The present observations, therefore, indicate the patients’ inability to recruit inhibitory and self defensive circuits against sensory repetition. The authors
Is thinking harder than it used to be? Do even little mental tasks seem effortful at times? It might not be that you’re thinking too little; it might be that you’re thinking too much.
Are FM patients brains being overwhelmed by too much information?
The three pound supercomputer we call our brain is a powerful instrument; the most complex thinking instrument ever devised but even it has its limits. It has to pick and choose how it uses its resources. Throw all the stimuli in our environment at it and circuits are going to fry. In order to get by in our complex world – to plan, to organize, to decide, even just to move our bodies – requires that our brains disregard some stimuli and pay attention to others.
At its most basic level it goes like this: your brain picks up a background noise, a glint of light or an odor, checks it out; determines if it’s useful or a threat or nothing special – and proceeds accordingly. If it’s innocuous – the category the vast majority of stimuli fit into – it files it into the “don’t pay attention to” category and moves on to more important things.
At least that’s what is supposed to happen.
We know the brain is not doing so well with stimuli in fibromyalgia. It’s misinterpreting minor stimuli as pain. It doesn’t like crowded, high intensity environments. It often feels that the environment is too cold or too hot or it’s too loud. This hyper-reactive response to pain and other stimuli is thought to be the result of hyped up pain producing and slumbering pain inhibiting pathways.
The Study
These researchers wanted to know if a similar breakdown in inhibition was occurring at a very, very basic level. Were FM patients brains turning themselves off when faced with innocuous stimuli or were they remaining stubbornly on?
Many types of stimuli (temperature, pressure, light, odor) exist but these researchers used sound to test FM patients brains. They took 19 FM patients and healthy controls, plopped a magnetic helmet on their heads, covered their ears with earphones and had them watch slides of “Where’s Wally” while they stealthily introduced small sounds and then measured the electrical signals it evoked in the brain. If signals moderate over time the brain has given them a pass and begun using its resources to do other things. If the signals stayed strong the brain essentially was stuck.
The Results
They found that the FM patients brains stayed stubbornly fixated on the sounds; no evidence of a normal pattern of “habituation” was seen.
A brain unable to tear its attention away from innocuous stimuli might not be so good at concentrating
What to make of this? This isn’t the only place FM patients brains fail at inhibition. Perhaps in the same way their brains fail to inhibit pain producing pathways, they also fail to inhibit attention to stimuli. Studies indicate that a network in the brain designed specifically to tone things down called “the inhibitory network”) is er….inhibited in FM.
FM patients are not alone in this. The same pattern of reduced habituation has also been found in migraine and irritable bowel syndrome. This suggests, of course, that chronic pain comes with an extra added component – a distracted, inefficient and easily overwhelmed brain.
Why this is happening isn’t clear. Problems with the thalamus in migraine are believed to cause sensory gating issues in that disorder. Sensory gating refers to a process where the thalamus filters out unnecessary information before it gets to the upper regions of the brain. Without gating or filtering stimuli the brain would be overwhelmed. Both thalamic and sensory gating problems have been found in FM and chronic fatigue syndrome. A recent study, though, suggested that sensory gating might not be the issue.
Recent studies suggest that FM patients brains may simply have trouble encoding or figuring out what to do with a stimulus; i.e. they can’t figure out which basket to put it in.
A 2015 study exploring the processing of non-painful stimuli such as sound and light found that sensory processing cortices of the brain were under-performing. That slowed response in the lower (or outer) brain regions was accompanied by increased activation of the higher brain regions. (A similar pattern is seen in migraine.) That low-high pattern suggested that the higher regions of the brain might be struggling to interpret bad information passed onto them by the sensory cortices.
Reduced blood flows, exhaustion of the sensory cortices or a defensive down-regulation of the sensory cortices by the upper brain regions have been proposed to explain the problems with sensory processing.
