by Cort Johnson
It was great to get an opportunity to talk to Daniel Clauw M.D. Clauw, with his hundreds of publications, was a key figure in helping drag the fibromyalgia field into the modern age. (In one of his talks, he recalled votes being taken at conferences as to whether fibromyalgia (FM) was a real disease…Those votes are no longer being taken.)
For all his work in FM, though, Clauw has never been simply a “fibro-guy” – his interests extend far beyond one disease and his first paper was on chronic pain and fatigue syndromes. In that paper from almost 30 years ago, Clauw proposed that central nervous system hyperactivity affecting different parts of the brain was likely responsible for the different diseases.
Over the past 5 years or so, Dr. Clauw has been focused on a new concept of pain, called nociplastic pain, that’s of relevance to diseases like fibromyalgia, ME/CFS, irritable bowel syndrome (IBS), migraine, etc. Echoing Clauw’s thoughts of 30 years ago, nociplastic pain is believed to originate in the central nervous system and particularly affects sensory processing.
The intriguing thing about nociplastic pain – a condition that produces widespread pain, fatigue, sleep, cognitive, and mood problems (sound familiar?) – is how widespread it is. It affects people with FM, ME/CFS, and long COVID but also a significant percentage of people with such disparate diseases as rheumatoid arthritis, osteoarthritis, psoriatic arthritis, lupus, low back pain, multiple sclerosis, post-cancer, and sickle-cell anemia.
The longer you have a pain condition, the more susceptible you are to your nervous system going
bananas and producing this symptom melange of widespread pain, fatigue, sleep, cognitive, and mood problems.
Exactly why this is happening is not clear, but Clauw referred to some recent studies from his lab in
children that are helping to determine how it’s happening. The 2022 “Neurobiological antecedents of multisite pain in children”, which followed children for 9 years, found that increased activity in some brain regions (sensorimotor regions) and circuits (insula, sensorimotor, and the default mode network) occurred prior to and predicted which children came down with nociplastic pain later.
Studies indicate that pain-vulnerable brain networks may get activated prior to people becoming ill. The nodes in these networks regulate autonomic nervous system functioning and play key roles in pain perception, sensory signal integration, cognition, and emotion. The problem lies not in structural
damage but in altered connections between brain regions. Activation of the insula appears to play a major role in these diseases.
Studies of children show that sleep problems come first, then fatigue, cognitive issues, widespread pain, and finally mood issues.
Thirty years of research appears to have only strengthened Clauw’s original idea that fibromyalgia, ME CFS, IBS, endometriosis, interstitial cystitis, migraine, and Gulf War Illness are all, at least in part, central nervous system drive sensory sensitivity disorders. Clauw believes the same process that’s producing pain Is also causing the sensitivity to bright lights, noises, and odors, and even the hypersensitivity many people experience with drugs, foods, etc.