In May of this year, I published an article in Therapy Today entitled Understanding Chronic Pain. In it, I describe chronic pain as caused in part by changes in the sensitivity of our central nervous system. I also described an evaluative process by which our brain can create protective pain in response to an actual or potential threat. I suggested that pain is therefore not simply just one thing; that it is complex, influenced by factors such as context and memory. To a degree, pain is personal, meaningful.
Given the emphasis placed in my article on pain as mediated through the brain, I was curious and a little concerned to read inThe Guardian recently (1st July ’21) an article with the title ‘Fibromyalgia may be a condition of the immune system not the brain – study’. The article’s author, Linda Geddes, refers to a 2021 study by Dr David Andersson from King’s College, London, called ‘Passive transfer of fibromyalgia symptoms from patients to mice’, published in the Journal of Clinical Investigation in 2021. In this paper, Andersson points to autoimmune factors affecting the peripheral – rather than the central – nervous system that contribute to the onset of fibromyalgia. As most autoimmune disorders affect more women than men, Geddes points out that Andersson’s research appears to explain why the great majority of fibromyalgia sufferers are in fact women.
Despite the implications of Geddes’ misleading title, however, Andersson does not in fact rule out changes in the central nervous system – especially the brain – as a key determinant of chronic pain. This matters. His research unambiguously points to a situation in which not only central but also peripheral alterations contribute to the long-term pain experience and fatigue associated with fibromyalgia. In fact, Geddes herself acknowledges the role of the central nervous system in chronic pain in a previous article forThe Guardian entitled ‘Sufferers of chronic pain have long been told it’s all in their head. We now know that’s wrong’ (28th June ’21) – a choice of words that manages equally to muddy the field somewhat.
It is clear that this remains an emerging field, one in which psychological therapists like myself have a major contribution to make. This is perhaps made evermore clear by the fact, apparently overlooked by Geddes, that Andersson’s no doubt robust research is a study of mice. Whilst it may be the case, as he has shown, that a rodent will demonstrate pain avoidant behaviour when injected with antibodies harvested from a human fibromyalgia sufferer, the repertoire of behavioural, cognitive and meta-cognitive responses to pain in humans differs greatly from that of mice, a fact which clearly leaves a lot of room for further research into the human experience of persistent pain.