Quite possibly the most perplexing medical disorder of our day, fibromyalgia affects an estimated 2–8 percent of the population. From the time it was first described by doctors in the early 1800s, it has been called everything from a mental illness to imaginary to a new kind of rheumatism. It is not until recently that fibromyalgia has begun to be understood and accepted. Even so, medical professionals consider it an idiopathic disorder because its cause is currently unknown.
What is it, really?
From a combination of Greek and Latin words, the term fibromyalgia means “pain” (algos) coming from the “muscles” (myo-) and “fibrous tissues” (fibro-). As such, the disorder is characterized by chronic body pain and a heightened, often painful response to pressure called allodynia. Further complicating the issue for both patients and their doctors is the fact that not all fibromyalgia symptoms are related to pain. Joint stiffness, sleep disturbances, and debilitating fatigue are reported by many fibromyalgia sufferers. Still others experience bowel and bladder abnormalities, numbness and tingling, and cognitive dysfunction.
How doctors describe it
Although the prospects for fibromyalgia sufferers have never been better, medical professionals are still playing catch-up when it comes to the disorder. Consider the fact that the first guidelines for treating fibromyalgia pain were not published until 2005! At present, however, doctors classify it as a central nervous system disorder that is caused by neurobiological abnormalities that produce pain and/or cognitive impairments for no apparent reason. In other words, they’re not sure what causes it, but they know what happens when patients have it. But even so, there is some controversy in the medical community regarding the causes and nature of the disorder.
As we mentioned earlier, experts are not sure what causes fibromyalgia, though they do have a few theories. Here are the most compelling ones:
Heredity. Like many illnesses, fibromyalgia is thought to run in families, meaning that some people may be born with a higher risk of getting it.
Injuries. It is believed that some accidents may be so traumatic that they alter the way our brains process and interpret pain.
Infection. Just like a traumatic injury, it is believed that some infections may change the way we experience pain. Infections that have been linked to fibromyalgia include: parvovirus, Lyme disease, hepatitis C, and Epstein-Barr virus.
Autoimmune disorders. Once mistaken as a form of rheumatism, some believe that fibromyalgia is the result of the body’s immune system attacking its own tissues, as occurs in lupus, rheumatoid arthritis, and other autoimmune disorders.
Psychological and emotional stress. The onset of fibromyalgia has long been linked with increased emotional stress.
As you might imagine, treating such a complex, often intensely personal disorder can be quite challenging. Because fibromyalgia is frequently associated with psychiatric issues like anxiety, depression, and stress-related disorders, medication may be helpful. In particular, antidepressants have been shown to alleviate the most common symptoms of the disorder, including depression, fatigue, sleep disturbances, and pain. Unfortunately, many patients eschew them because they have serious side effects that cause more harm than good. One atypical antidepressant, however, may offer hope to the millions suffering from this increasingly common disorder.
What is tianeptine?
Used primarily in the treatment of major depression, tianeptine is a tricyclic antidepressant that defies easy classification — much like fibromyalgia itself. Unlike most of the drugs in its class, tianeptine does not target serotonin, but rather acts upon glutamate, the principal
excitatory neurotransmitter in brain. Although its mechanism of action is not fully understood, the drug has a mood-brightening and anxiety-reducing (anxiolytic) effect that is uncommon in most antidepressants. In fact, many antidepressants actually increase anxiety in patients for the first few weeks of use. That includes the most popular antidepressants on the market today, namely Paxil, Prozac, Zoloft, and Celexa.
Far less addictive than most antidepressants and anxiolytics, the abuse rates for tianeptine are minuscule. By comparison, benzodiazepines that are used to reduce anxiety are among the most abused drugs on the planet, and popular antidepressants are not far behind! Altogether, both types are responsible for nearly 50 percent of pharmaceutical overdose deaths each year in America!
Tianeptine and fibromyalgia
Because it was only recently accepted as a diagnosable medical disorder, only a handful of medications have been tested for the treatment of fibromyalgia. One such test that included tianeptine was completed in January 2007 in Spain. According to researchers in that study, the drug proved effective at reducing pain associated with the disorder. As impressive as those results were, doctors cannot say for certain why tianeptine is effective. Although, once again, they have many theories.
Why Tianeptine might work
For its entire history, fibromyalgia has been linked to anxiety, depression, and other psychiatric illnesses. But why? Although a clear connection can be made between the secondary set of symptoms (sleep disturbances, debilitating fatigue, and cognitive dysfunction) and any of the aforementioned, how can a psychiatric disorder cause physical pain?
The simplest way to answer that question would be to say that pain is also a complicated issue. Pain perception involves many pathways and steps that may be altered for a variety of reasons. These alterations could result in a constant state of pain, even if the body does not experience any actual, physical pain. In other words, something goes wrong in the wiring that makes people who suffer from fibromyalgia perceive pain differently than healthy people. As result, a simple hug or a handshake could be excruciatingly painful for them.
Like other members of the tricyclic drug class, tianeptine has proven far more effective at treating the disorder than either selective serotonin reuptake inhibitor (SSRI) or reversible inhibitors of monoamine oxidase (RIMA). As such, it is widely used to treat the disorder in the countries where it is available. But why, exactly, might it be effective?
One compelling theory posits that the drug helps modulate glutamate receptors in the brain that would otherwise result in over-arousal and might cause the sensory gating issues that may be the primary cause of fibromyalgia pain. Although more research is needed to confirm that hypothesis, it would explain why many fibromyalgia patients who take tianeptine report almost immediate reduction in pain, fatigue, and other common symptoms of the disorder.
To say that doctors have a long way to go to understanding fibromyalgia would be a massive understatement. Because they are unsure what causes it, they must essentially work backwards and treat the symptoms of the disorder rather than the cause itself. In the studies that have been completed to date, tianeptine has proven remarkably effective at treating fibromyalgia pain over a protracted period of time. Again, we are not certain why this is, but explanatory theories abound. It seems only a matter of time before someone unlocks the key of this mystery and helps the millions who suffer from the debilitating disorder.