How a single word cracked the code for fibromyalgia

Academics involved in a Scotland-Taiwan research partnership have formally established an international collaboration scheme for research into the treatment of chronic pain.

Dr Guy Bewick, Senior Lecturer in Neuroscience at the Institute of Medical Sciences at the University of Aberdeen, was UK co-ordinator at the recent joint Scotland Taiwan workshop funded by RSE and Taiwan’s National Science and Technology Council (NSTC). Dr Bewick’s research was key to identifying a specific neural pathway for communicating chronic pain, which is entirely separate from the pathways that communicate acute pain.

Dr Bewick’s research counterparts in Academica Sinica in Taiwan had been studying a model for chronic pain and fibromyalgia for many years. This was aided by the fact that there is, as in many Eastern cultures, a specific word in Taiwan to describe this type of chronic discomfort. Such chronic pain-specific terms are widely culturally understood, while the Western pain diagnostic criteria do not communicate this sensation specifically and separately.

Dr Bewick explained: “Professor Chih Cheng Chen spotted that our work was overlapping with theirs. We were working on one neural system, and they were working on another, and we couldn’t work out why there were so many similarities, yet we were working on such different things.”

He added that his counterparts in Taiwan had been studying this issue, which they show is due to tissue acidosis, for more than ten years, but it was not gaining any traction in the West due to language and cultural barriers.

The Taiwanese word sng refers to a specific type of pain felt by people suffering with fibromyalgia. There is no equivalent word used in Western medicine, nor widely understood by people in Western countries, so describing the nuances of discomfort is a challenge in itself, and presents a hurdle in diagnosing, treating and managing chronic pain.

Dr Bewick explained: “We in the West don’t recognise the sensation – that is we don’t have a category for it either as a clinician or the person in the street recognises, whereas in the East it is culturally embedded.

“Sng is a particular type of sensation which is embedded, and the word for pain is a different type of pain which is embedded as well, and they know that the pain will respond to painkillers, but the sng does not.

“When they go to the doctor they have a conversation between equals. The patient knows they are getting the appropriate advice and treatment because of the specific category of pain that they are dealing with, and the doctor knows what the patient is feeling because it is culturally embedded. This sensation is different from that sensation.

“But in the West pain is a spectrum. It is an unpleasant discomfort, sometimes it is chronic, sometimes it is acute, sometimes it responds to painkillers, sometimes it doesn’t, sometimes it is across the entire body, sometimes it isn’t.

“It seems like this concept needs to be defined and translated here in the West. You’ve got this challenge of this cultural difference as well as the search for a treatment. In order to make advances in it you need the patient to know what it is they are trying to describe, and the GP or clinician to ask the appropriate questions to determine what the sensation is.”

A fuller understanding of the concept of sng has now led to advances in the field of study. Dr Bewick’s research was focused on areas of proprioception – the sense of where your limbs are in space – while researchers in Taiwan were researching this specific type of pain, or sng. The research has shown the mechanisms involved in sensing sng become chronically active when they interact with those used in sensing movement. Research has now identified the specific neurons involved in chronic pain.

The workshop in Aberdeen – funded by the Royal Society of Edinburgh and the NSTC under the Scotland-Taiwan Research and Innovation Workshop Grant scheme – was specifically on the topic of translating sng from the point of view of language, culture, and science to the whole range of key Western stakeholders.

Dr Bewick said: “Without the funding, this meeting probably could not have happened.  It has been absolutely essential and instrumental in allowing us all to get together to establish IC-SPRinT, the International Collaboration for Sng Chronic Pain Research into Treatment Development. That is what we were doing with the workshop, trying to get traction for researchers in the East with clinicians, researchers, chronic pain charities, and those with lived experience in the West. We know how the mechanism to cause chronic pain works and how it turns on, but we don’t yet know how to turn it off, so that is the next stage.

“We know now where to look, it may not explain all of chronic pain, but it explains some of chronic pain. To me it expands a horizon, it tells us where to look and what sorts of things to look for.”