Falls are a leading cause of injury, particularly in older adults, and can have serious consequences for independence and confidence. At Physioplus+ Guisborough, we specialise in improving balance, strength, and coordination to help reduce your risk of falling and keep you moving safely.

Why Falls Happen & How We Prevent Them

• Muscle Weakness & Poor Balance – Targeted strength-building exercises for stability.
• Dizziness & Vestibular Issues – Expert treatment for vertigo and imbalance.
• Reduced Mobility & Joint Stiffness – Improve movement and flexibility.
• Fear of Falling – Confidence-building exercises to keep you active.
• Environmental Risks – Advice on home and lifestyle modifications to prevent trips and falls.

Our Proven Falls Prevention Programmes

• Balance Training & Coordination Exercises – Improve stability and prevent unsteadiness.
• Strength & Flexibility Workouts – Keep muscles strong and joints mobile.
• Gait & Walking Assessments – Identify and correct movement issues that increase fall risk.
• Postural & Core Stability Training – Enhance control and reduce the risk of sudden falls.
• Education on Fall Prevention Strategies – Practical tips to make everyday environments safer.

Who Can Benefit?

• Older Adults – Maintain independence and avoid injury.
• People with Neurological Conditions – Support for conditions like Parkinson’s and stroke recovery.
• Post-Injury Rehabilitation – Regain confidence and mobility after an accident or surgery.
• Anyone Feeling Unsteady on Their Feet – Proactive balance training to prevent future falls.

The Physioplus+ Difference

• Experienced Physiotherapists – Experts in falls prevention and rehabilitation.
• Personalised Treatment Plans – Tailored exercises to suit your needs and abilities.
• State-of-the-Art Facilities – Equipped with the latest technology for balance training.

Book Your Falls Prevention Session Today

Preventing falls can protect your independence and well-being. Start your journey to better balance with Physioplus+ Guisborough.

📞 Call us: 01287 201006
🌍 Visit: www.physioplusguisborough.co.uk
📍 Find us: 79-81 Church Street, Guisborough, TS14 6HG

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​What Is Electroacupuncture?
Like traditional Acupuncture, electroacupuncture can use needles placed in the same spots. Then, a small electrode is attached to the needles. A small amount of electricity runs through the electrode and gives a slight vibration or soft hum during treatment. ‌

If you are sensitive to needles or scared of them (you aren’t the only one!) we have a small electrical device which can stimulate each acupuncture point without us needing to use needles, explains Jane Sutton BSc (Hons) MCSP MAACP MCSS, Lead Physiotherapist, Advanced Acupuncturist and Advanced Craniosacral Therapist at www.physioplusguisborough.co.uk  

The electrode gives off the effect of your acupuncturist activating the acupuncture point with their hands. This ensures you get the right amount of stimulation during your whole treatment. The treatments are also shorter because the electrodes can activate your acupuncture points more quickly. ‌

A benefit of using electroacupuncture is that it can cover larger areas of your body than traditional acupuncture. This ability makes this type of acupuncture more accurate than others. 

Background of Acupuncture
Qi (pronounced “chee”) is a fundamental concept in Chinese medicine. It’s believed to be a form of energy that’s universal. The belief is that your qi can be any manifestation of energy, and that acupuncture moves and activates your qi to help your body heal.‌

Electroacupuncture is meant to connect your physical and spiritual self. There are potential benefits for both parts of your body. Physically, this treatment is designed to help you feel better. Spiritually, this treatment is meant to help you understand your qi and the energy you have around you.  

How Does Electroacupuncture Work?
Electroacupuncture uses two needles in each meridian point, or acupuncture point, and then connects to a machine that passes a small electric current through the needle. ‌

Electroacupuncture helps to block your pain by activating bioactive chemicals in your body. This process may decrease your sensitivity to the pain you’re feeling. It’s also been shown to help reduce inflammation in your body. ‌

When you get electroacupuncture, it activates your sympathetic nerve fibres. By activating these fibres, your body releases endogenous opioids such as endorphins, which help to reduce inflammation. The activated nerve fibres may also help to reduce feelings of persistent pain. This makes it a good treatment for chronic pain and stress.‌

Studies have also found that electroacupuncture may help your body release mesenchymal stem cells (MSCs) into your bloodstream. MSCs are adult stem cells mostly found in your bone marrow. MSCs help your body create different types of tissues. They also have healing properties.

• Related: Can Acupuncture Help My Fibromyalgia?

