What is the autonomic nervous system?
The autonomic nervous system is a nervous network.
It maintains the functioning of our body without our noticing it.
The autonomic nervous system is also responsible for responding to stress (understood as stress to any stimulus either physical or emotional that attempts to alter the balance of our body).
It works with the endocrinological system responsible for the production of hormones.
There is a new method to measure its functioning, based on computer calculations, called analysis of heart rate variability.
Our advances in fibromyalgia.
Using this technology in the National Institute of Cardiology Ignacio Chávez we studied a group of patients with FM and compared it with a group of healthy people.
All the heart beats were recorded through a portable recorder for 24 hours.
The patients with FM had an incessant hyperactivity of the sympathetic nervous system, this abnormality was especially evident during the hours of sleep.
These abnormalities have been corroborated by other investigators and represent perhaps the most well-documented alteration in FM cases.
These results show that fundamental alteration of the FM is an imbalance in the functioning of the autonomic nervous system, with an incessant hyperactivity, which can cause sleep disorders, but there is also a low reaction to stress, which explains the deep fatigue and other symptoms related to low blood pressure.
These alterations of the autonomic nervous system also explain other frequent discomforts in FM such as abdominal cramps, urinary urgency, numbness of the extremities, anxiety and constant dry eyes and mouth.
It is known that after a triggering event (physical or emotional trauma, infection), in certain susceptible individuals, an incessant hyperactivity can be unleashed that induces an excessive production of norepinephrine (also called noradrenaline).
Hypersensitivity to palpation (whose medical term is allodynia) is a typical sign of pain mediated by the sympathetic system.
Our finding that patients with FM have pain induced by injections of tiny amounts of norepinephrine supports this way of thinking.
We have proposed that fibromyalgia pain is a “neuropathic” pain, that is, the fundamental problem is in the nerves responsible for transmitting the pain.
This pain is accompanied by abnormal sensations such as burning, tingling, electric shocks, discomfort when wearing tight clothes.
Most patients with FM report such abnormal sensations.
Examples of neuropathic pain are post-herpetic neuralgia, diabetic neuropathy and reflex sympathetic dystrophy.
Our proposal that FM is a neuropathic pain syndrome maintained by sympathetic hyperactivity has been reinforced by German research showing that people with FM often have the so-called “thin-fiber neuropathy”.
This type of alteration is characterized precisely by producing a neuropathic pain in addition to prominent alterations of the sympathetic nervous system.
Patients with fibromyalgia most often have a genetic variation associated with an enzyme that does not purge adrenaline effectively.
What is the treatment of fibromyalgia?
The treatment of fibromyalgia is holistic.
The recognition of autonomic nervous system dysfunction, in FM, requires an integral treatment.
A correct diagnosis is very helpful, since patients feel relieved to finally find a logical explanation for their multiple discomforts.
The answers to the treatments vary from patient to patient, therefore the treatment must be individualized and supervised by a doctor.
Aerobic exercise has shown to be effective.
The same can be said of mind-body relaxation therapies.
It is advisable to avoid substances with effects similar to adrenaline such as nicotine and caffeine (including cola).
The intake of water with a high mineral content could help the symptoms related to low blood pressure (fatigue, dizziness, fainting).
It is important to avoid excessive use of medications.
Patients must understand that there is no “magic pill” to cure all their discomfort.
Medications that modulate the autonomic nervous system and sleep in different ways partially improve discomfort.
Generalized pain should be treated with centrally acting analgesics.
Anti-inflammatories have little beneficial effect
The proposal that FM is a neuropathic syndrome, maintained by the sympathetic system, opens new perspectives in its treatment.
They are in period of study and development of various “antineuropathic” drugs.
The investigations that are being carried out in different parts of the world on this subject will surely result in different and more effective treatments.
In conclusion; There is reason for optimism.
The enigma of fibromyalgia is in the process of being resolved.
Scientific knowledge will finally prevail.
Soon we will see more effective treatments for this condition so
exhausting for patients and their families.