Fibromyalgia comes with three major types of pain sensations.
Hyperalgesia: this is our major pain as part of the syndrome itself. It is an abnormal sensitivity to pain. The crux of our pain dysfunction.
Allodynia: With allodynia, there is a triggered pain response from stimuli that does not normally cause pain. In this case, it causes a great deal of skin pain. The skin burns to the touch and is often described as a sunburn sensation and can be much more intense. Clothes hurt. Touch hurts. And it burns like hell. Often tramadol and topical Lidocaine are recommended.
It can happen anywhere. I have had it all down my back. On my thighs. And my arms. Right now I have a brutal patch that is insanely intense on my right upper back below the shoulder.
Paresthesia: Causes the ‘pins and needles’ sensations, an itch, tingling, prickling and numbness. And can cause pain.
I once had an insane bout of this that lasted a couple of years. Tingling and numbness below the waist. Disturbed my doctor who thought it could be any number of back issues and led to three MRIs. But, nope, FM. Not saying it wasn’t bad with the numbness intense tingling issues given the location. It got worse over time in a year and took about two years to dissipate. Well, in the sense it isn’t as bad as it was, but still mildly there.
Allodynia in Fibromyalgia
Does your skin burn like it has a sunburn on it? Does contact with your clothes aggravate you beyond belief? Does even the lightest touch make you want to jump out of your skin? That sounds like Allodynia.
Allodynia is a type of pain associated with Fibromyalgia and is considered a rare type of pain. With allodynia, there is a triggered pain response from stimuli that does not normally cause pain. In this case, it causes a great deal of skin pain. The skin burns to the touch and is often described as a sunburn sensation. Clothes will hurt against the skin. Even the slightest of breezes will feel painful against the heightened and tender skin. There is no exact cause for allodynia, but it is considered to be from central sensitization where there is an increase of excitability in the neurons of the central nervous system. As such, harmless stimulus – like a light touch – activates the nociceptors which are usually activated only in response to intense stimulus causing damage to the tissue and thus causing pain where there should be none.
The pain caused by touch is called tactile allodynia; when caused by movement, it is mechanical allodynia. Thermal allodynia is related to temperature. Other pain conditions can create this response such as neuropathy, post herpetic neuralgia and migraines. In fact, with migraines, allodynia is common in the scalp, although it can occur anywhere.
Allodynia can range from mild to severe and can be all over the body or only in certain areas. It can be continuous or come and go. My personal experience of allodynia has varied. I have had mild bouts of it in precise locations similar to a mild sunburn. In these cases, it is just a mild irritation – noticeable, but easy to ignore. Then I have had severe bouts in large patches of skin, like on my back and thighs, that was aggressive and hard to have clothes touching me. I even found it hard to just handle being in my skin, with showers being immensely painful experiences. Movement itself is an ordeal. Touch is out of the question. However, I have not had it continuously.
For me, allodynia seems to be more random, rather than a flare sort of thing. When it strikes, it lasts for weeks and then simply fades. During an episode, tramadol is the only thing that has ever managed the pain, although not very well, instead only slightly dulling the edges of the pain. With migraines, I regularly experience allodynia on the scalp, which is a regular occurrence. You know, that sensation you have a migraine so bad your ‘hair hurts’. However, during extreme weather, I also get thermal allodynia that can cause a great deal of all-over sensitivity and makes it difficult to be out on hot days and very difficult to weather the Canadian winters. Even in mild winter weather, I have to bundle up, especially my hands, as they will immediately burn from the cold and then hurt all day from the exposure. With thermal allodynia, I find when my hands get flush and hot that it helps to run them under warm or cold water. Take cooling showers also brings the sensation down for a little while.
Clothing is a common problem with tactile allodynia. There can be a burning or constricting feeling from waistbands, even if they are not tight. Bra straps can create a lot of discomfort. Any clothing closely pressed to the body can seem to be putting ‘pressure’ on the burning sensation, including tags and stitching. Generally, fabric choice can be a real issue as some will seem quite aggressive against the tender skin, but when it is severe, all fabrics will be equally aggravating.
Things to consider for allodynia
- This goes without saying, but dress in loose clothing with little contact with the skin.
- Heat can aggravate allodynia, especially thermal allodynia. If you find this to be the case, stick to the shade or wear a hat and/or sunglasses when outside. Consider bringing a cooling product with you like a cooling pad for travel (instant ice bags you squeeze to trigger a chemical reaction and they become cold instantly). Sometimes, even consider heat avoidance. The same goes for really frigid conditions. I have trouble with thermal allodynia in the deep winter months and find that I have to really protect my hands as I have a lot of difficulty with temperatures once they drop.
- It’s best to avoid hot showers and baths; keep the water warm or cool. When allodynia is severe, showers can be particularly painful, and I find baths are a better solution.
- Strong winds will also cause pain with this condition because the skin is extremely sensitive when hit with wind. It brings a whole new meaning to a biting and stinging wind.
- Capsaicin has been shown to help with allodynia; however, it can cause a burning sensation in itself so use with caution. Capsaicin is the only topical cream that has ever provided relief for me for FM pain, but I have never tried it for the allodynia. Many people also reference Tiger Balm.
- Generally, massage therapy may be helpful for FM pain, but it can aggravate allodynia. If you see a massage therapist, it’s best to have a conversation with them about your skin sensitivity and ask them what they can do about it. I recommend the same approach with chiropractors.
There are mediations that some people find helpful for allodynia:
- Anti-seizure drugs such as Lyrica (pregabalin) and Neurontin (gabapentin)
- Topical Lidocaine
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