Pros of Electroacupuncture
Electroacupuncture can be used as a part of your acupuncture treatment. It may help with conditions like: 
• Neurological diseases
• Chronic pain
• Muscle spasms
• Paralysis‌

Electroacupuncture is believed to help increase your blood flow. This may help to relieve any pain you’re feeling. In addition, this type of acupuncture warms your muscles. It may help with poor circulation and potential blockages. ‌

Another condition that electroacupuncture has been shown to reduce is chronic stress. Studies show that this type of therapy can help you reduce long-term chronic stress through stimulation. ‌

For many centuries, acupuncture has been used as a therapeutic treatment for pain, including chronic pain disorders. Electroacupuncture is a more modern form of acupuncture, and it can be a substitute for traditional acupuncture. ‌

You may like this treatment if you're ready to experience a new level of acupuncture. Because electricity and needles are involved, you should understand the potential drawbacks of electroacupuncture. 
Cons of Electroacupuncture

There are a few risks of electroacupuncture. With the electricity component used in this type of acupuncture, certain individuals aren't recommended to try this therapy. People who have a history of any of the following conditions should avoid electroacupuncture: 
• Seizures
• Heart disease
• Strokes
• Epilepsy‌
• Anti-coagulant medication (if needles are used)
• If you have a pacemaker

Talk with your doctor or acupuncturist if you’re pregnant and thinking about electroacupuncture. They’ll help you decide if it’s safe for you and your baby.‌

In rare cases, you could experience adverse effects from electroacupuncture. The electrically charged needles have the risk of causing infections or organ, tissue, and nerve damage. Other risks include low blood pressure, called hypotension, fainting, and vomiting during or after treatment. The risk of negative effects is low. But you may experience bruising, needle site pain, or a small amount of bleeding where the needles are inserted.‌‌

Electroacupuncture is a good alternative to traditional acupuncture. With the benefits of pain management and the potential to provide relief from muscle spasms, this therapeutic treatment is meant to help you feel relaxed and pain-free.

Before trying electroacupuncture, talk to your acupuncturist. They can help you determine if this is the right therapeutic treatment for you. If you’re looking for treatment, make sure that the person performing your acupuncture is certified and specializes in electroacupuncture.

See Jane at www.physioplusguisborough.co.uk who trained in this technique in 1985 (yes, that long ago!).

Is Acupuncture the Miracle Remedy for Everything?
• How does it work?
• What are the benefits?
• What to expect
• How to find an acupuncturist
• Home alternatives

Acupuncture, the practice of treating conditions through triggering certain points on the skin with needles, may help with allergies, migraines, arthritis pain, sciatica and insomnia. Acupuncture is an evidence-based medicine that has been proven by literally thousands of studies.

If you’re new to holistic healing as a type of treatment, acupuncture can seem a bit terrifying. How could pressing needles into your skin possibly make you feel better? Doesn’t that hurt?

Well, no, it’s definitely not the overtly painful procedure you may be imagining and considering that it’s been studied and practiced for over 2,500 years, it seems acupuncture enthusiasts could seriously be onto something.

Some people swear by acupuncture, citing it as a “miracle” to improving their quality of life because it’s said to be able to treat everything from depression and allergies to morning sickness and cramps.

What is acupuncture?
Acupuncture is an ancient Chinese medicine-based approach to treating a variety of conditions by triggering specific points on the skin with needles.

Paul Kempisty, a licensed acupuncturist with a MSc in traditional Oriental medicine, explains, “Acupuncture is a minimally invasive method to stimulate nerve-rich areas of the skin surface in order to influence tissues, gland, organs, and various functions of the body.”
“Each acupuncture needle produces a tiny injury at the insertion site, and although it’s slight enough to cause little to no discomfort, it’s enough of a signal to let the body know it needs to respond,” Kempisty says.
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“This response involves stimulation of the immune system, promoting circulation to the area, wound healing, and pain modulation.” Contemporary research on acupuncture relies mainly on this theory.

What’s the philosophy behind acupuncture?
The Chinese philosophy behind acupuncture is a bit more complicated, as the ancient practice isn’t traditionally based in science and medicine.

“They believed that the human body was filled with and animated by an invisible life-giving force which they called ‘qi’ (pronounced ‘chee’) and when the qi was flowing well and going to all the right places, then a person would experience good mental and physical health. When the qi was flowing incorrectly (blocked or deficient) that would result in illness,” says Kempisty.

The concept of qi isn’t too out there — think of it as your body’s natural inner workings. Sometimes you’re more prone to illness when feeling stressed or anxious.

When you’re relaxed and healthy, your body physically reflects that too. After all, your mood, mental health, and general well-being do affect your physical health. Thus, acupuncture aims to assist people in achieving balance, or qi, and, as a result, provide relief for many ailments.

What does acupuncture do?
You may be interested in acupuncture for a variety of reasons. For example, I sought treatment for my chronic headaches and sinus pressure.

