Wednesday, August 27, 2008

Ouch...that didn't hurt enough

Allergic rhinitis, or hayfever, is a common problem in the developed world. It's relatively rare in countries with poorer sanitation, where residents are exposed to many more bacteria, viruses, and especially parasites. There is a theory that our lack of exposure to virulent pathogens encourages our immune systems to hyper-respond to normal, harmless stimuli. I'm not sure if it's gotten past the theoretical stage in terms of scientific research, but it makes sense to me. I did see one solicitation for people with hayfever (like me) to willingly infect themselves with anywhere between 10 and 100 hookworms to see at what point hayfever symptoms improve. I'm guessing you'd have to fork out a lot of cash, even to those poor college students, to get many to sign up for that one.

So I have a new theory, sort of tandem to this. Fibromyalgia is a disorder of varying severity whose sufferers experience much more pain than non-sufferers at a variety of stimuli. If you gently but firmly press on a trigger point of a FM patient, they will experience pain, even though you or I wouldn't. It's a difficult disorder to treat, and certainly even more difficult to have. There's been a varying amount of acceptance in the medical community, but more recently PET scanning images of the brain have well demonstrated objective evidence of these subjective complaints.

All too often recently, I realize how little I use my physical body. I'm out of shape. I drive everywhere. I sit at work. I sit at home. I do light gardening, and if I wasn't still lugging around a 38.5 pound (go, Henry!) child I'm quite certain I'd have no upper body strength at all. Knitting needles don't count as weightlifting. I wouldn't say I'm a wimp, but on a 1-10 scale of who can handle the most pain, I'd give me about a 4. So when I read about women in other countries who squat to deliver a baby in the rice patty, then strap them on and keep working, I'm not sure we're made of the same protoplasm. I barely took the stairs for days after my first kid.

What can explain the difference? Perhaps the pain centers in our brains are scanning our nerves for pain sensations, to create a scale of sorts: no pain, hurts a little, hurts a lot. And when we don't enounter much "hurts a lot", the scale gets ratcheted down.

So, just like hayfever is a result of a babied immune system, could fibromyalgia be the result of our relative "lap of luxury" living? Do people raised in countries where kids do hard labor by the age of 8 experience fibromyalgia?

I need to find a ditch for my kids to dig.


SOCKS said...

Very interesting parallel -

Ken said...

To learn more about rhinitis and related treatment options visit

Jennifer said...

This seems SO accurate! I'm a nurse who has worked in Burkina, Uganda and Botswana. We do things like pull out rotten teeth on kids without any pain meds whatsoever and they take it like champs with hardly a tear. Yet in the ED I work in here in the states we give Vicodon to kids with sprains. What will we give for their chronic back pain 10 years from now because we all know Vicodon won't cut it anymore?!

pisceshanna said...

Yeah I wonder. American has such a high rate of a lot of diseases compared to the rest of the world doesn't it?

The Country Doctor said...

Excellent theory. I've had my own pet theory that fibromyalgia is a sleep disorder based on the total body aches I get after a rough night on call and the studies that show some improvement with tri-cyclics.

femail doc said...

I've always wondered what it would be like to walk a mile or even down the hall in the body of someone who suffers from fibromyalgia. What are they really feeling? I have no doubt it's real pain, but what does it feel like?

Can I sign my teenager on your ditch crew?

Anonymous said...

Dr. Smak, I can't believe you state that lifting knitting needles does not count as exercise...I thought you were my friend.