Let’s remember that despite all of our great science, we don’t fully understand either central sensitization or fibromyalgia. So the question is cute but unanswerable.
Central sensitization means that there is altered processing of sensation in the spinal cord and brain. Imagine you have an mp3 player and you plug it into an amplifier and then to some speakers. The mp3 player is like the tiny signals coming **constantly** from the nerves that touch all of your body. Central sensitization is when the amplifier is turned up. So various aspects of sensation are turned on high.
People with fibromyalgia have central sensitization. Their pain processing is amplified.
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But central sensitization is just one kind of physiologic imbalance that shows up in fibromyalgia. People with fibromyalgia can also have a variety of other physiologic imbalances, depending on the person.
That includes immune system dysregulation, activation of inflammatory cells in the brain, dysregulation of hormones like cortisol or thyroid, irritable bowel syndrome, nutritional deficiencies, impaired energy production by mitochondria. Based on physiologic principles and some research, these imbalances are related to interlocking vicious cycles. Positive feedback loops that drive the physiology forward.
These are underlying physiologic issues that probably result in the syndrome of symptoms that we call fibromyalgia. In other words: brain fog, abdominal pain, constipation/diarrhea, painful muscles with minimal activity, fatigue, insomnia, and so on.
In my judgment, the complexity of fibromyalgia is the reason why there is so much difficulty with diagnosis and treatment. In conventional medicine, we get trained to look for one cause and one treatment for a problem.
Fibromyalgia appears to be a different thing. There are many different triggers that can start to shift physiology. And many different perpetuating factors that can permit or drive the cycle of imbalances.
In the meantime, people with fibromyalgia get to decide whether they want to be conservative and go with the conventional approach or to be more open-minded and go with an integrative approach. That means
1. A strictly conventional medicine approach, which says ‘you have central sensitization, we don’t know what causes it, do therapy and exercise and try Lyrica, Cymbalta, gabapentin, and so on. or
2. An integrative approach says, ‘there are a number of physiologic imbalances that are probably driving the symptoms. We can try the meds if you want. And for sure address mind-body variables and movement.
But also let’s help you shift your diet, heal your gastrointestinal barrier and biome, use botanicals and supplements to help sleep, balance your hormones, nourish your mitochondria, reduce stress, and so on’.
In my experience, the second one gets real results for more people.
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