Fibromyalgia as a Dopamine Deficiency Condition

More Overlaps Between Chronic Stress and Chronic Illnesses

This follows on from my recent article:

Symptoms of Stress <-> Symptoms of Chronic Illness

in which I wrote, in reference to the overlaps between the symptoms of chronic stress and those of chronic diseases:

“…note also, that this is definitely not saying that everyone will get all of these symptoms… chronic stress manifests very differently in each of us, resulting in our own personalized basket of symptoms “picked” from these lists… the diagnosis we eventually get from the doctors then depends on how closely the contents of our unique basket matches to a specific collection of symptoms which has been given a disease label, almost via a flowchart…”,

Subsequently, a reader, Christine, sent me a link to an article reframing fibromyalgia as a dopamine deficient condition [just like Parkinson’s], which is a perfect illustration of the above sentiment. Here, we consider what this article about fibromyalgia has to say, and what we can learn from this connecting-of-the-dots. Not only does it re-iterate the point above that all these diagnosis labels are manifestations of the same thing, but it also highlights an important nuance I missed before.

The new lesson is that we can learn much more by considering the similarities and commonalities between various chronic disease diagnostic labels, rather than the emphasis on the differences. In my view, there is much to be gained by sharing the wisdoms and strategies gleaned across the different [artificially] siloed community boundaries. Indeed, I believe that this artificial silo-ing, mainly due to the ultra-specialized nature of our current medical systems, has done more harm than good. Thus, I advocate for knowledge synthesis and generalization above separation, specialization, and reductionism, and for much more cross-fertilization, and cross-pollination, between the different disease labels. Especially important is the co-sharing of solutions and wisdoms by members of the different communities themselves with each other.

The article we consider here is Central Role of Dopamine in Fibromyalgia, and the following quotes are taken from the article’s introduction.

“Fibromyalgia is a common disorder known chiefly for its association with chronic widespread pain and tenderness to light palpation. A diagnosis of fibromyalgia in the clinical setting is based on the classification criteria established by the American College of Rheumatology, published in 1990. While historically considered a disorder of the musculoskeletal system, included within the greater symptom complex that comprises the so-called ‘fibromyalgia syndrome’ are a striking number of neurological phenomena that include dysautonomia [disorder of the Autonomic Nervous System]… and restless legs syndrome. Patients also frequently complain of cognitive dysfunction (commonly referred to as ‘fibro fog’) characterized by impaired concentration and short-term memory consolidation, impaired speed of performance, inability to multi-task, and frequent cognitive overload.”

“Given the absence of readily demonstrable peripheral tissue pathology, fibromyalgia research in the last two decades has focused increasingly on the central nervous system as a potential source of symptoms. Indeed, among the more recent hypotheses regarding the pathophysiology of the disorder is that fibromyalgia represents a state of dopaminergic hypo-function [deficiency] that develops subsequent to changes in limbic function following exposure to chronic stress. This proposition was originally drawn from three key observations:

1. fibromyalgia has been characterized as a ‘stress-related’ disorder due to its frequent onset and apparent exacerbation of symptoms in the context of stressful events;

2. the experience of chronic stress results in the disruption of dopaminergic activity in otherwise healthy organisms; and

3. dopamine plays a dominant role in natural analgesia within multiple brain centers such as the basal ganglia, ventral striatum, thalamus, and limbic cortex.”

So here is a first example of cross-fertilization of ideas that can occur, by looking outside of our own particular “disease” silo: in all my research and studying of dopamine, in the context of dopamine deficit conditions such as Parkinson’s, I have never come across the concept that dopamine is explicitly a “natural analgesic” [pain reliever] before! Indeed, in their conclusions, the authors say:

“… dopamine is a catecholaminergic neurotransmitter that plays a prominent, albeit historically lesser known, role in natural analgesia within the central nervous system… indeed, it has been demonstrated that the analgesic capacity of classical analgesics (i.e., mu-opioid receptor agonists, such as morphine) is derived in large part from their capacity to activate dopaminergic neurons.”

This is news to me! However, it makes so much sense of what I experience every day: when a dose of the dopamine supplementing drugs kicks in, all my chronic pains and aches just melt away, and then just as suddenly come back in force when the dose wears off. I had in mind this was due to dopamine fluidizing the fascia and connective tissues, thus temporarily easing restrictions, but the direct pain relieving effects in the brain intuitively feels closer to the right answer.