There are numerous conditions and symptoms that acupuncture has been found to help with. Here are just a few:
• allergies
• anxiety and depression
• osteoarthritis
• chronic pain, often in the neck, back, knees, and head
• hypertension
• insomnia
• menstrual cramps and PMS
• migraines
• morning sickness
• multiple sclerosis
• sprains
• strokes

Studies suggest that acupuncture can help with cancer treatment as well. Most cancer centres now include acupuncture within their standard of care.

Limited evidence for
• acne
• abdominal pain
• cancer pain
• obesity
• insomnia
• infertility
• diabetes
• schizophrenia
• stiff neck
• alcohol dependence

While there’s no evidence that acupuncture is a miracle cure-all, it does seem to have some evidence as a worth-while treatment for people who may have multiple conditions and illnesses.

There’s a reason it’s been around for more than 2,500 years and as research grows, so will our knowledge of exactly what works and what does.

Incorporating acupuncture into real life
An acupuncture assessment lasts 45 minutes and will involve a short trial to be sure that you are happy with needles. If you aren’t, a small electrical current device can be used instead (see our blog on electro-acupuncture).

The actual treatment portion of acupuncture may last around 30 to 45 minutes. Many people actually request a longer amount of time. Dopamine is released during acupuncture and many patients who appreciate a relaxing experience due to the dopamine release prefer longer retention time.

In terms of results, it’s nearly impossible to say what one should expect, as everyone responds to and experiences acupuncture differently.

“There is no universal response to acupuncture. Some people feel relaxed and may be a little tired, others feel energized and ready for anything,” Kempisty explains. “Some people experience an improvement right away and for others it can take several treatments before noticing a positive change.”

The most common response to acupuncture, however?

“People feel happy and content,” Kempisty says. “It’s hard to put into words but there’s a distinct balanced and harmonious feeling that acupuncture gives most people and it just feels good!”

You may also feel tired after a treatment and see changes in your eating, sleeping, or bowel habits, or experience no changes at all.

How do I find an acupuncturist?
Both Jane and Ryan at Physioplus+ offer acupuncture as part of their treatments. Jane treats a wide range of issues as above, whilst at the moment Ryan uses trigger point acupuncture to treat pain and is pursuing further training later in 2025.

https://www.physioplusguisborough.co.uk/specialisms.html

This report on a study into decreased amyloid protein development during sleep is important to us as craniosacral therapists. We work on increasing blood flow and cerebrospinal fluid (CSF) flow into the cranium (your head) to help with all sorts of issues, including early stage memory loss.

We do this by increasing the space available for the skull foramina (holes in the base of the head bones) by gentle manipulation. This increases both blood flow (important to offset vascular dementia and improve health generally in the brain) and CSF flow around the brain and spinal cord (important to avoid amyloid plaques which are present in dementia and to decrease "brain fog" in menopause, ME/ chronic fatigue and fibromyalgia). Read the report below to see why the current research is moving towards improving CSF flow.

In a study published in 2023, scientists found that using sleeping pills to get some shut-eye could reduce the build-up of toxic clumps of proteins in fluid that washes the brain clean every night.

Researchers from Washington University in St. Louis found people who took suvorexant, a common treatment for insomnia, for two nights at a sleep clinic experienced a slight drop in two proteins, amyloid-beta and tau, that pile up in Alzheimer's disease.

Though only short and involving a small group of healthy adults, the study is an interesting demonstration of the link between sleep and the molecular markers of Alzheimer's disease.

Sleep disturbances can be an early warning sign of Alzheimer's disease that precedes other symptoms, such as memory loss and cognitive decline. And by the time the first symptoms develop, levels of abnormal amyloid-beta are almost peaking, forming clumps called plaques that clog up brain cells.

Researchers think promoting sleep could be one avenue to stave off Alzheimer's disease, by allowing the sleeping brain to flush itself of leftover proteins and the day's other waste products.

While sleeping pills may help in that regard, "it would be premature for people who are worried about developing Alzheimer's to interpret it as a reason to start taking suvorexant every night," said neurologist Brendan Lucey, of Washington University's Sleep Medicine Center, who led the research.

The study spanned just two nights and involved 38 middle-aged participants who showed no signs of cognitive impairment and had no sleep issues.

Using sleeping pills for prolonged periods is not an ideal solution for those short on sleep either, as it's quite easy to become dependent on them.

Sleeping pills may also lull people into shallower bouts of sleep rather than deep sleep phases. This could be problematic as earlier research from Lucey and colleagues found a link between less good quality, slow-wave sleep and elevated levels of tau tangles and amyloid-beta protein.

In their latest study, Lucey and colleagues wanted to see if improving sleep with the aid of sleeping pills could lower levels of tau and amyloid-beta in the cerebrospinal fluid that bathes the brain and spinal cord. Past research shows that even just one night of disrupted sleep can send amyloid-beta levels rising.