- Sensory Overload: Study Suggests Brains in Fibromyalgia Are Being Pummeled With Too Much Information
- Japanese Sensory Gating Study Reveals Profound Cognitive Deficits Present in Chronic Fatigue Syndrome
- Sensory Distress: The Other Side of Fibromyalgia
Conclusion
At its core FM appears to be more a pain and sensory inhibiting disease than a pain producing one. Because the pain pathways in the brain need to respond like lightning to an injury, they’re essentially always on-always ready to engage. The problem in fibromyalgia is that they’re not being turned off.
Several inhibitory processes seem to be broken in FM
The same appears to be true with sensory inhibition and with the autonomic nervous system. The brain is not turning off its attention to innocuous stimuli and the parasympathetic nervous system is not jumping in to tone down the sympathetic or “fight and flight” system. Deficiencies in the levels of inhibitory neurotransmitters (serotonin, y-aminobutyric acid) and in the feel-good endogenous opioid system have also been seen. Fibromyalgia is looking more and more like a disorder of blunted inhibition than anything else.
The authors suggest that future studies examine both sensory gating and the very early stages of stimuli processing. Whatever the cause, this and other studies suggest that the problems with processing sensory data extend far beyond the pain most associate with fibromyalgia.
On a personal level the consequences of poor sensory processing and the inability to turn off one’s attention to innocuous stimuli might include such things as problems with following conversations particularly in higher stimuli environments, difficulty concentrating, short attention spans, mental fatigue, the need to get to your cave, etc.
I have family members with ADD – easily distracted certainly – and wonder if there could be some sort of genetic connection for the brain dysfunction.
I read a book called “Explain Pain” by writers in Australia. Excellent book illustrating what happens to the brain with chronic pain-it didn’t categorize how the chronic pain came about but any non-cancerous pain. One illustration showed an orchestra playing at it’s peak but with loud notes all over the place. That’s what my brain feels like-loud and out of tune.
I was having trouble commenting earlier; Cort kindly posted (below) the comment I was trying to post.
I think what you say is important; the brain is being bombarded into dysfunction by the chronic pain, it is not that the brain is “creating the chronic pain”. Is that what you are saying?
Of course evil torture experts use sleep deprivation and constant infliction of pain to break victims spirits and minds, so why would it be any surprise that “natural” torture might do the same?
This is something I’m very aware of suffering from FM. I describe it as if blinkers had been removed. If you visualize horses when pulling carriages have blinkers to protect them when in crowded situations. It’s as if we should have ‘human blinkers’, it feels in FM that these have been removed. I used to feel this particularly when traveling on the underground in London, too much noise, lights and vibration (it felt like I was in the middle of a loud disco) which gave me mild panic attacks and I used to have bad fibro fog. Thankfully both have greatly improved after using the microcurrent device called the Alpha-Stim. This seems to have lowered the stimuli to my brain and increased the inhibitory messages.
Before I became sick I used to be able to daydream for hours to pass my work day…afterwards? I have never been able to daydream again. I wonder if to much outside stimuli is keeping my brain in a hyper alert stage so I can no longer relax. enough and preform daily life obligations… at the same time? I know it sounds strange, but it is one of my symptoms…
This doesn’t sound strange to me at all – in fact it was a relief to read about your experience regarding daydreaming! Daydreaming for me was a great escape and part of my coping mechanism. Maybe not that healthy but I’m just being honest. The more debilitated that I have become, the more I have lost the ability to escape to my ‘place of safety’. It’s as if that particular switch is permanently at ‘off’. Thank you
Sometimes I blame my introversion which I recognized as a child; sometimes the fibromyalgia which came on in my late 30s. For instance, I was always a child who hated noise and commotion, I tired easily and remember taking self-imposed naps at eleven years old, so tired after spending time with others, I had “growing pains” and complained to my mom about leg and arm pains. Now I wonder if there is some hereditary thread or some “personality trait” that is present? I have to avoid so much in this world — even a trip to grocery is exhausting.
