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Noise? Light? Smells? Pain?

Think you’re going nuts? Too much noise? Light too bright? Your doctors telling you that it has nothing to do with your Fibro?

Research has indicated that FM sufferers have an increased sensitivity to painful stimulation (Scudds et al. 1987) – Really? In 1993, it was formally hypothesised that FM involves a generalised pattern of hypervigilance, marked by increased attention to a variety of external and internal sensations (Rollman and Lautenbacher 1993)

Our brains become overly aware of things, which can include painful stimuli, noises, bright lights, and general activity. It is possible that the nature of the condition itself may augment hypervigilant behaviour (McDermid et al. 1995). Pain is the hallmark symptom of fibromyalgia (Rollman 1989) – again, really?

BUT clinical data suggests that the pain is widespread and intense, not limited to the tender points – 59.5% of FM sufferers reported that they had pain in 15 or more body regions and 68.8% experienced ‘pain all over’ (Wolfe at al. 1990). This could explain why our bodies react so strongly to sensation that most people wouldn’t experience as painful. ,

But what about the heightened responses we experience from other sensory stimuli? Things like sensory symptoms, tinnitus, and aggravation of symptoms by noise, lights, stress, posture and weather? Findings suggest that FM sufferers find a variety of bodily experiences to be aversive (Yunus et al. 1989) – do you want to say it this time? It was in 1986 that the term ‘Irritable Everything Syndrome’ was coined (Smythe 1986).

With hypervigilance, not only do we notice things more readily, we are likely to be unable to divert our attention from them. These diversions – things that are in everyone else’s background but, for some reason, seep into our foreground – are perceived as a threat by our fixated brains, and our physiological response is far more extreme than it should be.

With ‘normal’ people, their brains absorb a lot of information about their surroundings, of which they are not particularly conscious. With FM sufferers, too many signals are considered a threat, and thus get extra attention.

Perceptual amplification of pressure stimuli occur across a wide range of physical intensities, from those that are gentle and innocuous to higher levels that are strongly unpleasant or painful. The unpleasantness of stimuli does not appear to be the factor that determines whether they will be amplified.

The studies showed that FM patients had significantly lower threshold and tolerance values than the RA patients, who in turn, had lower values than the normal control subjects. The results of the psychological questionnaires revealed that the fibromyalgia and RA patients preferred lower levels of external stimulation than the control subjects. The outcome of this study supports that FM patients have a perceptual style of amplification – see? you’re not going crazy!

But what is the critical factor? So far, there does not appear to be a singular answer BUT it is proposed to combine two popular views into a unified model (Crombez at al.2004). Specifically, that hypervigilance begins as a cognitive process, in which an individual is concerned about, and therefore closely monitors, particular types of sensations— especially those that, while not necessarily unpleasant in themselves, accompany or warn of impending pain. Further, that sustained direction of this affect-charged attention to a particular form of stimulation produces, over time, an increase in the perceptual gain for all stimuli of that type. (eg: in FM, firm pressure on the skin routinely leads to pain; hence all pressure sensations, even gentle ones that pose no risk of pain, come to be amplified). If (and to the extent that) attention is habitually focused on sensations of a particular type, their amplification increases and becomes autonomous.

But let’s forget the science, sometimes, the symptoms of hypervigilance are hardest to deal with because they’re constant. They don’t have to increase to be a bother; the same level of intrusion day after day is enough to make us lose it!

References

Crombez G, Eccleston C, Van den Broeck A, Goubert L, Van Houdenhove B, Hypervigilance to Pain in Fibromyalgia: The Mediating Role of Pain Intensity and Catastrophic Thinking About Pain. Clin J Pain. 2004;20;98-102.

Hollins M, Harper D,Gallagher S, Owings E W, Lim P F, Miller V, Siddiqi M Q, and Maixner W, Perceived Intensity and Unpleasantness of Cutaneous and Auditory Stimuli: An Evaluation of the Generalized Hypervigilance Hypothesis. Pain. 2009; 141(3): 215–221.

Lautenbacher S, Rollman GB. Possible deficiencies of pain modulation in fibromyalgia. Clin J Pain. 1997;13:189–196.

Lautenbacher S, Rollman GB, McCain GA. Multi-method assessment of experimental and clinical pain in patients with fibromyalgia. Pain. 1994; 59:45–53.

McDermid AJ, Rollman GB, McCain GA. Generalized hypervigilance in fibromyalgia: evidence of perceptual amplification. Pain. 1996; 66:133–144.

Rollman GB, Gillespie JM. Disturbances of pain perception in temporomandibular pain syndrome. In: Lautenbacher S, Fillingim RB, editors. Pathophysiology of pain perception. New York: Plenum; 2004. pp. 107–118.

Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, Tugwell P, Campbell SM, Abeles M, Clark P, Fam AG, Farber SJ, Fiechtner JJ, Franklin CM, Gatter RA, Hamaty D, Lessard J, Lichtbroun AS, Masi AT, McCain GA, Reynolds WJ, Romano TJ, Russell IJ, Sheoin RP. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum. 1990;33:160–172.

Yunus M, Masi AT, Calabro JJ, Miller KA, Feigenbaum SL. Primary fibromyalgia (fibrositis): clinical study of 50 patients with matched normal controls. Semin Arthritis Rheum 1981; 11:151–71.