In the past week, the European Council has denied it!
Let's have a look at the history of fibromyalgia pain.
Fibromyalgia pain is a chronic pain syndrome. Like any other chronic pain syndrome, it is marked by an abnormal sensitivity to pain. A stimulation that normally should not be painful becomes painful!
This is due to a "pain memory" phenomenon.
If you pinch your skin it is painful until you release it. However, if you pinch your skin for a longer period, the pain will persist even if you release it.
But if you pinch it for more than 30 minutes, not only the pain will persist longer, it may even persist forever! And it can progress to the stage of abnormal painful stimuli. A caress that should be pleasurable may become extremely painful!
Why did I say 30 minutes? Because this is the time after which genetic messages are appearing (c-fos proteins). And they appear in the central nervous system (brain and spinal cord)!
It may disappear without any further problem. But sometimes chronic pain may develop.
This is marked by the activation of pain memory receptors that allow any stimulation to become painful. Those receptors are all over the central nervous system, including the brain where they even support the normal memory! This activation will generate the development of new circuits of neurons that are not normally involved in pain but are recruited and now become involved in pain!
This can be seen in all chronic pain situations. Brain areas that are normally quiet suddenly become activated! And fibromyalgia being a chronic pain follows the same path. Those pains have usually started anywhere on the body: a finger, a foot, an arm etc...
Central Pain is one type of chronic pain that is a bit different.
Central Pain is a chronic pain that develops after a lesion in the central nervous system such as a stroke, a spinal cord lesion etc... Those lesions are true ones: they can be seen! They are very difficult to treat, extremely painful and have sometimes been tackled with very invasive neurosurgery.
Out of the blue, fibromyalgia is labelled a Central Pain.
This happened a few years ago. The justification given was the abnormal brain activity. But it is abnormal like in any other chronic pain!
When those in support of this brain theory are asked about the absence of visible lesions in the central nervous system, they talk about microscopic lesions that are not yet visible!
Coincidence?
Whilst some drugs such as antidepressants and anti-epileptics had been used for chronic pains, those same manufacturing companies got attracted to the plight of fibromyalgia patients and diverse studies appeared.
Coincidence or not, this is when fibromyalgia got labelled a central pain without proof.
The studies where of short follow-up duration, up to a few months only, when the disease is a life long one. Some studies had even on their board a pharmaceutical company’s doctor!
The reason behind the European Council decision has not yet been detailed.
It is most probable that:
- The brain theory is unsatisfactory (many new studies point to this)
- The studies on those drugs do not provide a long enough follow-up to justify their prolonged use and classification for fibromyalgia treatment.
- A lot of doctors are unhappy to see many patients stopping the drugs because of
- side-effects
- they get worse
- the improvement is short lived and limited.
The lobbying in the USA has been very powerful for a multi-billion profit industry. The fact that those drugs are not classified in Europe as fibromyalgia treatment does not stop their use but it requires caution and good follow-up.
Fibromyalgia treatment does exist and the drugs are only a part of it, useful for crisis time but not enough on their own to treat it. They are not the magic pill that we were let to believe!
*The 3 drugs concerned: Lyrica (pregabaline), Cimbalta (duloxetine), Savella (milnacipran)
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