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Are All the “Feel-Good” Pathways Blocked in Fibromyalgia and Chronic Fatigue Syndrome?

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Reprinted with the kind permission of Cort Johnson and Health Rising.

Missing that runner’s high? Any high at all? Your living circumstances or the losses you have endured may not be to blame. The loss of those good feelings may not be due to depression.  Physiology could be behind all of them.

“Highs” or good feelings it turns out are – or should be – a natural part of living. Our body uses good feelings to reward good behaviors such as exercise.

But what if the reward system isn’t working? What if the production of those good-feeling chemicals are blocked? Does it result in something like fibromyalgia and chronic fatigue syndrome (ME/CFS)?

The evidence – most of it indirect to be sure – suggests that many of the pathways that produce feelings of pleasure, relaxation and rest may be blocked in these diseases.

Some of the pathways are familiar, but a recent study may have added a new one that may be quite close to home, into the mix.

Rest and Digest Down – Arousal Up:
Parasympathetic Nervous System Teetering in ME/CFS and FM

Studies suggest that the “rest and digest” or “feed and breed” part of the autonomic nervous system is on the ropes in both ME/CFS and FM. Parasympathetic nervous system (PNS) activity helps us relax, digest our food – and when the time is right – jump each other’s bones.

Its counterpart, the sympathetic nervous system, appears to be now firmly in control in both diseases. It leaves us wired, edgy and prone to catastrophic thinking. If you having trouble relaxing  – a wimped out PNS could be a reason why.

Reward Down –  Fatigue and Depression Up:
The Whacked Basal Ganglia Dopamine Reward System in ME/CFS

“Reward” is probably too tame a word for the basal ganglia’s dopamine system. Reduced basal ganglia activity has been strongly tied to both fatigue and reduced reward in ME/CFS and hepatitis C patients. Because the dopamine system affects both reward and movement, it’s easy to see how dopamine problems could have global effects, i.e., no reward…no future…little movement.

Natural High’s Down – Pain Up:  
Endocannabinoid Activity Reduced in FM

Indirect evidence suggests that endocannabinoid activity in fibromyalgia may be reduced. A recent review article, in fact, suggests that increasing cannabinoid activity could block the pain in fibromyalgia, irritable bowel syndrome, headache and muscle spasm. A survey that found cannabis to be the most effective pain treatment for fibromyalgia suggested the cannabinoid system could definitely use a little strengthening.

Finally, resesarchers found that knocking out cannabannoid receptors in mice caused them to reduce their running. The researchers proposed that the endocannabanoid system reduces the negative signals sent to our brain during exercise. When they knocked that system down, all the mice felt during exercise was pain.

Leptin Up – Reward Down:
Leptin Inhibits Reward and Movement in ME/CFS

Now comes a mouse study suggesting that leptin – the fat hormone that popped out in Jarred Younger’s Good Day/Bad Day chronic fatigue syndrome study – could also be blocking those feel-good systems. When Canadian researchers knocked out leptin in the dopamine regions of the mice brains, the mice jumped on the running wheel and ran and ran. In fact, those little mice ran 11 kilometers a day as opposed to the 6 kilometers they usually run. Mice LOVE to run.

The finding made evolutionary sense. Leptin is a fat hormone. Reduced fat levels, and therefore reduced leptin levels, put the body in running mode – the better to procure food.  High fat levels, on the other hand, put the body in energy conservation mode.

The ME/CFS Connection

The leptin levels in Younger’s ME/CFS study were not high but still appeared to impact a wide range of immune variables. That suggested that even small increases in leptin may have a big impact in chronic fatigue syndrome.

Some more interesting leptin facts:

  • Decreased leptin could help explain why some people with ME/CFS and FM do better during short-term fasting
  • Increased leptin levels during emotional stress could help explain how small stressors can be so darn stressful in these disorders
  • Since leptin is decreased by testosterone, leptin could in part explain why testosterone supplementation sometimes works.

A Complete Blockade?

In an article on the recent leptin finding, a biological anthropologist asserted that it takes a complex system to produce the motivation and ability to exercise. Every one of the systems he singled out could conceivably be impaired in ME/CFS and FM.

“The motivation to exercise is not a single protein, a single hormone, a single event. It’s a complex interaction. Opioids, endocannabinoids, dopamine, it’s an incredibly complex system.”

These findings suggest that virtually every “good-feeling” system in ME/CFS and FM may be blocked. That could help explain why studies find such low quality of life and functionality levels in these diseases. Tie together under-active feel-good pathways with a physiological inhibition on movement, and you’ve got a difficult situation.

Has a kind of perfect storm occurred in ME/CFS and FM? What do you think and what can you do about it?


About the Author: Cort Johnson has had ME/CFS for over 30 years. The founder of Phoenix Rising and Health Rising, Cort has contributed hundreds of blogs on chronic fatigue syndrome, fibromyalgia and their allied disorders over the past 10 years. Find more of Cort’s and other bloggers’ work at Health Rising.

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3 thoughts on “Are All the “Feel-Good” Pathways Blocked in Fibromyalgia and Chronic Fatigue Syndrome?”

  1. Juloo says:

    I’ve remarked to friends before that I just don’t think my body makes dopamine. My husband has always said how good it feels after exercise – that just does not compute. One of my doctors asked me the last time I’d takec pain meds, and it had actually been a few weeks “except for after my massage session.” She looked at me like I had three heads – massage is supposed to feel good! (said she). Well, it feels nice when it happens, but it takes a day or two for the resultant pain to completely dissipate and then I feel more limber. It was then that I think I saw a bit of shock and perhaps a glimmer of recognition of a tiny bit of what I deal with. And believe me, I’m one of the high functioning ones.

  2. siebertesther says:

    I would love some input on what people do who have these illnesses separately or both? I have both. I crave a massage to release muscle tension and used to get deep tissue massages which hurt at the time but made me feel better after a couple of days. Kind of the opposite of what you said. Now I am not sure of what kind of massage to ask for or whether more surface kinds of massage like Swedish would provide the release of muscle tension I am seeking. My fibromyalgia is relatively mild in terms of pain though worse than it used to be. I used to take pain reliever before my deep tissue massages and then we would joke about needing the therapist to hang a stick from the ceiling for me to bite on… 🙂 So I guess my fibro is not that mild. Any suggestions?

    1. Juloo says:

      My husband once got me a spa day which included a massage. This was not my normal massage therapist. When she started in on the long muscles in the front of my thighs, I was in so much pain that I asked her to stop. She didn’t stop right away until I said it again, louder. It was my impression that she had never had that happen before – that’s the difference between a spa experience and my wonderful massage therapist with whom I have a long history. I liked everything else about my spa day, especially the lunch and the steam shower.

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