This is from Phil who kept getting an error message when he tried to post his comment:
Some of us are becoming more and more convinced that the cause of FM itself affects the sufferer by way of bio-mechanical channels first, leading to such issues as reduced lubrication of the muscle fibres. The “brain” effects are downstream consequences of the actual physical dysfunction and pain.
Is it plausible that it can be the other way around? Is brain dysfunction the cause of the bio-mechanical dysfunction?
Whatever it is, surely once it is understood what is going on, research can head in the right direction for a cure.
Perhaps this is what we need: a large long-term study cohort of normal people who are monitored for all manifestations of FM, bio-mechanical and nervous; and in some small proportion who do develop FM, it can be seen what came first, and even what the indicators for vulnerability might be.
The problem is, the researchers are all having to work with people who have long since manifested all the issues. Diagnosis of FM doesn’t happen until the sufferer is complaining of the pain. No-one is identifying “FM symptoms” in their “mind only” manifestation before the bio-mechanical problems loom up.
I am inclined to think people who go down with FM, have had a combination of issues, and the coinciding of multiple issues is unfortunate for them. Infection / toxic substance exposure / stress / physical injury / trauma etc. I doubt the brain goes into dysfunction without bio-mechanical dysfunction creating pre-existing neurological overloads.
Do you think this is a hereditary trait. My mother (diagnosed as anxiety/depression but unable to function in society as she’s always ‘overwhelmed’), myself (rheumatoid arthritis and fibro) and my 11 year old son (ME/CFS) all display these hypersensitive reactions you describe here.
I would be very interested to know if it run in families and can be passed on through genetics. Seems a bit too coincidental for my liking…Unlucky dip!!!
A strong hereditary presence is clearly present in some families and not in others. My families is pretty small; my mother had an autoimmune disease I have a distant relative with MCS but these diseases run very strong in some families. Studies suggest the hereditary component in ME/CFS/FM is stronger than in most diseases.
I have a reasonable number of relatives; one first cousin has FM too, and a now deceased aunt suffered what was then known as rheumatism, all her life.
I think it’s the physical part my wife was healthy very strong’ then one day she had an accident at the skating rink someone jumped in front of her she fell and broke her wrist fractured her arm ‘ right after that she got fibromyalgia and ra
Not able to read it yet cuz of my sloooooow brain! 😉 I’ll read it in parts, so that my diminished capacities can assimilate all the information.
A perfect example, perhaps, of information overload. By the way, you can print it out by using the print/pdf buttons on the bottom of the blog.
I can really relate to this. I have been suffering with fibromyalgia for about 16 years. Sensory overload is definitely a problem! I’ve been in stores and there is a loud continuous beeping and it drives me nuts. It’s like I’m fixated on it and I am going to go out of my mind if they don’t shut it off. Driving is difficult too because I feel like there is too much going on that I have watch out for. It is very difficult to describe to people.
I suffer from ME. When I have these sensory overloads it’s like my brain shuts down completely. I usually say someone “pulled the plug” (sorry if I’m not explaining to well, I’m norwegian) It’s triggered by either to much activity, stress or to much input of some sorts, like you describe. People have found me suddenly just sitting in a chair looking straight forward with bright open eyes and not being able to speak, they have spoken to me, but get no contact. It’s like I’m not there. Start freezing, trembling. If it’s a bad “off moment” I can get trouble breathing, wet myself (embarrassing yes), loose conciousness…Like the whole system just shuts down. I do “come back” again after a little while with the help of some sugar, some calming hands etc. I usually tell my friends if it was to happen, try and think logical and do whatever you think will work to calm the system down. Don’t know why sugar does the trick there, but it works too, so dont ask me why 😉 Maybe the bloodsugar levels also get affected.
Sure sounds like system overload Kristin!
I’ve noticed that sweet things do help temporarily as well.
Me too.
