Hi - About 5 weeks ago I tripped and fell on my knee on concrete and the bruising is gone but the pain is still there. Then about 4 weeks ago I was digging in the garden wearing garden clogs and using a spade. The repeated action damaged my second toe somehow and its been weeks of swelling and pain (but no bruising) and its no better. Does fibro somehow boost the pain for these minor injuries? Normally something like these hurts would clear up after a few days of rest and ice - but these haven't.
I have soo many questions for you guys...
Bit of background / terminology / perspective, taken me a week to get round to this properly, but I think it's fundamental:
The answer of researchers that favour the CSS-hypothesis to
@longtimer's original question is: pain boosting/amplification is called
hyperalgesia and is together with
allodynia (touch felt as pain) commonly found in patients with fibro and should be explained by the neurological CSS-hypothesis that fibro is a form of
central sensitization (or
sensitivity)
syndrome, which
@Mirador is referring to.
However whilst this seems to be #1, there are at least 3 further mainstream hypotheses (and 3 or 4 outsider ones) about the cause of fibro, like the autoimmune one that was explained in the Guardian and sciencedirect articles a month ago, based on the study by Goebel. Also we do by far do
not all have hyperalgesia and/or allodynia - Mirador, jemima and myself for instance, sunkacola only occasionally. I haven't found statistics about this yet, but CSS / central pain hypothesis-proponents (have to) assume that many have it, but others also do, so it can be phrased "common", "typical/characteristic/defining for".
The further development of the CSS hypothesis can be seen in the definition of a 3rd pain type, which is being increasingly mentioned in research (pubmed since 2019 and in the fibromyalgia controversies convention in June 2021).
The
process of nociception is the normal perception of pain (
1) nociceptive pain) through threat or damage, as opposed to
2) neuropathic pain due to nerve damage and a new category developing in pain research around the concept of CSS since around 2019
3) nociplastic pain with neither tissue nor nerve damage, to which fibromyalgia pain belongs. (see the newest terminology on iasp-pain.org)
Another explanation for
some hyperalgesia is "
opioids addiction which can then lead to fibromyalgia problems" (fightfibromyalgia) and "Symptom of fibromyalgia often triggers the diagnosis of opioid addiction, tolerance or dependence." (fibromyalgiaresources)
I agree fully with
@Mirador that it's always wiser to check everything. And despite the above I wdnt explain either as pain boosting. Both @longertimer's knee and toe as well as
@Hopeful7's shoulder can still have an additional injury (e.g. the toe swelling), which hasn't been resolved yet, I'd think.
Which brings me on to a different idea. Whether nociplastic, autoimmune, small fibre, neuroendocrine, mitochondrial, caused by sleeplessness or low neurotransmitters, fibro is real pain. Plus we get additional pain with injuries. The two together are more pain. That can cause a protective/relief posture which worsens other pains. The three together are even more pain. Not the same "doubled"/"trebled", not imagined, not neurological, not oversensitive, but simply
added. The threshold isn't higher or lower, but the injury wdntve been enough to get over the normal threshold, together it is.
Wouldn't that be enough to explain it, apart from the fact that we don't yet know where the fibromyalgia pain comes from?
Now I see an interesting difference in experiences and ideas here,
@Peachy's seem to accord to the pain research quoted, whilst
@sunkacola and
@Jemima differ. What Peachy seems to imply when talking of "different things" is that there is a difference between pain threshold and pain tolerance, but sunkacola is already talking about
both, at least in her first reply (the 2nd is only about pain tolerance, hyperalgesia & allodynia). What research often claims is that we have a
low pain threshold and a
high pain tolerance. I'd chime in here with sunkacola & Jemima that I not only have a very high pain tolerance, but also a high pain threshold. Meaning as sunkacola has already said: Like before fibro I get skin injuries without realizing it. Plus neither pains nor the Ache are things that bother me about fibro. When I think I can carry on thru with some activity after 30-60mins my wife often looks at me and says: you look in dire straits and are greenish-white in your face. So while I agree that pain research says this, favouring the CSS hypothesis, our bodies are different. I don't know why this happens. Maybe the cohort selected for studies is no neutral or a too small a selection.
I also have the same experience als sunkacola & Jemima that my skin injuries heal just as fast as before fibro, whilst tendons / muscles
now heal faster than before fibro, because I'm wary of them and do something about them immediately, whilst at the beginning of my full flare there was just too much to cope with and not enough know-how about how tendons & muscles work & can be alleviated, so that's how they summed up.
Hello, I was interested to hear your question as I had this conversation with my rheumatologist and she confirmed that one of the key traits of fibromyalgia is the body’s inability to heal quickly, if ever, from things that people without fibromyalgia would typically recover quickly from. So, to answer your question, yes, it is very common in those with fibromyalgia. That’s not to say it’s the same for everyone of course but it certainly is in my case. Injuries take a very long time to heal and some of them never do. They keep recurring and I just have to manage them.
We read things like hyperalgesia is a "key trait" too, e.g. fibromyalgiaresources about it, but it isn't a
key trait in the sense most have it, more in the sense if you have it then it's likely you have FM, unless you've overused opioids. Maybe this is how 'key trait' is meant here too.
I don't think what the rheum. said about healing is nec. wrong, but out of context. sunkacola, Jemima and I aren't representative of course, but we do exist and do have FM ;-D.
I have noticed that when I get a flare up, old injuries reappear as pain
I had this with clavicle pain I hadn't had for a few years too, originally from breaking it, but everything else seemed "new". Here too I think it hadn't been healed properly and it didn't amplify, but everything added up. Now it's been treated by my acupressurist better than the osteopath before it has disappeared, however much pain I may otherwise have.
certain days. When that is happening, just lightly bumping into something is very painful.
This'd be more hyperalgesia and I don't ever have it, I don't think, everything hurts just as much as it used to. I've had allodynia tho, sensitive to longer touch of my wife, which
really sucks.
What irritates me is that hardly anyone ever
distinguishes between single, often alternating pains in a certain body part and a general fluey-type Ache all over - fibromites, docs & researchers alike - only my acupressurist asks exactly what type of pain I mean. But the other day it turned out that even what she calls her fibromyalgia pain was only single pains esp. in her thighs, and didn't really realize that I distinguish that, so no wonder she often doesn't really how bad my FM is thru the Ache etc. and thinks we may be thru with it soon....
Any ideas on this?
(I started a sentence a week ago, I hope if I leave it here I'll remember some day... "Brings me to the idea that the term hyperalgesia is...")
