What your doctor DOESN'T know about fibromyalgia pain is hurting you!

after watching the first few minutes of this video You're Gonna know more than most doctors do about what causes fibromyalgia pain and how to treat it really effectively I'm Dr genevra I'm a physician with fibromyalgia myself I'm on a mission to share the empowering and inspirational knowledge needed to defeat this illness I call this being fibro fierce so are you ready to learn more about what actually causes fibromyalgia pain and how to really get effective pain treatment let's Dive In here's what your doctor or health care provider probably knows about fibromyalgia pain that it is caused by Central sensitization this is where the spinal cord and brain have become hypersensitive to pain signals essentially faulty volume control in the central nervous system for pain while this is absolutely a component of fibromyalgia pain it is really only the tip of the iceberg there are three huge areas involved in fibromyalgia pain that most doctors have no idea about and that is the contribution of the sympathetic nervous system the immune system and myofascial abnormalities to fibromyalgia pain generation so because most stocks only know about that one aspect of fibromyalgia pain they're really Limited in their treatment options and if you were to go to most conventional docs and say hey I need some help with fibromyalgia you'd probably walk away with a prescription or a recommendation for one of these three things either an anti-convulsant like pregabalin or Gabapentin an snri antidepressant like Duloxetine or melnazapram or a recommendation to exercise literally this is it this one slide it sums up the entirety of most doctors understanding about how to treat fibromyalgia pain I honestly can't think of another disease or medical condition that their entire treatment could be summed up in one slide like this and this is in large part because our scientific and medical understanding of fibromyalgia pain and fibromyalgia in general has really lagged behind other illnesses because we are bogged down for so many years about arguing whether fibromyalgia even was real or existed we didn't really start to have a lot of research done until about 20 23 years ago the good news is during that time we have come out with actually a lot more understanding about what causes fibromyalgia pain and we have a lot more treatment options than are listed on this slide unfortunately your doctor probably doesn't know about them so compare the last slide with its kind of three pitiful lonely treatment options to these expanded fibromyalgia treatment options that I'm going to teach you about today your doctor probably doesn't know about these but these are all supported by research most are available right now in fact there are so many different treatment options that I can really only cover each one briefly in this video but you can find much more detailed information in my books blogs and other videos because your doctor probably doesn't know about these additional fibromyalgia pain treatment options you may have to bring them the information yourself keep in mind doctors always want to see the research and supporting studies for any treatment and they're going to want to do their own investigation into any potential new treatment but you can certainly give them a guide in the right direction that's actually why I wrote the fibro manual as as a guide both for patients and for their doctors and there's about an eight page section at the back which is designed to share with your physician with the goal to kind of bring doctors really quickly up to speed about our current scientific understanding of what causes fibromyalgia and how to treat it you can find much more detailed information about all the treatments I'm going to talk about in this video in the fibro manual in my blogs on drgenever.com and in other videos right here on this channel so now when we look at kind of the standard fibromyalgia treatment options the slide looks kind of pitiful and it's really frustrating and infuriating to me that more doctors don't know about how to treat fibromyalgia pain or fibromyalgia in general but truly your doctor doesn't know about these treatments not out of any malevolence but simply because they haven't heard about them part of the reason for that is medicine changes really slowly and it can take years decades even for new treatments to go from the research being published in journal stage to actually being used in clinical practice this this delay is probably even slower in fibromyalgia because a lot of fibromyalgia research is not really published in the big prominent medical journals that most doctors try to stay stay on top of the other problem is that some of these treatments come from more the alternative or complementary world and just not going to be on most conventional doctors radars Central sensitization is really the end result of what I call the chain reaction of fibromyalgia pain this starts with a constant state of fight-or-flight activation or sympathetic nervous system hyperactivity that results in muscle tension myofascial inflammation neural inflammation and ultimately Central sensitization I'm going to go in more detail in the next few slides into the scientific studies that really document each aspect of the Chain Reaction what's going wrong in fibromyalgia and how we can use specific treatments to address each step of the reaction the more we can intervene the more places we can intervene this Gene reaction and the earlier we can intervene the better pain outcomes we have to understand what's happening in fibromyalgia pain we first have to know a little bit more about normal pain Transmission in the body so let's say you stub your toe in this scenario pain signals from your toe are going to be sent up the nociceptors That's the pain sensing nerves that are in your toe they're going to go up the peripheral nerves land in the relay station that's called the dorsal root ganglia it sits right outside the spinal cord and it is going to uh kind of the signals processed in the dorsal root ganglion and then usually transmitted kind of unaltered to the spinal cord where it's sent up to the brain and registered as pain what's happening in fibromyalgia is we have excessive amounts of pain signals we know that our peripheral