interesting article i found... FMS: Disease Out Of Sight, But Not Out Of Mind ... a closer look at the brain's astroglial cells Chronic pain seems to be the final frontier in medicine. It's the one main holdout for an easy-to-identify, explainable abnormality. Yet, at the August 5th AFSA 2000 conference in Tucson, AZ, Robert Olin, M.D., Ph.D., from Sweden, was quick to point to the amazingly high incidence of people with FMS (or similar symptoms). Roughly 10% of women and 5% of men have chronic widespread pain according to a survey done in Norway, although not all of them met the strict tender point criteria for FMS. With chronic pain diseases like FMS being so prevalent, there ought to be more rebellious outcry from patients because truly effective treatments aren't just a doctor's visit away. The number of people struggling to survive with FMS is incredible, and with Dr. Olin's background training in psychiatry, he insists that FMS doesn't fit the model for a psychiatric disease. Patients aren't just faking it: the pain and dysfunction are real. Yet the situation doesn't make much sense when you consider the devastating toll that FMS takes on people's lives. Millions of people are left to live in the shadows of FMS with their pain sight-unseen. This seems to defy logic, unless one factors in an unexpected adversary: the medical insurance industry who demands proof beyond a shadow of a doubt that the pain of FMS equates to serious dysfunction. The 100% absolute proof that Dr. Pellegrino jokes about in the October 2000 issue is a real dilemma because the theories behind FMS pertain to problems in the brain's inability to function properly. These could be problems that scientists might not be able to prove with current techniques unless patients are willing to donate slices of their living brain tissue to research! Olin proposes a theory about why your body's functioning could completely contradict the way you appear physically (no swollen joints, no visible abnormalities on X-rays, no obvious signs that you are seriously ill). He hypothesizes that your symptoms have to do with a dysfunction of the astroglial cells in your brain (astroglial cells and glial cells are all part of the central nervous system's cells called the glia). It's only a theory, but one that many brain researchers are beginning to focus their attention on these days as they look for answers to diseases that have none. "As patients, you have to ask: Why do I hurt?" He adds, "What is the cause? Was it an infection or trauma? Is it due to the initial pain that started in my elbow? What is it? The problem with conditions like FMS is that something started it, but the trigger (and there may be many of them) is probably of no importance at the stage that you are now at. The situation that started your FMS has already hit you, and then sort of runs away, leaving it difficult to trace what actually happened to you." How do astroglial cells fit into the picture? "In the early 1980's, people thought that everything which was occurring in the brain was happening inside the brain's neurons," says Olin. "Then slowly throughout the 80's, the focus started to shift to the astroglial cells. They were originally thought to play a passive role, to just be the connective or supporting tissue within the brain. Now we know that this is not the case. Astroglial cells comprise 50% of the brain's cells and they surround every neuron, providing regulatory and nutritional functions. They also have receptors on their cell surfaces that respond to neurotransmitters and, if something is wrong, they react by sending signals throughout the brain. If you look at the data on brain imaging in FMS (such as the work of Laurence Bradley, Ph.D.), you will find that several areas have disturbances in brain blood flow ... this could be due to a malfunction in the astroglial cell transmission system." Olin points out that astroglial cell membrane functions can be disturbed, even long-term, by infections reaching the central nervous system, by physical trauma, as well as by sensory overload. "In this context," explains Olin, "pain is a very strong sensory signal!" Olin believes this theory not only explains the symptoms of FMS, but also the associated neurological, immunological and hormonal system disruptions. Adding to Olin's theory are research studies done by Ian Campbell, Ph.D., at Scripts Institute in La Jolla, CA, in which he has shown that mice bred to overproduce an immune chemical called IL-6 (a cytokine), look fairly normal on the outside. Yet, they have serious memory concentration problems and they are highly pain sensitive. They die prematurely and a look at their astroglial cells reveals that they are under siege by inflammation. Without an autopsy, however, the mouse's problems appear sight-unseen. Olin concludes that his astroglial cell theory explains why FMS is stubbornly persistent and why it is so difficult to reach these cells in terms of effective treatments. BUT, once researchers start to look at these and related cells in the brain, the future for FMS patients could swiftly change! Medically reviewed and edited by Robert Olin, M.D., Ph.D.