Anti-depressants and Cognitive Behavior in Fibromyalgia

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Category: Fibromyalgia (FMS) Published on Saturday, 19 December 2015 Written by Yong Tsai, MD
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Patients with fibromyalgia (FMS) suffer with chronic widespread, generalized muscle pain, along with headaches, irritable bowel syndromes and chronic fatigue, Patients with FMS also experience an exaggerated response to painful stimulus (hyperalgesia), prolonged length of response after brief stimulus (persistent and widespread pain), pain after the simple act of touching or rubbing due to a reduction of pain threshold (allodynia). FMS, one of the central hypersensitivity syndrome, occurs when the central nerve system (brain and spinal cord) become hypersensitivity to different stimulus and lead to many different symptoms.

Currently, we have adequate scientific evidences that central hypersensitivity is mainly caused by imbalance of neurotransmitters such as serotonin, norepinephrine or others. Serotonin and nonepinephrine are produced and regulated within in our brain and spinal cord to keep everyday pain sensation and mood in sync by balancing pain and other signals. When levels of serotonin or nonepinephrine are decreased and unbalanced, which occurs with fibromyalgia or depression, the brain becomes incapable of processing the transmitted pain signals properly. Pain signals can be exaggerated and even disordered. Patients can become depressed.

Research has shown that by increasing levels of either serotonin or norepinephrine or both in the brain with the use of anti-depressants, pain signals can be decreased. Selective serotonin re-uptake inhibitors (SSRIs) such as Prozac, tricyclic-depressants, and especially serotonin and nonepinephrine reuptake inhibitors (SNRIs) such as Effexor, Cymbalta and Savella, which are dual-acting anti-depressants that can increase both serotonin and norepinephrine, have proven capable of decreasing pain while treating both depression and chronic pain.

Our mind, a source of thoughts and feelings, allows us to experience sensations, including those of pain. Even though pain signals are processed by our brain, they are heavily influenced by our mind. Our mind and mood are also influenced by neurotransmitters. Scientists have proved we can train our mind and then change our brains (neurotransmitters). Cognitive-behavior therapy (CBT) focuses on altering distorted belief, attitude, and expectation patterns by substituting a new response to a given pain or suffering and shows individuals how to evaluate things in a more balanced manner. Three principles of CBT are to recognize the problems, to offer retraining of coping skills, and to teach the patient how to apply these skills in everyday life by utilizing relaxation training, activity pacing, advance scheduling, cognitive restructuring, problem solving, visual imagery, distraction strategies and goal setting.

Many studies have already proven that combining CBT with anti-depressants can offer relief to sufferers of chronic pain with or without depression and put them back in control. The key is to realize that some situations cannot be changed, but you can change yourself and the way you react to them.

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