pain sensing nerves are overwhelmed we know that at the dorsal group ganglion the combination of immune signals and nerve signals result in the dorsal root ganglion cells rather than just passing the signal along unaltered basically tells the spinal cord hey there's something wrong here you need to amplify this pain signal so the dorsal root ganglion cells actually signal to the spinal cord cells hey you need to amplify this pain signal and then part of this amplification process results in neural inflammation and the neural inflammation impairs the brain's ability to do its natural inhibition or regulation or filtering of pain signals so basically in every component every area of the pain pathway in fibromyalgia something has gone awry and that's why we need to look at each component and specifically Target our treatments to each each area where the abnormalities occur now as far as research supporting each abnormality in in each step of the Chain Reaction first we have to start with what sets it all off which is the constant over activation of our fight or flight or sympathetic nervous system our sympathetic nervous system sends out signals that ready our body to fight or flee as part of that we get information sent to our muscles to tighten up that gives us that extra strength needed to potentially fight off or run away from danger that's great in the short term but really problematic in the long term what we see in fibromyalgia is rather than the normal regulation where the fight-or-flight nervous system should only be activated when there actually is danger or perceived danger in fibromyalgia it's activated all the time it's like a smoke alarm that goes off even though there is no smoke and in all the different ways that you can measure the sympathetic nervous system activity whether it's heart rate variability tilt table testing or measuring how much nerve activity is going from the sympathetic nerves to the muscle in every way that we can measure it it is abnormal in fibromyalgia as far as treatments go we don't have any way to completely reverse this process or basically normalize that fight or flight response in fibromyalgia well we do have are some very good ways that temporarily put the brakes on the sympathetic nervous system hyperactivity I go through all these Avenues in an entire chapter in my book The fibro manual but briefly some of them include things like deep belly breathing yoga cranial sacral therapy biofeedback therapy it's important for us to do as many of those as often as we can to limit that sympathetic nervous system activity that is really pounding our body so hard and driving so many of the downstream negative effects and symptoms of fibromyalgia so all that sympathetic nervous system activation really acts primarily on the muscle right so what it does is it tenses our muscles so that we can fight our flee and what we see in fibromyalgia is increased muscle tension and increased muscle Activation so EMG studies show that The Electoral activity in our muscles never reaches that state of normal relaxation anybody with fibromyalgia will say hey my muscles always feel tense they never feel relaxed we also see increased muscle pressure also known as muscle tension in the fibromyalgia muscle and a very interesting study measured the pressure inside fibromyalgia muscles using a pressure gauge needle similar to what we would use to measure like the pressure inside a basketball and what they found was the pressure inside fibromyalgia muscles was three times normal this level of pressure is harmful to the muscle results in low-grade damage and triggers inflammation tight muscles and fibromyalgia are much more prone to painful knots called myofascial trigger points than healthy muscles one study found that fibromyalgia subjects had an average of 12 trigger points compared to zero to one in healthy controls these trigger points are really important sources of muscle pain not just locally but they actually act in distant areas as well because they they act sort of like a snag in a sweater where it affects not just the the local area but actually affects distant areas that's because our fascia the connective tissue really forms one myofascial continuous web through the body the fascial tissue in fibromyalgia is also abnormal the myofascia or fascia surrounding the muscle in particular is what I'm referring to and this is the connective tissue sheath that both surrounds each muscle it also surrounds each bundle of muscle fibers and actually each muscle cell itself so it kind of surrounds and penetrates and provides the structure for the muscle and biopsy studies in fibromyalgia muscles show that there is inflammation and fibrosis or excess collagen deposition in the fascia in this on the top here this shows biopsy findings from fibromyalgia patients fascia compared to healthy controls and you can see in the fascia areas here that there are increased levels of inflammatory markers and connective tissue foreign so we can address myofascial inflammation trigger points and muscle tension in fibromyalgia in a variety of ways this is where exercise and gentle stretching come in to relax and loosen some of our tight muscles we can manually break up those painful knots of tissue the trigger points with either insertion of a needle as a part of a trigger point injection or dry needling or through sustained pressure either with a treatment tool like this or sustain pressure from a therapist's hands now for me by far my favorite pain reduction method and what I think is one of the most effective fibromyalgia pain reducers out there is myofascial release therapy this is basically slow manual traction or prolonged assisted stretching is another way to think about it and when I say prolonged I mean prolonged we're talking three to five minutes that's what it seems to take to break up those painful connective tissue and fascial restrictions and this is an example of what I'm talking about so in this example of myofascial release the therapist hands here are gently pressing on the shoulder away from the therapist body so pressing down the hand here under the patient's occipital region there is pulling towards the therapist so what you have is sort of gently pulling in opposing motions and this gentle slow traction is what seems to break up those painful connective