As an aside, this natural analgesic effect of dopamine also explains why we are all so prone to addictions in the modern world, because, at least initially, our addictions quite literally take away our pain through generating dopamine. Of course, this eventually backfires as our bodies and brains become acclimatized, requiring more and more dopamine to have any pain relieving effect, requiring in turn more extreme “hits” from our addictions, and then just making the pain worse as we have larger and larger dopamine crashes on the other side.

Book Review: "Dopamine Nation: Finding Balance in the Age of Indulgence"

The other part of the author’s conclusion is:

“… an increasing body of evidence suggests that fibromyalgia is associated with dysfunctional dopaminergic neurotransmission as demonstrated by neuroimaging studies that have revealed both a reduction in dopamine synthesis at baseline and a disruption of dopamine release in response to tonic painful stimulation…”!

So, in the view of the authors of the article, the pain of fibromyalgia is due to low baseline dopamine levels, meaning sufferers are more prone to chronic pain, but also that they cannot produce their own natural analgesic effects, as they cannot generate enough of their own dopamine for this purpose. The same will therefore be true [is true in my experience] of folks with a Parkinson’s diagnosis, who also have problems generating enough of their own dopamine supplies.

“Many of the symptoms that comprise the greater ‘fibromyalgia syndrome’ may also be related to a disruption of normal dopaminergic activity, including Restless Leg Syndrome, dysautonomia, dysphoria and cognitive dysfunction. Strategies aimed at enhancing dopaminergic activity, therefore, represent a rational approach to the treatment of fibromyalgia.”

The authors back this up by mentioning the success of some trials of low doses of the dopamine agonist class of drugs developed for Parkinson’s on folks with a fibromyalgia diagnosis.

I wonder, though, why they went straight for the dopamine agonists and don’t mention trials of the mainstay drug therapy for PD, namely straightforward l-dopa supplementation, either via natural sources [velvet bean extract] or pharmaceutical grade [Madopar, Sinemet, etc.]? I would be very interested if anyone with a fibromyalgia diagnosis was willing to self-experiment, at their own risk and of course provided they are not on counter-indicated drugs, and in consultation with medical professionals, by taking velvet bean [Mucuna Pruriens] extract to see if this helps? I would recommend taking one capsule of Biovea’s “Mucuna Dopa” supplement brand for this experiment, as I can vouch for the quality of this product, and that one capsule of this is exactly equivalent to a standard capsule of Madopar [pharmaceutical grade]. If it does work, this would switch off the pain symptoms for a while, like it does for Parkinson’s.

Indeed, this would be a test of how far the analogies between the two diagnoses go, with the caveat if this does work for folks with fibromyalgia diagnoses, this is still not the long term solution, because of the same trap that folks with a Parkinson’s diagnosis get stuck in: needing ever increasing amounts of exogenous dopamine, and hence getting ever increasing side-effects.

Instead, the goal is to start self-generating enough of our own endogenous supplies of dopamine again. So we now turn the arrow of cross-pollination the other way, and see what sufferers with fibromyalgia might have to gain from the lessons learned and wisdom gleaned by the more archetypal dopamine deficient Parkinson’s community.

First and foremost, we now know that folks with fibromyalgia would greatly benefit from reducing stress, and keeping as calm as possible for as much of the time as possible. This is because adrenaline, which is generated by stress, is made from endogenous dopamine supplies - that is, stress gobbles up natural dopamine. This not only means that acute stress will, in the moment, make the symptoms worse, but also when we are chronically stressed, we are constantly using up our dopamine as quickly as we are generating it by converting it to adrenaline, and hence there is never enough left to play an analgesic role. This is also another reason that exogenous dopamine supplementation is not the answer, because it just feeds into adrenaline, and hence helps to fuel chronic stress.

The Dopamine-Adrenaline Connection

Folks with a Parkinson’s diagnosis have found that dealing with, and healing our traumas is a massive part of this necessary stress reduction, and the same will be true for fibromyalgia according to the above findings.

Secondly, folks with a fibromyalgia diagnosis will need to avoid disappointment, and cultivate a mindset in which we learn to take pleasure in the motivating part, in the effort, the seeking and striving, because celebrating the win (a big, quick peak in dopamine) more than enjoying the pursuit, rebounds into the pain side of the pleasure-pain balance system, and too much of this will lower baseline levels of dopamine.

The Role of Disappointment in Chronic Illness and Modern Society

Thirdly, folks with fibromyalgia diagnosis will benefit by avoiding and overcoming addictions, as these also result in much lower baseline dopamine levels (see my review of the Dopamine Nation book cited above).

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