New Source of Fibromyalgia Pain Identified

Biological cause of fibromyalgia pain finally identified! 

This discovery was made by a team of researchers who study skin-related pain.  It was published in Pain Medicine, the official journal of the American Academy of Pain Medicine.  The study focused on women who suffer from fibromyalgia pain and sensitivities in their hands.

Fibromyalgia Pain   iStock

Fibromyalgia-Related Palm Pain – iStock

 

In the study, researchers used microscope technology to examine the nerve endings in skin tissue samples taken from the palms of the participant’s hands.  What they discovered was a huge proliferation of sensory nerve fibers near the blood vessels of the skin.  They concluded that altered blood flow may be the source of fibromyalgic pain!

This finding is very exciting because altered blood flow could conceivably be the cause of most symptoms associated with fibromyalgia pain: deep muscular aches, joint pain, insomnia, and cognitive issues.  The current theory of centralized pain is just not specific enough to explain major fibromyalgia symptoms.

How Sensory Nerve Fibers Control Blood Flow in the Hands

Sensory nerve fibers are found just under the top two layers of skin.  Their job is to sense and transmit heat, pain, and other uncomfortable sensations.  When sensory nerve fibers malfunction, a person may experience tingling sensations, pins-and-needles, numbness, burning, and pain.

Sensory nerve fibers are also involved in blood flow and temperature control. There is a close interaction between sensory nerve fibers and sympathetic nerve fibers in order to control blood flow throughout the body.

Blood supplies nutrients to the muscles, nerves, organs, and tissues.  It also carries away waste products.  

When we engage in any activity, we use our muscles.  Muscle activity generates heat.  Muscle-generated heat related to activity or exposure to environmental heat can cause the body to become over-heated.  To cool itself off and protect vital core organs, the body sends the heat (carried in the blood) to the hands and the feet.  Hands and feet appear to be reservoirs of blood in the body directly related to temperature control. Blood also supplies nutrients to the muscles, nerves, organs, and tissues while carrying away waste products.

Sensory nerve endings in the hands and the feet connect to and control tiny muscular valves of the circulatory system, known as arteriole-venule (AV) shunts. Sensory nerves signal the AV shunts to open or close, regulating blood flow to release or conserve body heat.

The Problem with Excess Sensory Fibers and Overstimulated Sympathetic Nerves

The researchers suggest that the presence of excess sensory nerve fibers in the palms of the hands and feet may be interfering with the smooth flow of blood through the body.

Perhaps the excess sensory nerves are overstimulating the sympathetic nerves or vice-versa to cause AV structures to constrict blood flow. Over-constriction would interfere with efficient temperature control, the smooth flow of blood to the deep muscles of the body and the cognitive centers of the brain.  

Altered blood flow begins to explain some of the symptoms related to fibromyalgia pain: fatigue, build up of lactic acid in muscles, difficulty sleeping, and deep-seated muscle aches.

The next step in this research is to see if men, who also suffer from fibromyalgia, have excess sensory fibers in the palms of their hands and feet.

The findings of this study echo theories of pain proposed in Traditional Chinese Medicine, known as Liver Depression Qi Stagnation which will be the subject of a future post!

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Sources

Follow this link to read an official layperson’s report written by the researchers of the study.

http://www.intidyn.com/Newsroom/article-0009.html

American Academy of Pain Medicine

Pain: A Measurable Experience?

What difference would it make, if we could measure pain?  We usually learn what pain is from our earliest experiences of physical tissue damage.  It may also have a psychological or emotional basis.

Pain can described as a subjective felt experience because it is influenced by an individual’s feelings, mind, and experience. That’s also why it can be so tricky to diagnose and treat.  It is so intangible.

pain in elbow

Can this pain be measured? (iStock)

Limits of the Visual Analog Scale

When working with adults in my clinical practice who suffer from acute or chronic pain, I often use the Visual Analog Pain Scale (pain levels of 1-10) to both evaluate levels of pain and to measure the effectiveness of a treatment protocol. Health insurance companies repeatedly challenge practitioners to justify the need for treatment. Ultimately, the patient loses because it is so difficult to measure or verify the type of pain being experienced which can interfere with patients getting the help they need.

There also is the most vulnerable population to consider, those who may not be able to describe their discomfort because they are either too young or elderly, minimally conscious, or cognitively impaired.

All together, these factors beg the question, is pain a measurable experience?  If it could be measured, what impact would that have on diagnosing and managing it?

Tor Wager’s fMRI Pain Measure Studies

In a series of four studies, Tor Wager  and colleagues set out to objectively measure and predict pain intensity through the use of functional magnetic resonance imaging (fMRI) brain scans. Their findings look to be a game changer.

Study #1 

In the first study, 20 normal, healthy human subjects were exposed to varying levels of heat and then their brains were scanned in order to identify which brain structures were involved and whether any identifiable patterns would emerge.  What they discovered was a neurological signature for heat-induced pain, that is, specific brain regions consistently lit up more than 94% of the time.  The signature was discovered to be specific to pain and sensitive to changes in heat intensity.  Brain maps were generated from these initial findings and then applied to new participants in Study #2, in an effort to predict pain. 

Study #2

In the second study, the neurological signature identified in Study #1 was tested with a new group of 33 participants.  This study aimed at predicting pain by measuring its intensity through the ability to discriminate between painful heat and non-painful warmth across six temperatures. The researchers were able to show that the signature response increased as the pain intensity increased, resulting in the creation of a code using a 100-point Visual Analog Scale that was about 93% accurate.  The results suggested that the neurological signature was measuring the subjective sensation of pain as well as the intensity of somatic stimulation.  They also found that the signature response discriminated between intense and mild non-painful warmth.  This is a very significant finding because it may be useful in further studies of allodynia or hyperalgesia, two unusual types of pain.  

Study #3

The third study was a test for specificity.  The researchers took the results of the first two studies involving the mapped neurological signature and the ability to predict pain, and added in the new component of social pain.  In this case, 40 participants were studied who had recently experienced a romantic break-up and were still suffering from feelings of rejection.  In addition to being exposed to painful and non-painful heat, they also viewed an image of a close friend and an image of the “rejecter.” Which brain structures would be involved now?  While researchers were able to discern that regions for physical and social pain were both activated, the neurological signature still clearly discriminated between physical pain and social pain.

Study #4

This study explored how the neurological signature for pain would respond to the administration of the opiod agonist remifentanil during fMRI scanning.  The goal was to elicit analgesia without sedating the participant while they were exposed to a painful heat stimulation or a warm stimulation.  They found a parallel response, that as the effects of the drug on the brain increased, the signature response decreased up to 53%.

Why This Study is Important

This study successfully identified a fairly universal and reliable neurological signature brain pattern for heat-associated pain. It also validates earlier studies aimed at measuring sensitivity and specificity for pain using fMRI scans.  More studies are needed before it can become clinically useful.  Since the study was done with healthy persons, there is much work to be done in assessing individuals who are in pain.  Although the task is daunting and there are so many variables, this study makes a very important contribution.

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References:

An fMRI-Based Neurologic Signature of Physical Pain by Tor D. Wager, Ph.D., Lauren Y. Atlas, Ph.D., Martin A. Lindquist, Ph.D., Mathieu Roy, Ph.D., Choong-Wan Woo, M.A., and Ethan Kross, Ph.D. N Engl J Med 2013; 368:1388-1397April 11, 2013DOI: 10.1056/NEJMoa1204471

The researchers used data-mining algorithms to search for brain patterns in subjects who were exposed to different levels of heat. What they found was surprising. Instead of the patterns being unique to each individual studied, they found that pain patterns manifest as neurological signatures across multiple brain structures.

Baby Boomers Sicker Than Their Parents

Mature couple seeking health care advice.

Aging and Health Care – Baby Boomers Sicker than Their Parents at the Same Age –iStock

‘A massive generation of sick people.’  Those are the words Reuben Greg Brewer used when blogging about the recent JAMA study which found that today’s baby boomers are sicker than their parents were at the same age, suffering from chronic illness and disability related to:

How often I have heard my own mother say (who is now 80 and who just underwent her third joint replacement surgery), “These pills are keeping me alive.”

While the gist of Mr. Brewer’s blog trumpets health-field related investment opportunities for the savvy (Weight Watchers, Nutrisystem, Pfizer, Procter & Gamble, Teva Pharmaceuticals, CVS Caremark), it really is a sad commentary on the general state of health in these modern times, to find that today’s baby boomers are sicker than their parents were at the same age.  It is also  a confirmation that chronic illness is big business in the Western world.

What’s wrong with this picture?

Research about the consequences of a sedentary lifestyle and stress is not new, by any means.

Why have we as a society bought into the illusion of “the magic pill?”

Why have the majority of people refused to take responsibility for their own health and wellness?

We are finite beings.  We have limitations.  We wear out.

What changes are you willing to make now, today, to improve your chances of aging well?  Although your body is ready, willing and able to restore function and mobility, beware of waiting too long.

A final thought, will you invest in yourself and/or in health-related companies on the stock exchange, each offering a unique ‘golden opportunity’?

The Embodied Self—An Emergent Process

I am fascinated by the concept of the embodied self, how the sense of core self develops and how this creates the mind.  Yes, the emergence of the embodied self is a fascinating topic, one that boggles the mind and fires the imagination.    

The embodied self is an emergent process--like baking a cake, iStock

The embodied self is an emergent process–like baking a cake,
iStock

This emergent process is not unlike baking a cake!  

Basic cake ingredients include flour, salt, sugar, oil, eggs, milk, and a leavening agent. However, it only emerges as cake once the combined ingredients are subjected to heat.

Similarly, researchers in the field of developmental neuroscience suggest that the fire that gives rise to and animates the embodied self (and mind) is the aggregation or assemblage of environment, experience, and social interaction.

The Environment 

Human beings are conceived and develop within a complex, dynamic, multilevel interactive person-environment system (attachment theory).  The development of the embodied self involves exposure of our genetic material to an environment that fosters development and growth.

One source defines environment as “the sum total of all surroundings of a living organism, including natural forces and other living things, which provide conditions for development and growth as well as of danger and damage.”

The relationship humans have with their environment is a reciprocal one. Throughout life, we both shape and are shaped by the environment.

What are the basic environmental conditions required by a child to support its existence, growth, and welfare?

We begin with the obvious.  Since an infant is born helpless and dependent upon the care of others, he or she requires a committed caregiver, someone who will supply food, comfort, and protection, at the very least.

A consistent, predictable, and nurturing environment paves the way for optimal brain development because it supports the organized integration of neural synaptic circuits that foster social and emotional functioning, perception, and behavior, all vital to the formation of a coherent sense of self.

Experience

Experiences drive patterns of functional, emotional, and psychological development.  Brain development is essentially an experience-driven learning process that gives rise to the mind and the core self. Experience also involves participation in events that accumulate over time, creating a knowledge base. Events are perceived through the senses and invoke body-based responses and implicit memory, an embodied self.

For optimal development, infants and young children require a constancy of experience that is nurturing and consistent. Loving caregivers who have been observed responding to their infant in a contingent manner do it by matching the infant’s facial expressions and vocalized sounds.  This behavior allows for a meeting of the minds which is essential to the development of self-in-relationship-to-another. The opposite is also true.  An unpredictable, volatile environment can wreak havoc on the development of the brain’s emotional centers, seriously impacting a child’s sense of self.

Social Interaction

Self-in-relationship-to-another begins before birth and continues throughout the lifespan. When an infant or young child experiences consistent, empathetic, and anticipatory attention to its needs, the experience is embodied to foster a coherent sense of self, self-agency, and the capacity to achieve and maintain a sense of well-being. Research findings also strongly suggest that the quality of an infant’s attachment experience sets the stage for future relationship expectations and is linked to the development of effective or ineffective coping strategies and social, emotional, or behavioral disorders.

Do you think that the growing body of knowledge of the complexities related to the development of the core embodied self will have a positive effect on society in general?  Will it motivate prospective parents to learn effective, empathetic parenting skills?   Will it humanize us?  Please share your thoughts!

Wow, I’m Sixty Years Old Today! Where Did the Time Go?

New York August 2012Maureena & Tim

New York August 2012
Maureena & Tim

Yes, another year has rolled around and I find myself another decade older this time–sixty years old!  For all you youngsters out there, you will eventually understand the reality of the often repeated phrase, “I don’t feel any older, I am the same person I have always been . . .” yet, truth be told, when I look in the mirror, I see the changes in my body and my face—gravity!  Some days, my bones can be a little achy too. However, I am still as keenly interested in everything that makes like worth living: loving relationships, passion for learning, enjoyment of my surroundings, meaningful work and activity, and a good measure of health.  I am committed to aging well.

Last year at this time, I was preparing for a parathyroidectomy—the surgical removal of a parathyroid gland that had become dysfunctional.  The parathyroid glands play such an important role in body chemistry, bone production, and health.  I was fortunate to find an excellent surgeon with a crack team, Dr. Michael Yeh, at UCLA.  The surgery was successful and I have been experiencing a good recovery.  Surgery, like chronic pain or illness, is always taxing to the body and can be very depleting.  My main concern was how to support the healing process and to optimize the healing of the surgical incision.  As many of my readers know, scar tissue is a topic I am keenly interested in and I am happy to report that the therapies I used post surgery supported the optimal healing of my surgical incision, leaving few internal adhesions.

I’m so grateful to have accumulated so much experience in the holistic field of medicine which has helped me come back stronger than before.  At the present time, my personal health recovery regimen includes chiropractic, acupuncture, herbal medicine, and movement and body alignment practices (Alexander Technique, Restorative Exercise, and Pilates).  My goal this year is to become even more aware of my body alignment, knowing that the way I move in my body and how each part communicates with the next, will determine my capacity for regeneration and strength and will help me to correct and limit the patterns that underlie chronic degeneration.  No matter what our age, isn’t that the best choice to make?

How will you support your self, your body, and your health this coming year?

P. S. I am so enjoying the gift that cumulative life experience brings to all aspects of my life!

Winter Flows in the Water Element

The Transformative Nature of Water

The Transformative Nature of Water

The amazing properties of water are well understood in scientific research.  Its ability to change states from a liquid to a gas or a solid (depicted in the beautiful image of the lake with rising fog and clouds above), make it a unique constituent of all living systems. Water is also a solvent, capable of dissolving other substances in order to produce unique solutions vital to sustain our physiological processes and life on this planet.  Let’s see how the Water Element relates to our body’s health.

The Water Element

Winter is the season of the Water Element in Traditional Chinese Medicine’s (TCM) Five Element Theory which depicts the generating cycle of life (Ko). The energetics of winter are yin which foster time for reflection, introspection, and quietude in order to to nurture one’s inner self.  My favorite author on this topic is Eldon Haas, author of Staying Healthy With the Seasons. He asserts that giving the appropriate attention and support to the meridian and organ systems assigned to the Water Element during its dominant season will help us to move into spring with renewed vitality and purpose.

The Kidney/Bladder Meridian and Organ Systems

In the Ko cycle, the Kidney/Bladder meridian and organ systems are represented by the Water Element.

The Ko Cycle

The Ko Cycle

The Kidneys represent the deepest energies of the body because they are involved in the generation of vitality, the self, the brain, bones, and marrow.  The Bladder meridian and organ system are responsible for separating the pure from the impure which aligns well with the western physiological model of filtering the blood, recycling substances, and eliminating waste.

Water is also associated with bodily fluids in TCM, such as blood, lymphatic fluid, saliva, urine, tears, cerebral spinal fluid, and perspiration.  These fluids help the body function optimally by delivering nourishment and moisture and by carrying away waste products.

Salt is the flavor associated with the Water Element. Have you ever found yourself craving salty foods? This may signal an imbalance in your Kidney/Bladder system.

Fear and terror are the emotions expressed by the Kidney organ in TCM.  If you find yourself feeling fearful, negative, anxious, or aching, think of an imbalance in this vital system. I’ve seen many patients who experience free-floating anxiety even when their life is going well. This is often due to the dominance of cold qi emanating from the Kidney which reduces the fire of the Kidney’s yang energies which must rise to the brain to support clear thinking.

Deficient Water energy can lead to hyperactivity, difficulty sleeping, and reduced understanding and compassion for others (an inability to listen) while an excess of Water can cause sluggishness, frustration, and a feeling of heaviness. The latter results from a breakdown in the body’s inability to transform water in the body.

When the organ and meridian systems assigned to the Water Element are functioning optimally, the skin is benefited through the release of toxins via perspiration. The color, tone, and clarity of your skin, the sparkle in your eyes or lack of it, and the texture and thickness of your hair also provide clues to a healthy or stressed Water Element.

Supporting The Water Element During Winter

Warm food, rest, warm clothing, and the warmth of friendship and companionship will help you to successfully navigate the winter season. Watch your calorie intake because we are usually less active during the winter. Cook with miso, garlic, ginger, cinnamon, cardamom, onions, cayenne, and turmeric to warm you body and delight your senses!  Seaweeds eaten toasted, raw, or in soups can also replenish the Kidneys.  Elson Haas, recommends herbal teas concocted from the following western soft and hard roots, barks, seeds, leaves, and flowers: comfrey, burdock, fennel seed, ginger root, fenugreek, chamomile, and peppermint, to name just a few!

Stay healthy and well this season!

Palpation: The Use of Touch in Dis-Ease

Dis-ease is a key precursor to illness.

It is a state of subtle energetic imbalance which may reflect deep-seated experiences of anguish, grief, distress, misfortune, suffering, or trial.

If relief is delayed too long, the energetics associated with these states of being may eventually materialize in the tissues of the body, towards a diagnostically identifiable state of physical disease.  Hans Selye described this process as “the general syndrome of sickness” and identified  energetic signs which usually preceded the appearance of an illness or disease related to loss of adaptation (one’s physiological capacity for stress regulation).

Diagnosing subtle energetic imbalances is a primary component of Oriental (Asian, Chinese, Korean, Japanese) medical theory and practice.  A stand-alone system of health care, it utilizes four basic observations: questioning, listening, smelling, and palpation.

Palpation as a Preventative Tool     

Hara Palpation Zones

In Oriental medicine’s Hara diagnosis, abdominal palpation is used effectively to pick up on subtle energetic imbalances in body systems which have not yet shown up as symptoms of disease, such as a mass or tumor.

The hara is the body’s energetic and physical center, the core of a person’s vitality. All the primary meridians root in the hara so any tenderness on palpation, tightness, indentation, temperature variation, change in skin color or texture or swelling, indicates an imbalance in a particular organ and meridian system which responds rather quickly to treatment at this stage.

This diagnostic tool is highly valued as it can identify subtle changes even if a person’s tongue, pulse or lack of symptoms seem to fall in the  “normal” range.

But there is something more to palpation that is equally as intriguing—the energetic exchange that occurs between practitioner and patient when acupoints are palpated. Research has demonstrated that acupoints along the meridians exhibit distinctive electrical qualities.  Palpation of an acupoint prior to inserting a needle affects the qi of the point, helping the practitioner achieve the best results via depth of insertion, angle, direction, and location.

That’s why I love what I do!

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Reference:

Hara Diagnosis: Reflections on the Sea by Kiiko Matsumoto & Stephen Birch

Copenhagen Heart Study: Is It Aging, Lifestyle, or Genetics?

What did you think of the results of the Copenhagen Heart Study?  It was released November 6, 2012, at a meeting of the American Heart Association.

Four Visible Factors Identified in Copenhagen Heart Study

Copenhagen Heart Study Risk Factors

Increased Cardiac Risk Factors – AHA

The study linked the following four visible signs of aging to an increased risk of heart disease and heart attack:

Here’s what fascinates me about this study—

Researchers found that an individual’s risk (both men and women) increased with the number of aging factors present, whether or not they were smokers, had high cholesterol, or high blood pressure. 

So what factors are at play here?  Is the increased risk due to aging, lifestyle, or genetics?  The findings suggest that a good or poor lifestyle did not matter. Neither did a person’s genetics.  Simple aging seems to be the issue.

An interesting puzzle, won’t you agree?  

Loss of Mobility, Myofascial Restriction, and The Turn of the Screw

Myofascial Restriction Leads to Loss of Mobility

Simply put, mobility is what separates the living from the dead.  That’s why cultivating and retaining it should be a primary focus of healthy aging. However, the gradual loss of movement and myofascial restriction are so subtle that we are often taken completely by surprise when one day, basic movements like looking over our shoulder, bending over, unscrewing the lid of a jar, or buttoning up a shirt become hard to do. Further, loss of mobility is often coupled with chronic joint and muscle pain, putting a damper on one’s efforts to stay active. Two key factors that herald this downward spiral are the loss of adaptation and compensation.

Adaptation and Compensation

Adaptation is the term coined by Hans Selye, who explored homeostasis and stress regulation in the 1970s.  More recently, this concept has been expanded to include Sterling’s concept of allostasis, which describes the body’s capacity to adjust moment-by-moment to internal and external changes in the body or stressors in the environment. This process may involve phases of tissue breakdown or tissue repair.  Over time, the body’s ability to effectively adapt to insults or challenges diminishes, losing its capacity to compensate mentally, emotionally, and physically.

Selye’s General Adaptation Syndrome-
Google Images

Bodily compensation refers to the ways the body changes its structure and function to accommodate chronic changes linked to inflammatory conditions, injuries, or surgery, in an effort to stabilize and protect important structures like arteries, organs, spine, and brain. These changes are easily seen in myofascial tension or strain patterns which are often multi-layered, reflecting the cumulative nature of compensatory patterns.

How do myofascial tension patterns affect tissue mobility and function over time, impacting one’s health and well-being?

Myofascial Tension Patterns

Multi-layered myofascial tension patterns and bodily compensation work hand-in-hand to keep us going after our body has suffered structural changes.

Fascia is the ubiquitous connective tissue matrix that gives our body structures and organs their shape.  Myofascial tension patterns develop as ligaments, tendons, and fascial tissues are recruited to act as guy wires (to brace) or struts (to resist compression) to stabilize and support the body.

Patterns may manifest as a torsion or twist, as hips or shoulders attempt to counterbalance each other, one in the anterior plane and the other displaced in the posterior plane.  Or, there may be a top/bottom pattern, often seen in whiplash injuries, where the forward displacement of the neck is counterbalanced by tension in the low back. This pattern is also associated with years of computer-related head-forward posture.  Adhesions related to scar tissue can also induce abnormal motility patterns in visceral organs, reducing normal patterns of excursion.

Eventually, trigger points form, creating patterns of referred pain, further altering normal neuromuscular function by reducing range of motion.  Finally, nerve entrapment contributes to movement-induced chronic pain.

The Turn of the Screw

Time, wear and tear, inactivity, and reduced range of motion become the turn of the screw that leads to decompensation, phase four of Selye’s general adaptation syndrome.  Decompensation occurs when the body no longer has the resources or raw material (reduced hormones, strength, and function) necessary to sustain compensatory patterns.   Joints, discs, and bones begin to breakdown, muscles and visceral organs lose their tone and torpor sets in, accelerating the aging process.

Not a pretty picture, yet it is the common pattern facing us all.  Make the choice today to enhance your chances of aging well.

Aging well involves the foods we choose to eat, our activity level, social support, thinking patterns, movement practices that support functional anatomy (Feldenkrais or the Alexander Technique), as well as the support of  practitioners who can help us improve and maintain our mobility: acupuncture, myofascial release, frequency specific microcurrent, craniosacral therapy, or rolfing.

What are you doing to age well?

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