But I’ve wondered if perhaps that’s the “normal” desire to reach for food, especially carbs, when fighting to carry on despite fatigue?
I heard of some recent studies (ie within last year or two) showing a malfunction of some sort of satiety signal in people who are overweight (so they are literally never satisfied), and I wondered if it might be a similar kind of brain signal malfunction to the ones we’re learning more about in FMS. I also wonder if such signal malfunctions are more likely to come in clusters than singly.
Certainly we know that other autoimmune disorders often appear where there is already an autoimmune disease. I for example have FMS (and?MS?) as well as one involving skin and some other stuff …..so I have had several neurologists, a rheumatologist, an internist, a bunch of gynaecologists, two dermatologists, several psychiatrists, even a neuropsychiatrist
Sounds like hypoglycemia to me… Exactly what I get
Phil queried: “Is it plausible that it can be the other way around? Is brain dysfunction the cause of the bio-mechanical dysfunction?” I think Phil is right. I work part-time seasonally and colleagues have remarked on how absorbed I get in my work as a tax preparer. This is something that has only occurred since diagnosis with CFS 5 years ago although I’ve had fibro for nearly 30 years. For the last 6 months I’ve been doing exercises designed for autistic children and have noticed some definite issues with capabilities I once thought I had but no longer do. It is very difficult for me to “switch gears” and move from one topic to another (for instance a complex tax issue to reading a study on fibro) which wasn’t always the case. The autistic exercises seem to be improving not only my memory but also my ability to pull together information.
Cort, the top two lines of the article seem to be in the wrong place:
“The present observations, therefore, indicate the patients’ inability to recruit inhibitory and self defensive circuits against sensory repetition. The authors”
Thank you for this article, I found it very interesting. My brain gets stuck on certain mental ideas. For example, this past week my vertigo came back and I felt unstable walking. It’s natural this would generate fear and I have been being careful and have been okay. But what happened was that I felt I was walking around with Terror. And it stayed with me for a whole week. When I was much younger doctors with tell me oh you’re just thinking about that symptom too much and that’s why it hurts. It was like they were scolding me. But, perhaps, it’s how my brain works. It gets stuck on something and I can’t get it unstuck by myself. Learning from the doctor that I was ok would get me unstuck. Today I saw my therapist and we worked with the terror and I am much more relaxed now. Very very interesting.
Indeed Laurel, I have come to the conclusion that the sheer fear and panic, really, that these diseases causes does not help at all. My experience suggests that stress – which is built into these illnesses – does indeed cause distress. I’m glad you were able to find a way to deal effectively with that.
I see this as something common to FM, ME/CFS and many other conditions. I was struck by the similarity of my own cognitive and sensory symptoms with those of people I used to treat post-stroke, post-traumatic brain injury and even autism. I know there are studies showing that given a simple cognitive task, the brains of people with ME/CFS light up too much, i.e. too many areas of the brain are activated, and this is also the case for people with, say, the language disorder aphasia post-stroke. I imagine there have been similar findings in FM too. I think it’s neuroinflammation. We all seem to need reduced stimulation and uni-tasking to function well. Bring on the research so we can get us some neuro-anti-inflammatories!
I too have been intrigued by the similarity between my fibro symptoms and those attributed to physical head injury. I spent three years working part time as a care assistant to a lady with a traumatic brain injury, she had a motorbike crash in her early 20’s and had to learn to walk and talk again, her head injury was severe. She has done well over the last 20 years to get her life ‘back to normal’ as far as it can be, but she still suffers with exhaustion, confusion, short term memory problems, sensory overload and anxiety and is very easily overwhelmed. Obviously her issues were caused by a physical brain injury, and mine are fibro related, but we have had many discussions about how our symptoms present, and what helps/doesn’t help etc; the similarities are mind blowing. In fact the only differences we found were that I had a lot more pain, and her cognitive difficulties were more extreme. I actually spent a while trying to think back over my childhood in case there was some kind of head injury i’d simply forgotten about.