A group of volunteers aged 45 to 65 years old received one of two doses of suvorexant or a placebo pill, an hour after researchers tapped their cerebrospinal fluid to collect a small sample.

The researchers continued to collect samples every two hours for 36 hours while the participants slept and during the next day and night, to measure how protein levels changed.

There were no differences in sleep between the groups, and yet amyloid-beta concentrations were reduced by between 10 and 20 percent with a dose of suvorexant usually prescribed for insomnia, compared to a placebo.

The higher dose of suvorexant also momentarily reduced levels of hyperphosphorylated tau, a modified form of the tau protein linked to the formation of tau tangles and cell death.

However, this effect was only seen with some forms of tau, and tau concentrations sprung back up within 24 hours of taking the sleeping pill.

"If you can reduce tau phosphorylation, potentially there would be less tangle formation and less neuronal death," said Lucey, still hopeful that future studies in older adults testing sleeping pills for months could possibly measure a lasting effect on protein levels (whilst noting any downsides of sleeping pills).

Increasing CSF flow by any means can also therefore decrease the potential for tangle formation, neuronal death and development of Alzheimer's.

Talk to the Team at Physioplus+ for hints on how to do this yourself and for an Assessment of CSF and Blood Flow if you would like one.

Initial assessment is done using the Montreal Cognitive Assessment Test to give us a baseline of how your memory is doing at the moment.

Please let us know if you are dyslexic beforehand, as it can affect the results and may also mean the test needs to be adapted a bit. There isn't a lot of reading.

Then the fun bits start ! As with most of our treatments,  you will lie down on our comfy couch and we will gently assess the cause of your symptoms. It usually boils down to a decrease in circulation and/or flow of cerebrospinal fluid (CSF) around the brain, basically, the feeding and cleaning up team that keeps your brain cells healthy. In early stage memory loss, there is sometimes an area of gliosis (minor cell damage) around the outside of one of the lobes of the brain.

We use techniques taught by Ted Wanveer MD (see references) to gently move brain structures and promote healing. At the same time, we go on a detective journey to see what is causing the decrease in nutrient flow and waste removal. The usual culprits are the foramina (holes that are supposed to be there!) in the temporal bone at the base of the skull. Problems elsewhere in your body can alter their position or angle and restrict fluid flow.
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Most commonly the problem is in the neck, but we have found altered foot position, previous back or disc problems and other unexpected areas contributing to the issue. Depending on where the problem originates, we will give exercises to solve the cause if possible, and probably a set of tennis balls to use at the base of your skull to gently stretch the soft tissue and give more space for the temporal holes and the structures that pass through them.

We will retest you every 4 to 6 weeks. Based on our experience so far, we recommend treatment once/twice per week for 4 weeks, slowly tailing off as improvements occur. Expect a course of between 12 and 16 sessions.

Unfortunately, once there is already a diagnosis of Alzheimer's Disease or Vascular Dementia, it is too late for treatment to be started, as we have found that although it MAY slow progress, it certainly doesn't stop the disease process from developing and we are unwilling to start treatment or give false hope knowing this.

If this sounds like you or someone close please call 01287 201006 on a weekday morning 9 am to 12 midday to make an appointment.

For more information on Alzheimer's prevention please read the report of the research article "Recent research in Alzheimer's Disease"

a few thoughts on ... not just a physio

We have your best interests at heart.

One of the most important stages is to understand the current problem but perhaps more importantly the cause and at the same time your medical and health history.

Physioplus+ has 2 parts of a successful treatment

• Reduce, minimize or eliminate pain
• Treat the areas of pain and the areas of the symptoms

Ultimately, solve the causes not just the symptoms

... and as a practice we always moderate our promises and then work towards over-delivering

So to understand and investigate what can do, look at, treat and solve - click on Specialisms below

PhysioPlus+ - Specialisms

To get your treatment started telephone 01287 201006
Mon to Fri between 9 am and 12 noon

oh ... and tell your friends
​... all of them

​Craniosacral Therapy assists the body's natural ability to heal using gentle manual techniques, offering relief from pain and stress. This therapy is suitable for a wide range of pain symptoms.

Craniosacral Therapy is a respectful treatment which improves overall wellbeing.

We all have things happen to us in life that can cause dysfunction in our bodies. A trip up a step, a sporting injury or a car accident. Our bodies compensate for this but may develop tension patterns which cause symptoms from stiffness to pain. This is also the case with emotional stresses, causing headache, neck stiffness and a whole range of other symptoms from tiredness to anxiety. Craniosacral Therapy helps bring the body back into balance so you can get on and live your life fully.

