Tuesday, October 2, 2012


I always knew I was dysfunctional.
I just didn't know it ran so deep.
Clear down to my neurotransmitters.

I think we all have a dysfunctional neurotransmitter system. There has to be a reason that we don't all have the same symptoms and we don't all respond to the same therapies and medications. 

We have pain perception problems. 
Isn't this linked to neurotransmitters?

Chronic stress can contribute to Fibromyalgia but it isn't a cause, otherwise, everyone on the planet would have it. We all know that chronic stress changes the neural pathways in the brain but to what end?  Depression isn't the cause because not everyone who is depressed has Fibromyalgia. I think it's like everything else. There may be risk factors for the development but that doesn't mean you're going to get it. There may be a genetic predisposition depending on many things, but again, what is the trigger?

I'm on a roll here.
So what do we know?

1. We know that Substance P, glutamate, are elevated in Fibromyalgia and this accounts for an increased pain sensitivity. 

2. The lowered levels of serotonin and noradrenalin in the central nervous system could be the reason that the descending neural pathways are messed up.  This can cause issues with sleep and depression. 

3. The HPA (hypothalamus-pituitary-adrenal) axis and the sympathetic nervous system are off but it may be a symptom but not a cause of Fibromyalgia. Dopamine levels are also off which can cause our achy-breaky stiff muscles and brain fog.

I'm not a doctor (obviously) but doesn't this suggest subgroups? I know people with Fibromyalgia and they have pain but the fatigue seems to be more of an issue than the pain. With me....yes, I have the fatigue but pain is far more of an issue with me. Maybe this is why medications like Cymbalta and Savella work well with people who have more of an issue with serotonin levels and less of an issue with elevated Substance P and glutamate. 

Maybe by targeting the specific subgroups and medications that work specifically for that group.....is that a way to get better results than lumping us all into one group? It seems that pain with depression and pain without depression respond differently to medications. 

The only thing that works for me is the oxycodone in very small doses (5 mg.) and Zaniflex which controls the muscle spasms. Lyrica made me squirrely and gain weight and did nothing to help the pain or fatigue but others swear by it.

What I find VERY interesting is that Zaniflex (tinzanidine) reduces Substance P levels. Since the prevalence of pain is my main issue isn't this why this might work for me and not for someone that has a predominance of fatigue?

I think that the argument against using opioid in treatment  has more to do with the general issue of doctor liability and the risk of dependency. Right now it's politically correct to be against these in pain management because of a group that abuse them. 

I don't like a lot of them because of the addition of acetaminophen. Long term use can cause damage to your liver. When I went on the oxycodone my pain doctor and I had a long talk about it. He did explain the risks but also told me this would be better as a long term treatment because of the damage that anything with Tylenol or acetaminophen would cause. He knew that addiction and dependency were two very different animals and I was low risk for addiction. 

I just don't think you can pour everyone with Fibromyalgia in a bowl.

It's like making a cake.

You need to add one ingredient at a time.

If you add too much of one,

You get a mess.

This is what they've done with us.


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