Whole Health Rheumatology of Cape Cod - Our First Blog Post!

Hello friend!

I am super excited to introduce you to my first Blog of 2024 (and the first one of the Whole Health Rheumatology of Cape Cod practice evvverrrr). We opened our doors on 11/30/2023, eek! 

My name is Dr. Martina Ziegenbein, I am a board-certified Rheumatologist. Rheumatology is a field of Medicine that deals with all kinds of arthritis but also autoimmune conditions like lupus, vasculitis, and myositis.

Whole Health Rheumatology of Cape Cod is currently a general Rheumatology private practice. My expertise lies in diagnosing and distinguishing inflammatory conditions from noninflammatory ones. Chronic pain is one of those non-inflammatory conditions and part of my expertise. So I will talk a lot about chronic pain here.

The reason it is so relevant to talk about it is because chronic pain is a huge issue in healthcare. One out of five people in the world and in the USA suffer from some form of chronic pain.

Over the next several days, each day I will share a small but crucial piece of the puzzle of chronic pain.

Today, the first question to be addressed is: Where do chronic pain and fibromyalgia pain come from and how is chronic pain different from acute pain?

Fibromyalgia has many definitions in literature. It can be most simply described as “pain all over'', literally. It affects more women than men and those patients often describe the pain as being present “from head to toe”. And as if the pain was not enough, it often comes along with a bunch of other symptoms including, but not limited to: brain fog, overwhelming fatigue, irritability, inability to concentrate, headaches, jaw or TMJ pain, IBS, vaginal or bladder pain (sometimes also referred to as interstitial cystitis). Many patients with fibromyalgia also describe weird tingling or burning sensations in their hands or feet.

Fatigue and pain are the most overwhelming symptoms and literally rule the life and make lives miserable for many women who are unfortunate to suffer from it. 

No one is really sure what is causing it. Genetic reasons, prior trauma (whether physical, emotional, or psychological) are all suspected causes. In general, the origin of the fibromyalgia pain is NOT believed to be autoimmune.

Rheumatologists usually see a patient with fibromyalgia for the initial consultation, to confirm the diagnosis and then generally the patient is returned to the primary care doctor with recommendations on what to implement in a treatment plan. My practice is different in that I KEEP all the patients with fibromyalgia who want to keep working with me! 🙂

I have been fascinated by fibromyalgia for a long time. It has not always been “smooth” to care for these patients - the solution to pain felt too elusive and out of reach. Many times no matter what I tried for these patients, the pain would not remit or not remit consistently. After I moved from WI to Cape Cod in March 2021, I studied more materials, immersed myself in all things fibromyalgia and I was so happy to realize that the solution clearly IS AVAILABLE. 

What is causing the pain? First of all – PAIN IS REAL. In the past, many women felt not believed or dismissed because the pain was referred to as “psychosomatic” which for some reason meant that it was not real. Let me tell you – the pain IS REAL. You feel the pain, it hurts – the pain is real. However, the pain is not coming from where we feel it - in the body – but rather from the brain or central nervous system! Let me explain.

When we sprain our ankle or burn our hand on the stove – the pain is referred to as acute. The pain receptors in the tissues that are injured communicate the information through neurons into the spinal cord and from the spinal cord the information goes into the brain. The brain tells us to stop doing whatever we were doing that injured us. We limp for a while, we have a burn on our hand, we heal and the pain resolves. I will refer to that pain as “plain” pain or “regular” pain. It is a survival mechanism and was meant to alert us to danger. So far so good? Acute pain leads us away from danger and promotes healing.

Fibromyalgia pain on the other hand, is chronic, happening on a daily basis and fluctuating in severity. There is nothing healing about it. Through rigorous and extensive research studying functional MRIs of the brain of patients with pain, it was discovered without any doubt that the chronic pain of fibromyalgia is basically a conglomerate of misfiring neurons. It is a mistake of the brain who is mis-interpreting regular signals from the body as “danger”. I just mentioned above that the brain interprets pain as danger and that it is a survival mechanism. We are wired to interpret pain as danger. Danger is meant to put us on high alert. High alert means augmentation of our senses which can lead to (or even create) more pain. More pain leads in turn to more danger signals – which leads to more high alert messages to the brain which leads to more pain. It is referred to as NEUROPLASTIC or BRAIN PAIN. Chronic pain – neuroplastic pain. That means the fibromyalgia pain is brain pain, it comes from the pain. 

I feel it is important to stress again that the pain IS REAL. There is nothing imaginary about the pain. But the origin of the pain is basically brain centers that are full of misfiring neurons that are dealing with faulty information.

As a side note, there are cases when chronic pain is NOT neuroplastic, for example patients with cancer – these patients have chronic pain that is not neuroplastic. OR they have a combination of acute and neuroplastic pain.

One other way (though not a perfect way) to distinguish between acute and chronic pain is response of the patients to usual medical interventions or surgeries. Acute pain tends to respond well to meds. Chronic neuroplastic pain usually does not.

The most exciting feature of chronic pain is that it CAN be made better. Our brains are adaptable. Neuroplasticity means that the brain pain pathways that are misfiring, CAN be rewired. And that is why I am excited to start bringing this knowledge to all the women with fibromyalgia who have not been able yet to improve their pain consistently. It can be done and I will show you how.

So in summary, in this blog we covered the difference between acute or plan/regular pain and chronic pain of fibromyalgia that is also referred to as “neuroplastic pain” or brain pain. Stay tuned for the next blog where I discuss how it comes to be.