We need to listen to our bodies as they know what changes are necessary to keep them healthy. Our bodies speak to us most of the time, but we aren't very good at listening to them. Eventually we pay the price.

Sometimes our assumptions about ourselves and our lives cause strain on the body. Craniosacral Therapy and Somato Emotional Release help identify these assumptions using incisive questions to free them. Touch with quality attention creates an environment for communication between the mind and body to facilitate healing.

When therapists at Physioplus+ are undertaking Patient Treatment we  will take a full case history, listening with care, to allow the creation of a plan of treatment specifically for the patient.

During treatment, the patient will lie fully clothed on a treatment couch, or if this is not comfy on their side or sitting.

The therapist places her hands gently on the patient's body to locate areas of reduced tissue motion and uses manual techniques to release these areas. Patients may notice a change immediately or gradually. Most people find the treatment relaxing. Afterwards patients may feel energised, tired, or no different to normal. It's a very individual thing.

Sometimes during a treatment memories surrounding a past injury or shock may be recalled. This is Somato-Emotional Release. It helps patients to reconnect with what they are feeling in their body and return to optimal health. Therapists will work with the patient using visualisation and dialogue to explore what is coming up in a respectful way. When stressed, we become tense and trapped in our thoughts and anxieties which causes pain and discomfort. Working in this client-centered way is very effective in facilitating personal growth and promoting wellbeing.

Contact for treatment by telephone - Physioplus+ on 01287 201006

We will be starting a pain-free exercise class for those with Fibromyalgia when we have sufficient interested patients.
 
The general opinion now seems to be that there is some sort of central nervous system irritation that leads to the widespread symptoms of Fibromyalgia. Raised levels of inflammation have been found in the central nervous system of Fibromyalgia patients, but is this a symptom or the cause? Still to be discovered. The symptoms remain difficult to manage
 
We will be doing very gentle neurological stretches in the classes, and some body-centred relaxation and mindfulness techniques for pain and relaxation. 
 
Each participant will have a brief assessment of their personal nerve structure at the first session so that exercises can be tailored individually. The class will run initially for 10 weeks, and for longer if enough participants wish to continue. 
 
Classes will take place at Physioplus+, 25-27 Redcar Road, Guisborough, TS14 6HR. 

The first session will be assessment, a cup of tea or coffee and cake, and essential form filling with assistance to show your pain patterns and comply with data protection regulations. 
 
Follow-up sessions will be gentle individual exercise and group relaxation. Please bring a pillow or two so that you can lie comfortably on the floor or sit comfortably in a chair for this. 
 
Booking is essential, as numbers will be limited to ten participants. 
 
You need to ring 01287 201006 between 9:00am and 12:00 noon to book with Christine, our practice manager stating that you want to join the fibromyalgia class.
 
If you sleep in the mornings, leave a message on the answerphone with your number, and mention the Fibromyalgia class and best time to ring so that we can get back to you.
 
If the class fills quickly we will have a waiting list, or possibly put on an evening class at a later date.
 
Payment is required in advance by credit or debit card, cheque or cash. You will only pay for EIGHT classes, as it is expected that you may miss a couple due to brain fog or a bad day.
 
Each class will be run by a physiotherapist with many years of experience in Fibromyalgia assessment and treatment. 
 
Please also read this excellent article (below) by Stephani Sutherland on current research.

https://www.physioplusguisborough.co.uk/articles/relief-pain-research-news-insights-ideas-by-stephani-sutherland
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Pain-free Fibromyalgia Classes in Guisborough at Physioplus+ https://www.physioplusguisborough.co.uk/articles/pain-free-fibromyalgia-classes-in-guisborough

Fibromyalgia: Cracking the Case

Researchers are just beginning to understand the biological underpinnings of a long-misunderstood condition.

Fibromyalgia. Many patients with this perplexing diagnosis have seen doctor after doctor in search of an explanation for the widespread pain, fatigue, and disordered sleep that has disrupted their lives - sometimes severely. Depression, anxiety, and “brain fog” also commonly affect people with Fibromyalgia. Despite decades of research, seemingly everything about Fibromyalgia remains mysterious. But, encouragingly, researchers are finally making progress toward understanding this long-unexplained syndrome. Those who study Fibromyalgia hope this will legitimize a condition that physicians have long doubted, and bring much-needed relief to patients.
 
A difficult diagnosis
 
Not everyone with all-over pain receives the diagnosis of Fibromyalgia. The label usually comes from a Rheumatologist - a doctor who specializes in musculoskeletal and autoimmune disorders - only after other ailments are ruled out. But other chronic pain diagnoses, including temporomandibular joint disorder (TMJD), chronic pelvic pain conditions such as interstitial cystitis (IC), and irritable bowel syndrome (IBS) often mimic the symptoms of Fibromyalgia, also often with no discernible physical cause. The diagnosis that a patient receives might depend on the specialist they see, experts say.
 
