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Fibromyalgia is not a well-understood malady, but scientists are making breakthroughs that could eventually help pin down both the causes and the cures.

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[INTRO ♪].

Fibromyalgia is one of the most commonly misunderstood disorders out there— which is saying something, considering that there are a lot of misunderstood disorders. It’s characterized by widespread pain throughout the body, making it a literal pain in the everything.

But it’s also difficult to figure out what causes it. And that’s led some people to argue that fibromyalgia isn’t even real. Admittedly, it is a controversial diagnosis, and scientists are still hotly debating a ton about it, including what role psychological factors play in causing symptoms.

But let’s debunk this myth up front: Fibromyalgia is not a delusion. The disorder, known in chronic pain communities as fibro, was first formally defined in 1990. It’s a chronic condition that affects 2 to 8% of the population.

Besides the widespread pain, it also includes symptoms like increased sensitivity to pain, difficulty sleeping, numbness, and problems with things like concentration and memory. Usually, it’s treated by medications or cognitive behavioral therapy, which aims to prevent patients from focusing on or panicking about their pain. But fibro has also been surrounded by controversy, and a lot of that is because psychologists have had a really difficult time figuring out how to diagnose and classify it.

With such widespread symptoms, you’d think that it would be easy to take some physical measurements and diagnose someone with fibro on the spot. But it’s trickier than that, because some of those symptoms can also be caused by other simultaneous conditions like arthritis. And as for what actually causes fibromyalgia….

Well, here’s where things get especially messy, because there are a whole lot of factors that might trigger or contribute to all of these generalized, body-wide symptoms. The most famous ones are psychological or environmental. For example, those who've had significant physical injuries or experienced psychological trauma, especially in childhood, are more prone to developing fibromyalgia.

To be clear, though, that definitely does not mean that everyone with fibro has experienced trauma in their lives. It’s just one risk factor. Another major one is genetics.

Fibro runs in families, and several studies have shown relationships between its development and dysfunctional genes controlling certain neurotransmitters— specifically, serotonin, dopamine, and norepinephrine. So, getting a diagnosis isn’t always easy, and neither is figuring out what causes the disorder. And all of that has led psychologists to disagree about what fibromyalgia should even be considered.

Actually, that’s a pretty big understatement. Over the years, there has been a ton of controversy over this. Some scientists have believed that, since fibro is often linked to psychological factors, it should be categorized as a somatic symptom disorder.

This is a mental condition where psychological issues manifest as physical symptoms. But other researchers have argued that it would be better classified as something else, since it can also be triggered by biology or the environment. Today, though, many scientists say that instead we should look at fibro in the context of biological, psychological, and social factors combined.

Maybe unsurprisingly, this is what’s known as the biopsychosocial approach. It suggests that traumatic physical or psychological events, likely in combination with a genetic predisposition, may lead to that extreme response to pain and those other symptoms. Of course, the specifics vary case to case, but all three branches are known to interact and play a role in producing fibromyalgia.

The exact mechanics of how this plays out in the body, though, are so far unknown. And unfortunately—and especially because of the psychological factors involved in fibro—that’s led to a common misunderstanding that patients are suffering a delusion that they’re in pain, rather than being in actual pain. This misunderstanding is actually so widespreadmthat it can be difficult for those with fibro to access available treatments, because they’re just not being taken seriously.

But, like, you can’t just shrug fibromyalgia off. Even if psychologists argue about how to classify it, current research is clear that there’s nothing delusional about it. In one 2018 study, for example, researchers studying the mechanics of fibro patients’ sensitivity to pain showed that their brains were acting sort of explosively in response to pain stimuli.

In the study, scientists used EEGs to test ten females with fibro, taking readings of their brain waves. The readings showed signs of so-called electrical instability—brain waves behaving more erratically than expected in response to stimuli. This made the researchers consider if what they were measuring may be similar to what’s seen in something called explosively synchronizing networks.

Explosive synchronization, or ES, is a phenomenon that’s usually studied in fields like physics, like with power grids, rather than medicine. When it happens, a tiny stimulus causes a dramatic, synchronized reaction across a network. In brains … that’s, well, explosive.

To a fibro sufferer, a poke in the side that would feel like nothing to your average person becomes way more intense, becoming painful much more easily. To see if this is actually what was happening, the researchers created computer models of a brain with fibromyalgia to see how it would respond to mild stimuli. And like they suspected, the models reacted to pain in the same, explosive manner that patients reported.

This really tells us that fibro isn’t just a case of people believing they’re experiencing more pain, or something to ignore. Instead, it suggests that there’s a physical overreaction to pain stimuli in their brains. It may still be fuzzy what causes that, but this was a big step in the right direction, even if the study was only with ten people.

And with more research, we could someday use this model to create new treatments for fibro. There’s still a long way to go, but there’s lots of hope. And in the meantime, one thing is for sure: despite all the misconceptions, fibromyalgia is nothing to ignore.

Thanks for watching this episode of SciShow Psych! If you would like to keep learning about the brain and mind with us—and how those things make us tick— you can go to [OUTRO ♪].