tissue adhesions and restrictions there also are ways to give yourself myofascial release with either using tools or the right positionings or able to get that sustained assisted stretching for me myofascial release was by far the most effective pain reliever it's really what got me well enough to get back to medical school it's still a huge part of how I manage my fibromyalgia pain today and studies mostly out of Europe have shown that myofascial release therapy is very effective in reducing fibromyalgia pain and actually gives some sustained benefit so that means even after the last myofascial release session one month and even six months after that fibromyalgia patients still had reduced pain compared to before they started the myofascial release treatment so it is a really important thing to consider I'll put some links Below in the description to learn more about it and find therapists near you so now we've added some options to treat myofascial pain another way we can lessen myofascial pain is to lessen the or block some of the pain signals that are being sensed by those pain sensing nerves that are in the myofascial tissue and for that we look to topical analgesics there are a lot of different topical analgesic options I have listed some of them here there's actually far more than this I feel for fibromyalgia and myofascial pain what's the most helpful often is something in the non-steroidal anti-inflammatory class I also think that cannabinoids whether it's CBD only or includes the THC component I think these two are really effective for myofascial pain hot spots so those localized hot spots of pain might be areas that are flared up from overuse might be areas where you have trigger points might be areas where you have another pain generator like osteoarthritis I think that topical options are a really great tool to try they tend to have very little absorption into the bloodstream so very few side effects the ones that are start here are available over the counter and the bottom four here are commonly combined in a compounded analgesic cream and these analges that creams can really be customized with a lot of different medications kind of targeted at whatever the specific pain etiology is whether it's from more neuropathy pain or myofascial pain those are prescriptions if you want to talk about trying them with your physician I've got information in the fibro manual also most compounding pharmacies have information they can share with interested Physicians that kind of help them figure out how to order them and how to best use these compounded topical analgesics we've added topical analgesics to our fibromyalgia pain treatment toolbox the next stop on our pathway here is the dorsal root ganglia and this is where the peripheral nervous system and the central nervous system meet and there's a lot of processing of the information here and what we're learning is that the cells in the dorsal root ganglia have receptors both for immune system signals and nervous system signals so it also seems to really be an area where there's a big overlap between the immune system and the nervous system in fibromyalgia Recent research has shown us the importance of antibodies and how they may play a role in triggering the dorsal root ganglia to ramp up signals that it sends to the spinal cord which then ramps up its signals so immune system modulation really has a lot of potential as a future huge treatment for fibromyalgia in the early days don't have any big studies looking at this now but all the drug companies that have any agents out there that modulate the immune system in such a way that it potentially could help in this scenario are actively looking at where that their drug could help in fibromyalgia so I think in the next several years we're going to see a lot of research being done and a lot of studies being published in that regard for now this is more of a potential treatment as far as prescription options but from the alternative or complementary medicine options we do have B Venom therapy which is just what it sounds like B Venom injections you want to avoid this if you're allergic to bees but B Venom therapy actually shows some of the same kind of immune system modulation effects that could really benefit what's happening really reduce that immune system activity that's happening in the dorsal root ganglia that's triggering the dorsal root ganglia cells to send that signal to amplify the pain signals of the spinal cord so stay tuned but I think that immune system modulation is going to be a really huge area of fibromyalgia pain treatment going forward we have a lot of available options that can actually help at the level of the spinal cord to reduce that pain volume amplification that we see in fibromyalgia spinal cord pains transmission is actually a pretty complicated process with a lot of neurotransmitters and receptors involved but when you're talking about Central sensitization the primary players here are glutamate and the nmda receptor glutamate binds to the nmda receptor and that is part of what ramps up the pain volume in the spinal cord so anti-convulsants like pregabalin and Gabapentin they act kind of indirectly to Tamp down some of this activity there's agents that actually block the nmda receptor things like IV ketamine have shown good benefit for helping reduce fibromyalgia pain but not really practical for ongoing use because they really only have short-term benefit there are some nasal formulations of ketamine that are being looked at for managing chronic pain there's one that's available currently for treatment resistant depression momentine which is actually used for treatment of dementia is a very helpful nmda antagonist that is an oral daily pill I found it to be really helpful in a kind of an additive agent to help my patients with fibromyalgia in the clinic reduce their pain some good studies out of Europe show momenting lowers fibromyalgia pain volume dextromethorphian which is the active ingredient in a lot of cough syrups it also has the effect of blocking the nmda receptor unfortunately to really get pain reduction effects from it you have to take pretty high doses people don't tend to tolerate those high doses well so not really practical for ongoing use but maybe something in combination down the road could be utilized as a kind of an