Roland Staud, University of Florida, Gainesville, US, likens the current understanding of fibromyalgia to the traditional Indian story of seven blind mice trying to determine the identity of an elephant. One blind mouse feels a leg and calls it a pillar; another grabs ahold of the tail and reports finding a rope. Not until all the parts are considered as a whole does a complete picture of the beast emerge.
 
Likewise, Rheumatologists with patients complaining of muscle aches may diagnose Fibromyalgia, whereas a gastroenterologist proclaims IBS the cause of pain, but apart from complaints of regional pain in IBS, the overall symptoms of these two conditions look remarkably similar. Patients with low back pain, osteoarthritis, and other common chronic pain conditions can also develop this characteristic set of symptoms.
 
Today, researchers are sketching out a picture of Fibromyalgia as a pain disorder that can be triggered by any number of individual maladies, each one heightening future risk for developing this enigmatic condition.
 
Brain pain?
 
Researchers and doctors have traditionally classified different types of pain into several categories. Nociceptive pain is the acute protective signal of impending tissue damage that arises from stepping on a tack, for example. Inflammatory pain results from the activity of immune cells, as in osteoarthritis. And neuropathic pain springs from nerve damage that results from diabetes or chemotherapy, for instance. Fibromyalgia has been a conundrum in part because it doesn’t really fit into any of those categories, though some symptoms resemble inflammatory pain, and others neuropathic pain.
 
Over the years, researchers have tried to craft a new category to contain Fibromyalgia, which they have variously called functional, dysfunctional, or somatoform disorders. “The term that we prefer is ‘centralized pain,’ meaning that pain clearly is coming largely from the brain rather than from out in the periphery,” says Rheumatologist Daniel Clauw, University of Michigan, Ann Arbor, US.
 
Because the pain of Fibromyalgia seems to originate from the muscles, for years Rheumatologists studied patients’ muscle and joint tissues, but found no evidence of inflammation or damage that could cause pain. Without evidence for bodily injury underlying the pain, many researchers turned to studying the brains of people with Fibromyalgia. Some, including Clauw, have embraced the idea that Fibromyalgia is primarily a disease of the brain.
 
The unifying symptoms, like widespread pain and fatigue, of Fibromyalgia and other such syndromes indicate that changes in the central nervous system are at play, Clauw says. Brain imaging studies have indeed shown evidence of structural and functional changes in the brains of patients with Fibromyalgia. And anti-depressant and anti-seizure medications that are effective for some people with Fibromyalgia work in the brain, he adds.
 
But other researchers contend that all chronic pain conditions lead to changes in the brain, and in fact every experience of pain - whatever its initial cause - emerges from the brain. Many researchers in the field therefore are still searching for as-yet-undetected pathological processes in the body that may be driving the symptoms of Fibromyalgia - processes that might be reversible.
 
Evidence of peripheral nerve damage
 
In 2013, several groups published evidence of neuropathy, or damage and dysfunction, in the small nerve fibers that transmit pain signals from the skin, in patients diagnosed with fibromyalgia. One study led by Claudia Sommer, University of Würzburg, Germany, found dysfunctional nerve activity in twenty-five adults with fibromyalgia, according to sensory testing (in which subjects reported when they detected hot or cold stimuli) and electrical recordings of peripheral nerve activity. In addition, skin biopsies from Fibromyalgia patients often revealed withered or sparse nerve endings. These abnormalities were not present in healthy control subjects or in ten subjects without pain but with depression, a condition that shares some aspects of Fibromyalgia such as fatigue and inactivity.
 
Another study, led by Anne Louise Oaklander at Massachusetts General Hospital, Boston, US (see related RELIEF podcast with Oaklander here) also used skin biopsies, with similar findings. Oaklander found that forty-one percent among 27 adult subjects meeting diagnostic criteria for Fibromyalgia also met the diagnostic criteria for small-fiber polyneuropathy (SFPN), a common neuropathic pain condition with myriad causes, whereas only 3% of healthy control subjects showed signs of SFPN.
 
A third study, led by Jordi Serra, MC Mutual, Barcelona, Spain, and Neuroscience Technologies, London, UK, measured dysfunctional nerve activity in the peripheral nerves of fibromyalgia patients and showed that it mimicked nerve activity seen in patients with SFPN but not healthy controls. Serra uses a highly specialized technique called microneurography to record activity from individual nerves in a person’s skin.
 
Together, these reports suggest that, somehow, damage to or dysfunction of peripheral nerves is a contributing factor in many cases of what has been diagnosed as Fibromyalgia. But many questions remain about the link between neuropathy and Fibromyalgia.
 
