Thread by @BadgleyLaurence

FM & DM
DO FIBROMYALGIA & DIABETES SHARE SAME PATHOPHYSIOLOGY?
@fibromyalgiaME:
“The latest Fibromyalgia - ME - Chronic Pain! paper.li/fibromyalgiaME… Thanks to @item9labs @Travis_Statham @SoIsFibroReal #fibromyalgia #anxiety. Is insulin resistance the cause of Fibromyalgia”

MY RESPONSE: Landmark study or red herring? Study of 23 patients with Fibromyalgia (FM) & small fiber neuropathy(SFN; found in FM & diabetics) showed elevated HgbA1c levels & pain reduction with use of Metformin.

The authors point out the obvious: people with Fibromyalgia are often sedentary due to pain. Sedentary people ➡️ obese. Obesity ➡️ Diabetes, which ➡️ small fiber neuropathy.

No one knows if chronic peripheral pain independently ➡️ small fiber neuropathy. Darwinian evolution might postulate such an adaptive neurological compensation to reduce nociceptive pain.

Metformin reduction of pain has been previously known. Pain reduction is not a known function of lower glucose levels or regional density of small fiber neuropathy. No one knows metformin mechanism of analgesia; might be centralized in brain.

Dynamic overlooked by etiologic hypothesis of authors is predominance of Fibromyalgia in women. Clearly femaleness is not genetically coupled to diabetes or even to predisposition to diabetes.

I have studied hundreds of Fibromyalgia (FM) patients for over a decade. Fibromyalgia is a disorder that is multifactorial and which, because of progressive musculoskeletal disorders d/t lifestyles, begets itself.

Understanding Fibromyalgia requires linear observations of sufferers for months & years, historical knowledge of mechanisms of injury, & recognition of co-morbidities common to FM sufferers.

Inciting injury seems: bio-mechanical low back/pelvis injury or severely incapacitating illness (e.g. viral illness).
Bedrest & a sedentary existence leads to global musculoskeletal weakness, additionally excessive bedrest, lack of sun, & low Vitamin D.

Poor nutrition & depression seem to attend pain-interfered sleep & locomotor inabilities to shop for & to prepare nutrient dense foods.

The timeline for evolution of Fibromyalgia is measured in months and years. It takes this time for chronic widespread pain to evolve as result of global myofascial/muscle weakness & consequent compensatory soft tissue spasms.

Perhaps greatest clue to etiology of Fibromyalgia is association of FM & Hypermobility Spectrum Disorder (HSD). Persons with HSD are predisposed to chronic joint ligament injuries ➡️ chronic pain generators.

Hypermobility Spectrum Disorder is genetically linked to femaleness; explaining predominance of Fibromyalgia in women. Childbirth is associated with increased laxity/pain of pelvic girdle; especially in women with HSD.

Chronic low back pain is a sine qua non for Fibromyalgia. Chronic pelvic girdle instability leads, over months & years, to functional scoliosis, shoulder girdle asymmetry, & crossed-muscle syndromes in neck & shoulders.

Consequences of upper body tower musculoskeletal asymmetries are Cervicalgia, Arm-Hand Syndrome, TOS, Migraine, & Dysautonomias (Vagus n. impingement) of POTS & Gastroparesis.

There is a timeline for evolution of these phenomenon, but it is long (months & years), & serial evolution of these disorders/symptoms needs to be observed/documented in dozens of people for etiology to be appreciated.

In October 2019, I presented (on line) eight papers which captured the timelines for various symptoms & disorders attendant with Fibromyalgia; at the 10th Interdisciplinary World Congress on Low Back & Pelvic Pain in Antwerp.

Fibromyalgia is real. The cause is officially determined to be “unknown”. One reason for this circumstance is that Fibromyalgia has multifactorial causations.

Finally, phenomenon of recovery from Fibromyalgia is known. Survivors’ stories are video-reviewed @cfsunravelled. Survivors focused their healing journeys on reversal of the multiple factors described above.

The insights and clinical impressions herein are of my own inventions and gained via an iterative evidence based method of medical discovery. They are not intended for medical advice.

@threadreaderapp unroll