"For a long time, patients were considered to be conceited sick people"

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Constantly inexplicable pain - fibromyalgia has long been considered a puzzling phenomenon. Prof. Claudia Sommer answers the first answers to the question about the causes in the interview.

Prof. Dr. Claudia Sommer

Prof. Dr. Claudia Sommer is the senior physician in charge of the neurological clinic and polyclinic of the Würzburg University Hospital.

Prof. Sommer, for a long time there was no explanation for the phenomenon of fibromyalgia.

That's right. The patients suffer from diffuse pain that could not be explained medically for a long time.

It was not uncommon for those affected to hear that their pain was purely psychological. This assumption is now off the table - thanks in part to one of your studies.

That was a mere chance finding. It has long been hypothesized that people with fibromyalgia have impaired central pain processing. We wanted to test that on our patients too. In our laboratory, however, we also have the opportunity to examine the function of the peripheral nerves.

... these are nerves that are located outside the brain and spinal cord. For example, pass on sensory stimuli from the skin.

Right. We thought that if we already had this option, then we'd just do the tests right away. We were then very surprised when our fibromyalgia patients differed significantly from healthy control persons in this regard.

What was different with them?

In tissue samples we could see, among other things, that they had fewer of the small pain sensors in the skin, the so-called nociceptors. With further tests we were able to show that fibromyalgia patients perceive and pass on temperature differences on the skin more poorly.

Wouldn't one now think that fewer nerve fibers also mean less pain?

In the beginning, we couldn't really explain why fewer nerve fibers cause more pain. But in the meantime a Spanish-English working group has investigated precisely these little pain sensors in fibromyalgia patients. And that's when the colleagues discovered that they are overactive in fibromyalgia patients - and that in turn means more pain.

Those affected who hear this are probably relieved that there is a specific finding.

That's right. For far too long they were considered to be conceited sick people.

Is there a targeted therapy in sight?

Unfortunately we are not that far yet. But we know that so-called ion channels are responsible for the activity of nerve cells. One or more of these must be impaired in their function in fibromyalgia patients.Various groups are currently working on identifying the disturbed canal - but this is similar to looking for a needle in a haystack. Whoever finds it will have done a great job, because then we can finally develop a therapy.

As long as there is no causal therapy: what can be done?

There are certainly things that can alleviate the discomfort. Take warm baths, for example. Massages, on the other hand, make symptoms worse. Antidepressants can also help, as they not only have an effect on the psyche, but also have a pain-relieving effect. Many also benefit from certain medications that are also taken for other neuropathic pain. Unlike in the USA, however, they are not approved for the treatment of fibromyalgia in Germany - as a doctor, you have to make a special prescription.

However, what helps one patient does not work for another. Usually you have to try it out a bit. That is why I would advise anyone affected to contact a specialist who has experience with the subject of fibromyalgia. In this case, the family doctor is often not the right person to talk to - the subject is too specific.

Those who are in pain tend to hide. But this is the wrong way to go about fibromyalgia.

Exactly. It is very important to stay active - both physically and in your own life. That is easier said than done - especially with patients who feel pain in every movement. Training programs especially for pain patients are recommended. Those affected experience that exercise may have a short-term effect of intensifying pain, but then it improves the symptoms. If you don't do anything and withdraw, your life will be worse - you get into a vicious circle.

Those who are active are also distracted from their pain. Does that also play a role?

Yes, that is a very important point. When I am distracted, I also feel stronger pain less than when I sit and think "My knee is hurting". The reason for this is our body's own pain control system. This can be more active or less active. If you don't focus as much on the pain, it will be more active and you will feel the pain less.

Your advice to patients?

Accept the disease, but don't give up!

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