Oaklander stresses that it’s important to identify any potential underlying medical causes of Fibromyalgia because some can be halted or improved. Most cases of SFPN can be traced to potentially treatable conditions including diabetes, chemotherapy for cancer, an autoimmune reaction, or rarely a genetic abnormality; some cases of SFPN remain mysterious in origin. Oaklander says that many of her patients with neuropathies have improved with treatment of these underlying conditions rather than relying on a standard course of treatment with painkillers. Certainly, not all cases of Fibromyalgia are rooted in undiagnosed SFPN, Oaklander says, “but pulling out the 40% who appear to have SFPN may help researchers to find the cause in the remaining 60% as well.”
 
But for patients, a diagnosis or even treatment of SFPN may not be sufficient to halt Fibromyalgia. Kathleen Sluka, University of Iowa, Iowa City, US, says that while the findings of peripheral neuropathy in Fibromyalgia patients are an important piece of the puzzle, “patients need to understand this is not going to lead to a miracle cure. There are multiple mechanisms underlying Fibromyalgia, and there may be several going on at once. Treatments need to be aimed at each of those components and tailored to the individual,” she explained.
 
Is it a real thing?
 
While Fibromyalgia has gained recognition in recent years as a condition with biological underpinnings, many doctors practicing today still doubt that Fibromyalgia is real, or they refer to it as a psychological disorder - one that’s “all in the head.” But, like many diseases in the history of humankind, Serra says, Fibromyalgia is evolving in our cultural consciousness. For example, 200 years ago, people with epilepsy were regarded as crazy, or possessed by the devil. Only when electroencephalography (EEG) came along - a test that records brain activity using electrodes attached to the scalp - did doctors realize that the disease was rooted in abnormal brain activity.
 
“Now, no one doubts that epilepsy is a neurological condition that can be treated. But back then, it was impossible to convince doctors it was a real disease. Fibromyalgia is very similar, in that we have patients who complain of pain and other mysterious symptoms and are studied by physicians who find nothing wrong,” so they often dismiss or ignore the patients, Serra says.
 
That dismissal can make patients feel crazy, even though they know their pain is very real. “One of the most frustrating things for patients is that they are often not believed—and this may be constant, going on for years,” Serra says. While the new findings of peripheral nerve damage in fibromyalgia patients may not offer a cure or even an immediate treatment, they represent the first objective, physical evidence of dysfunction linked to their illness. “The skin biopsies and microneurography are objective tests. To have a doctor say your nerve activity is abnormal, or that you have small-fiber neuropathy” can be a source of tremendous relief and validation for patients, Serra says.
 
It’s entirely possible that, until now, studies have missed signs of damage or dysfunction in nerves, Serra says, because they were undetectable with the relatively blunt diagnostic tests used in the past. Peripheral nerves, Serra says, are incredibly sensitive to slight changes in their surroundings, which can alter their activity. “The excitability of nerves is very fine-tuned,” he emphasizes. For example, a pain nerve fiber might be spontaneously active, but once the patient relaxes, that activity stops. That might happen because the patient’s breathing slows, perhaps changing the acidity of blood, or some other factor in the nerve fiber’s environment. “Just this little change in balance determines whether the nerve is firing or not firing,” Serra says. This finding, he explains, also fits with the relationship between stress and pain. “We know this—all patients say, ‘when I’m stressed, I’m worse, and when I’m relaxed, I feel better.’”
 
Stress and trauma have long been known as contributing factors in Fibromyalgia, but researchers are still struggling to find out how they increase risk. “We know that psychology is strongly associated with chronic pain,” Staud says. “Emotional trauma is one of the vulnerabilities for the pain modulatory system, and families with emotional disorders are at much higher risk for chronic pain than others.” Genetic differences in genes associated with pain or stress, for example—may explain some of that risk, but traumatic experiences seem to accelerate the development of Fibromyalgia, even in the absence of physical injury.
 
“Clearly any kind of stress or trauma can bring it on, whether it’s physical, emotional or even a stress on the immune system,” Clauw says. “That includes everything from early-life trauma to a major auto accident to the psychological stress of being deployed to war. Stress is so important.” Today, researchers are actively investigating what types of substances might circulate in the blood or affect the brain to link stress with Fibromyalgia. The top contenders include stress hormones and inflammatory molecules released by immune cells in the brain or body.
 
End of the line?
 
Many researchers agree that what is now called Fibromyalgia—characterized by widespread pain, fatigue, and cognitive and emotional disturbances—may be the final station on the chronic pain track. “Fibromyalgia is the endpoint—the end of the continuum,” says Clauw. “And maybe we can prevent people from getting there if we identify their risk early and treat aggressively,” which might include anti-depressant medications shown to improve Fibromyalgia pain in some patients, he says.
 