adjunctive treatment for fibromyalgia magnesium actually is well known as it kind of blocks or plugs the nmda receptor most of us with fibromyalgia are deficient in magnesium this is part of why I recommend magnesium supplementation for almost every person with fibromyalgia I talk a lot more about how to do this in the fibro manual but basically any supplementation seems to help block some of this uh nmda receptor activity and the final step is you can actually avoid eating excessive amounts of glutamate and the primary dietary sources of really kind of toxic levels of glutamate are things like MSG monosodium glutamate which is a food additive flavor enhancer that has been shown to really act just like glutamate in the spinal cord activate those nmda receptors and ramp up pain signals aspartame which is in artificial sweeteners certain artificial sweeteners also can act very similarly and is best avoided if you have fibromyalgia Now we move up to the brain where we can reduce fibromyalgia pain by lowering neural inflammation and by improving the brain's ability to filter pain signals which it loses as part of central sensitization there's good evidence for neural inflammation in fibromyalgia we can tell this through studies looking at inflammatory chemicals and inflammatory markers in the cerebral spinal fluid the fluid that Fades and surrounds the brain and spinal cord we can look at it based on the activation of immune cells in the brain these immune cells are called glial cells normally they should not be activated in the fibromyalgia brain this uh this is from a study where they looked at glial Cell Activation throughout the brain and you can see that there is large areas of the brain where lots of glial cells are activated and to me this really looks like a Brain on Fire and this is a huge component of lessening fibromyalgia pain finding ways to if not extinguish the fire in the brain to at least lower the levels of the fire and contain it and this is where treatments that really help with the glial cells to become inactivated and go back to their resting state that's where these glial cell modulators play a big role so the glial cells are support and immune cells in the brain typically they don't play a huge role in pain under normal circumstances but in abnormal circumstances like in fibromyalgia the glial cells become activated they generate inflammatory chemicals this neural inflammation generated by the glial cells results in the brain not being able to filter or process pain signals correctly there are several treatments available that can help reduce neural inflammation by pushing glial cells from their activated state where they're generating all sorts of inflammatory chemicals back to their resting or hibernating state where they're not the ones that I've listed here are the the typical ones that we use including low-dose Naltrexone CBD or cannabidiol pea which is a supplement that acts indirectly by activating the endocannabinoid system to put glial cells back on hibernation and reduce neural inflammation and hyperbaric oxygen therapy this is where you are exposed to increased levels of oxygen and increased level of pressure this kind of pushes oxygen into the brain cells it has been shown to really reduce brain inflammation in a lot of different conditions including traumatic brain injury or stroke in fibromyalgia it's been looked at and hyperbaric oxygen therapy actually reduces a lot of fibromyalgia symptoms including pain in part it does that by reducing neural inflammation now some of these have a mild effect on symptoms for example CBD on its own while reducing neural inflammation really typically has more of a mild or subtle effect on reducing pain similar with pea hyperbaric oxygen therapy and low dose Naltrexone data tend to have a more dramatic reduction in pain but I think it's it's in the combination of various agents for example low-dose Naltrexone plus CBD I think that combination is incredibly helpful and that combination really results in amplification of the benefits much more than either one alone now that we've added agents that lower neural inflammation by putting glial cells back in their resting or hibernating state the final treatment options available for fibromyalgia pain treatment are those that help the brain to inhibit or suppress pain signals agents that can help improve the brain's ability to filter or Tamp down pain signals include the snri antidepressants cannabis and primarily the THC component of cannabis and opioids but with a big caveat when opioids are used chronically particularly at higher doses they actually activate glial cells and worsen pain hypersensitivity however when they are used intermittently for example only for pain flares they don't have that effect and this is where I see opioids can be used with good benefit over the long term in fibromyalgia where you're just using them not daily but on an as needed basis for more acute pain episodes opioids can also be combined with very tiny doses of Naltrexone called Ultra ludos Naltrexone and this combination lessens some of the pain hypersensitivity that the opioids can can trigger so these are all the fibromyalgia pain treatment options that I wish every doctor knew about it's important to remember that these are just a menu of options that may take a combination of a few different treatments to get maximal pain benefit there's also not one magic bullet or not one treatment that works for everybody and trial and error is definitely key in this process if I had to pick just two though if I if I was on a desert island and I can only pick two treatments for fibromyalgia I would say the ones that I found the most effective in my clinical practice and that I think have the most positive evidence supporting them are low dose nortrexone and myofascial release remember though that each of the ones I talked about has some good evidence supporting it I only covered the highlights of each treatment in this video if you want to learn more details check out my book The fibro manual my blogs at drgenever.com other videos on this channel thank you so much for joining me until I see you next time stay fierce

Channel: Dr. Ginevra

Views: 41,544

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Id: u87CE0twn58

Length: 31min 32sec (1892 seconds)

Published: Tue Aug 08 2023