got fibromyalgia!
There is no genetic screen, imaging test, or fancy molecular assay for fibromyalgia or many other chronic pain conditions for that matter. Combine diagnostic ambiguity with lack of understanding and gender bias, and fibromyalgia in women is often not taken seriously or its severity is underestimated. Some patients fail to convince a doctor that their pain is real and are instead referred for mental health treatment to help overcome “imaginary” or “exaggerated” pain. Underdiagnosing and undertreating fibromyalgia happens all too often, forcing people to live in extreme discomfort or to self-medicate.
Causes of fibromyalgia
The cause of fibromyalgia is still not well understood. It’s not always the result of an injury or disease that leads to pain, like headaches after a traumatic brain injury or pain after chemotherapy treatment. There may be genetic influences, but it’s not a genetic pain disease like neurofibromatosis. Sometimes there are trigger events that lead to the start of fibromyalgia, like emotional trauma, heavy stress or even prolonged viral infections. But just as often there is no trigger.
What causes it?
One leading theory suggests that fibromyalgia is a dysfunction of the systems in the body that regulate pain. If the pain system had a thermostat, imagine controls for turning up pain, making it more intense, and controls to turn it down, reducing pain. Ideally, all systems are in balance, with the body indicating pain at the right intensity only when necessary, to alert the body to injury, illness or other abnormalities. When those systems become imbalanced, pain sensitivity can be set too low, be pushed too high and may even fail to shut off.
This is the leading theory for what causes fibromyalgia. The systems boosting pain become too active, and the systems blocking pain are suppressed, leaving people with the condition in a constant and sometimes never-ending state of hypersensitivity that makes the slightest sensation feel like pain. It's why the international symbol for fibromyalgia awareness is the purple butterfly whose gentle touch is enough to trigger excruciating pain for many suffering with this condition.
Treating fibromyalgia
Several factors make fibromyalgia hard to treat:
• It’s often difficult for women with this condition to convince doctors to take their description of pain seriously.
• There is often no obvious cause – a broken bone to be healed, a surgery from which to recover, or a serious disease like cancer or diabetes to be treated. Without an obvious underlying cause, doctors are at a loss to diagnose this type of pain and equally challenged to find ways to treat it.
• Finally, fibromyalgia is difficult to treat with medications commonly used to manage pain. Over-the-counter NSAIDS and even powerful opioids can have little to no effect. Antidepressants like duloxetine can partially correct pain regulation imbalance, providing significant relief for some but offering little to no relief for others. Gabapentin can be effective for some patients, but generally remains effective only for limited periods of time.
Non-drug therapy can be helpful, too – talk therapy to help with depression and anxiety that accompanies this pain; physical therapy and exercise; special diets; pain management devices; even occupational therapy to make work and home environments less taxing.
Ultimately, most of these options don’t provide significant or lasting relief for most fibromyalgia patients. One very large study examining 29,962 patients involved in 224 pain-related clinical trials found only slight to moderate benefits from many of the most common fibromyalgia treatments and little to no evidence of any particularly effective medication or method. In another survey of more than 800 patients, 35% felt their pain was not well-managed by their current treatment and 25% were unable to work even with treatment.
In another study of 670 fibromyalgia patients, although more than half of respondents indicated that their medications were effective in treating their pain, the drugs gabapentin, acetaminophen with opioids and cyclobenzaprine; were the most highly rated. But some of these medications are known to be effective only for short periods of time, while others have high-risk side effects from long-term use. It’s no wonder that 66% of respondents said they’d tried complementary or alternative medicine to manage their fibromyalgia.
Complimentary and alternative medicine includes a wide range of possibilities, including dietary supplements, pain management devices, acupuncture, hypnotherapy, chiropractic, physical therapy and more. Nápreva is one such option, a new and promising dietary supplement developed using plant terpenes to help with chronic pain.
Promising potential of terpenes
Terpenes are small molecules produced by all plants that give them their signature scents and flavors. Limonene imparts the distinctive smell and taste of citrus. Linalool gives lavender its dreamy, relaxing scent. And pinene – you guessed it – gives pine and other conifer trees their familiar, woodsy aroma.
Over the years, these molecules have been tested in scientific studies for effectiveness in various types of chronic pain. Dr. John Streicher, head of R&D and Science, is also a principal researcher and professor at the University of Arizona, school of medicine in the department of pharmacology. There, he has been the very first to test some of the key terpenes used in Nápreva in a model of fibromyalgia where they were found to be as effective as opioids.
At the same time, Dr. Streicher and others have shown that these terpenes are non-addictive with no significant side effects. The caryophyllenes have even been recognized by the Food and Drug Administration (FDA) as Generally Recognized as Safe (GRAS). This means that these terpenes are considered safe to be used in food and beverage products we consume daily. Dr. Streicher’s research further suggests they could help manage fibromyalgia pain without the consequences of drugs like opioids.
Fibromyalgia is a difficult disorder that is hard to treat and even harder to live with. But there are promising treatments on the horizon. Of equal importance, through the efforts and advocacy of millions of fibromyalgia patients, there's growing awareness of the validity and seriousness of this condition.
Learn More:
