*Possible Risk Factors for Fibromyalgia

Did you ever wonder why fibromyalgia or chronic pain might occur?  A recent study in the Journal of Pain has shown possible links between regional neck and back pain and the later development of fibromyalgia and chronic widespread pain (CWP). 

 The study looked at 550 subjects with back or neck pain.  The researchers compared questionnaires filled out in 2001/ 2002 and then again in 2007 to see how many people had developed chronic widespread pain.  They found that nearly a quarter of these people had developed chronic widespread pain in the 5-6 year period.  The diagnosis of CWP was made if the person indicated pain in three out of four body quadrants (left and right, arm and leg).

 They found seven factors that increased the likelihood of developing CWP from regional neck or back pain.  They are:

• Moderate or severe pain intensity
• Female gender
• History of family abuse
• Family history of chronic widespread pain
• Interference with general activity
• Having one or more other conditions (irritable bowel syndrome, irritable bladder syndrome, restless legs syndrome, and/or migraines)
• Using more pain management strategies.

 Interestingly, they did NOT find a link with the following (although obesity and depressive symptoms were found to be almost significant):

• Number of depressive symptoms
• Pain duration
• Age
• BMI (body mass index- an indicator of obesity)
• Number of medications used
• Receipt of disability benefits

Out of all of the traits linked to development of CWP, they found the strongest predictor to be increased initial pain severity.   They stated that current research supports the theory of painful input (neck or back injury) causing changes in the nervous system leading to the development of more widespread pain. 

It is important to understand this study did not look at all people in general, but started with people who already had neck or back pain. It also does not mean that neck or back pain is the only cause of development of CWP.  The researchers also pointed out possible limitations to their findings in the use of questionnaires and the low subject response rate (24.4%) due to subjects moving in the 5-6 yr time span of the study. 

Fibromyalgia and chronic pain are not easy conditions to understand.  While this research does not give us immediate answers, it does present some useful information.  It gives clinicians or future research a place to start looking for ways to prevent the transition into fibromyalgia and more long term pain. 

*November is Jaw Joints-TMJ Awareness Month

TMJ or Temporomandibular Joint pain affects many people.  These are the joints where the jaw meets the skull just below the ears.  Often, people develop face and jaw pain with chewing or even at rest.  There may also be joint sounds such as clicking with mouth opening and closing.  Headaches and neck pain are commonly associated with TMJ problems as well.  It may be caused by a trauma such as a car accident or fall.  It is also caused by clenching and grinding of the teeth over a period of time.  Simple things such as avoiding chewing steaks and large sandwiches can help.  Cut food into small bites and avoid clenching teeth together.  Physical Therapists who work with this area can help by working with the joint and muscles to allow more normal movement for less "wear and tear".  Posture is also very important to get the best pain relieving joint position. 

*Interesting (and funny) pain research

Here’s an interesting article that will make you smile. A study at Keele University in Staffordshire, UK found that swearing increases pain tolerance compared to not swearing. They compared cold pain tolerance between people who repeated a swear word versus those who repeated a neutral word. Yes, you read that correctly. There has been a study done to show the effects of cussing on pain tolerance. They hypothesize that cursing increases heart rate which induces a fight-or-flight response which “nullifies the link between fear of pain and pain perception”.

Actually, as funny as this seems, there is some benefit to anything that blocks the brain’s perception of pain and cussing is one of the few things that is still free. I’m just not sure I can advise patients to do this and keep a straight face. (But I won’t tell anyone if you put it to use yourself! :)

http://www.ncbi.nlm.nih.gov/pubmed/19590391?ordinalpos=7&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

*Arthritis- Tai Chi for Pain

A new study has found that Tai Chi improves pain and disability among arthritis suffers. Tai Chi is a gentle but effective form of exercise and movement that emphasizes flowing movements in functional positions. People practice it in standing and this helps by stimulating balance reactions, gentle weight bearing and range of motion.

Researchers at The George Institute for International Health did a systematic review of the literature and found positive effects of Tai Chi on improving physical performance, reducing tension and improving quality of life. For a systematic review, researchers compare and synthesize multiple studies to answer a specific question.

Hall A, Maher C, Latimer J, Ferreira M. The effectiveness of Tai Chi for chronic musculoskeletal pain conditions: A systematic review and meta-analysis. Arthritis Rheum 2009; 61:717-724.

http://www.thegeorgeinstitute.org/events/latest-news/research-proves-tai-chi--benefits-for-arthritis.cfm accessed 6-24-2009