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


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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