Like so many things I’ve read here, I’ve found this article fascinating. Well, actually, besides the inherent interest factor, there’s always a mix of sadness and comfort reading these dispatches. The facts are depressing, but the progress in understanding what we’re up against is comforting. And the very familiar ring to it all, including these comments, is really validating.
I’ve known for some time that I’m easily overwhelmed, that I’m not able to make transitions in particular. Embarrasses me, but I literally have trouble not just when there’s more than one thing at a time going on but also I struggle with moving from one thing to another. Simultaneous overload as well as sequential paralysis!
I feel like I’ve always known there was brain malfunction involved. I remember realizing to my horror that I simply couldn’t think very well anymore and that it was like a living nightmare to have to go on using this brain that is malfunctioning to try to understand what was happening to it.
I was originally diagnosed with MS. I recall having the long MRI in that horrible coffin like tube and learning that the were these lesions alarmingly located in my white matter and elsewhere….and how I couldn’t concentrate because our toddler was going everywhere in the room….
The cognitive losses have been one of the most emotionally wrenching aspects of this disease for me as well. Hopefully we will have more answers soon -and when we get them we will understand them (lol) 🙂
Oh my goodness….a lightbulb moment…so glad I read this…maybe I’m not a basket case after all…
Have struggled cognitively for two years at least, and didn’t know why.
I have M.E/CFS/Fibro + hypothyroidism…..got sick again two years ago and lost my job as I just couldn’t get well, no matter how hard I tried. Cognitive impairment has affected me really badly, my head hurts, can’t do forms, read a book, be in a large crowd, brain freezes mid-conversation….I thought I was going mad….not so..?
Not so – just ME/CFS/FM.
Back in 2005, I was injured protecting a two year old at work. I had four surgeries, developed two DVT’s in my leg where I had surgery. Because I couldn’t use a cane, nor walker, it was difficult to use a wheelchair because I had injured my wrist, shoulder, ankle, neck and back. I was in pain, vulnerable, overwhelmed and felt helpless. I struggled. I developed FMS. Slowly I didn’t know what was going on. I couldn’t think. I was always taking fast, interrupting people because I couldn’t “hear” them. Overprocessing conversations, over thinking them…taking way too fast. My brain was traveling at warp speed and I was exhausted all of the time. I was always ready to sleep but if I lie down, I could not sleep and my pain would flair. This article, what I could grasp of it, was point on. I only wish it were dumbed down. My intelligence is way above normal, but I can’t access it. It is difficult for me to read. It’s as if my eyes can’t “hear” the words, (if you know what I mean). My brain if I could draw you an analogy would be… Someone let a kindergarten class loose up there and they rearranged all the books in my library and I can’t find anything. Lol. That’s how this feels. And I’m traveling at hyper speed trying to find everything on no sleep, with all of this stimulation going on, interfering, bombarding…bouncing off the walls. Sigh…..
Rough stuff ZIZI – we are going to start adding a basic points sections to the blogs so you can get the gist easier. Good luck with everything.
Hooray! I’m not going crazy! Noise is incredibly painful for me. I don’t travel on trains or buses and can barely manage a rare flight except with whiz bang ear plugs. I hate crowds and shopping centres and parties are a complete drain. And the interrupting as I can’t hear – thank you ZiZi for sharing that – People think I’m being rude all the time, so now I just opt out, sit there and say nothing and like you ZiZi, I’m a highly intelligent woman.
Honestly, it’s a pretty crummy condition to be in. Reading everyone’s comments makes me feel sad and relieved. But today, mainly sad!
I have fibromyalgia, IBS, and osteoarthritis. It’s hard to focus most days. Everything feels like such a huge task, and when I make a mistake, it feels like I just failed the whole world. I hate the brain fog, the broken sleep (even with my Cpap machine) and the constant need to get away and just be alone, even though most of the time I can’t.