Staud went further, saying that everyone might be at risk for chronic pain. “It’s not just the end of the line for chronic pain patients; it’s the end of the line for all of us.” How quickly we get there, he says, depends on how well we can fend off risks. “If you avoid significant trauma in life, be it physical or emotional, that can help keep your pain modulatory system very active and competent.” Otherwise, he says, “you get closer to chronic pain.” Of course not everyone develops chronic pain; some people seem to be protected for life. “For some, it’s a very flat trajectory toward that endpoint; for others, it’s very steep.”
 
How can people build up this protection to stave off chronic pain? Staud says there are four concrete steps to take in order to minimize risk, whether an individual already has chronic pain or not. First, prevention of injuries or other traumatic events that can lead to pain is important. Of course, this is not always possible, but for someone with Fibromyalgia, it might mean avoiding stressful situations that could trigger a pain episode. Second, Staud says, physical exercise seems to condition the body against pain. Third, sleep is also protective, so getting as much high-quality sleep as possible will help. Finally, psychological coping skills are protective against pain. “The ability to adapt to stress of all sorts is critical,” Staud says. Cognitive-behavioral therapy (CBT), mindfulness, and supportive social interactions can all help build this resilience. However, Staud says, “there is a relatively small group of people who practice these steps consistently and effectively. The majority of the population does not.”
 
Staud stresses that all of these recommendations require tremendous effort on the part of the patient—effort they might not be able to expend. Telling people with fibromyalgia to exercise, sleep more and get therapy, he says, “is similar to telling poor people to save more money and be frugal in order to get rich.” Staud says the emphasis in pain care should instead be on prevention and early recognition, and then on building financial, social and emotional support for patients.
 
But, for those who are able to exercise, Sluka says the research shows that physical activity is perhaps the single most effective approach to alleviate chronic pain. “In the scientific literature, there is strong support for exercise as a way to mitigate pain—it’s one of the most effective treatments,” but only recently are doctors coming around to the idea of “prescribing” exercise for pain. Inactivity, she says, which is common in Fibromyalgia patients, might contribute to or even cause some symptoms of Fibromyalgia. “Research shows that higher physical activity leads to greater pain inhibition, it can improve cutaneous nerve innervation [the health and number of nerve fibers supplying the skin], and it can alter the immune system. Exercise does wonderful things.”
 
Sluka also says it is important that patients play an active role in setting the course for their treatment, though this does place an additional encumbrance on patients already bearing the burden of chronic pain. “Patients need to take control and help manage their own condition,” Sluka says. That’s for two reasons: first, because things like improving sleep and getting exercise, which are under a patient’s control, may lessen pain and improve function. And second, by gaining a sense of control, patients can reduce their stress and pain.
 
Finding a doctor who recognizes fibromyalgia and is willing to try different approaches is also crucial. Some people suffer from Fibromyalgia for years, seeing only doctors who tell them there’s nothing wrong with them, or they undergo surgery that doesn’t help, and they become discouraged. “For a lot of people, this is a long struggle. They end up beaten down, feeling helpless and hopeless,” Clauw says. When Clauw encounters these patients, he says it’s very difficult to help them. “We have to attempt to prop them up and reinvigorate them. Patients have to embrace the fact that there are things they have to do to get better. We can’t give them a drug to cure this - we can’t do that with any pain condition. The goal is to get pain appropriately diagnosed and treated early on, so they don’t get to that end of the pathway.”
 
“The notion that there’s nothing we can do for people with Fibromyalgia is really just wrong,” Clauw says. “When you look at everything available, there is almost always something that will help.” It’s important to try different medications and nondrug therapies, he says, because which treatments may work will vary from person to person.
 
Although many questions about the causes and treatment of Fibromyalgia remain unanswered, Serra says, “it’s a very exciting moment in pain research. We’re beginning to see things we couldn’t even imagine. We will begin to make sense of this disease soon.”
 
Stephani Sutherland, PhD, is a neuroscientist, yogi, and freelance journalist in Southern California. Find her at StephaniSutherland.com or on Twitter @SutherlandPhD
 
Additional Reading:

• Fibromyalgia: Maligned, Misunderstood, and (Finally) Treatable by Bret Stetka, Scientific American
• Nerve Damage Might Explain Chronic Pain by Stephani Sutherland, Scientific American Mind

 
Related RELIEF content:

• Is There a New Explanation for Fibromyalgia? A Podcast with Anne Louise Oaklander
• Related Pain Research Forum content:
• Multiple Studies, One Conclusion: Some Fibromyalgia Patients Show Peripheral Nerve Pathologies
• Elucidating the Pathophysiology of Peripheral Neuropathies: A Conversation With Claudia Sommer

 
By Stephani Sutherland