Fibromyalgia is a condition causing chronic pain and tenderness at various points in the body. Though the condition is more common in females, but its incidence is rising in males, too. Veterans are much more likely to experience chronic pain and have higher intensity pain than the general population. Hence, they are also quite likely to experience fibromyalgia.
Moreover, fibromyalgia rarely exists alone. Those living with fibromyalgia are more likely to have various mental health issues like depression, anxiety, PTSD, and so on. All these conditions are known to be more prevalent in veterans.
Although it is unclear how many veterans are living with fibromyalgia, but it is quite likely an underdiagnosed condition. It is estimated that 5-10 million people are living with the condition in the US.
Over the years, diagnostic criteria for fibromyalgia have improved. Still, it remains a diagnosis of exclusion in many instances. This means that doctors would diagnose someone with the condition only if they excluded other common conditions that cause chronic pain.
In fibromyalgia, most lab tests might be normal or close to normal, unlike in other physical conditions. Of course, this does not mean that there are no pathological changes in the body in fibromyalgia patients, but those changes are challenging to identify using modern diagnostic approaches.
Thus, for example, those living with fibromyalgia might have inflammation, changes in the immune system, gut microbiota changes, emotional disorders, and much more. These changes can be identified and might suggest fibromyalgia. However, these issues might be present in many other clinical conditions. Thus, the diagnosis of fibromyalgia is largely clinical.
Yet, another issue with fibromyalgia is pain management. There is no single drug that may work for all patients. Some might benefit from commonly used medications like NSAID, but the majority of the patients fail to report benefit. Moreover, certain population groups, like veterans, differ, and they are less likely to respond to traditional pain treatment. Thus, only one-third of veterans respond to commonly used painkillers.
Opioids are a particularly poor fit for fibromyalgia. The pain is centrally generated rather than nociceptive, so an opioid is treating the wrong mechanism, and continued exposure drives the receptor desensitization that makes pain worse over time. That treatment gap is precisely why non-drug approaches matter here.
So, there is definitely a treatment gap, and doctors are exploring various pain management methods for such chronic pain syndromes as fibromyalgia. One such safe and effective treatment worth exploring is cranial electrical stimulation (CES).
Recently, a study was initiated on 50 veterans from the Atlanta Veterans Affairs Healthcare System (VAHCS) who were diagnosed with fibromyalgia. They were randomized to receive CES or sham treatment. Both groups were assessed for pain scores at 6 and 12 weeks. The study also used brain scanning using functional connectivity magnetic resonance imaging (rs-fcMRI).
The study’s initial results were presented at the recent ASRA Pain meeting. Early findings suggest that CES could be a safe and effective way to modulate pain sensation in veterans with chronic pain syndrome like fibromyalgia.
CES is quite a safe treatment as it involves applying electrodes over the head to stimulate the brain. It is a non-invasive treatment, and it has been shown to help with mood disorders like depression and anxiety. And now, one of the new studies shows that it may also help with fibromyalgia.
Source:
Ree, A., Rapsas, B., Denmon, C., Vernon, M., Rauch, S. A., Guo, Y., Cui, X., Stevens, J. S., Krishnamurthy, V., Napadow, V., Turner, J. A., & Woodbury, A. (2024). A Randomized, Sham-Controlled Trial of Cranial Electrical Stimulation for Fibromyalgia Pain and Physical Function, Using Brain Imaging Biomarkers. Journal of Visualized Experiments: JoVE, 203. https://doi.org/10.3791/65790
Dr. Gurpreet Singh Padda, MD, MBA, MHP
