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Fibromyalgia
A combination of chiropractic, trigger
point therapy, and lifestyle changes has proven to be very effective in
decreasing the severity and duration of the physical pain of fibromyalgia.
The word fibromyalgia comes
from the Latin term for fibrous tissue (fibro) and the Greek ones for
muscle (myo) and pain (algia). Fibromyalgia syndrome is
chronic disorder which includes widespread muscle pain, fatigue, and multiple
tender points that affects 3-6 million people in the United States. For reasons
that are unclear, more than 90% of those who develop fibromyalgia are women. It
is not currently known whether the predominance of women who suffer from
fibromyalgia is a phenomenon of the socialization of women in the American
culture or whether it is some combination of the female reproductive hormones
and other genetic predispositions.
According to the American College of
Rheumatology (ACR), fibromyalgia is defined as a history of pain in all four
quadrants of the body lasting more than 3 months. Pain in all four quadrants
means that you have pain in both your right and left sides, as well as above and
below the waist. The ACR also described 18 characteristic tender points on the
body that are associated with fibromyalgia. In order to be diagnosed with
fibromyalgia, a person must have 11 or more tender points. In addition to pain
and fatigue, people who have fibromyalgia may experience:
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sleep disturbances
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morning stiffness
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headaches
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irritable bowel syndrome
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painful menstrual periods
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numbness or tingling of the extremities
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restless legs syndrome
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temperature sensitivity
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cognitive and memory problems (sometimes
referred to as "fibro fog")
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Fibromyalgia is often confused with
another condition called “myofascial pain syndrome” or “myofascitis.”
Both fibromyalgia and myofascitis can cause pain in all four quadrants of the
body and tend to have similar tender point locations, but the two conditions are
worlds apart. Myofascitis is an inflammatory condition due to overuse or injury
to your muscles, whereas fibromyalgia is caused by a stress-induced change in
metabolism and healing. Myofascitis tend to come on rather suddenly and is
usually associated with a particular activity or injury, true fibromyalgia has a
slow, insidious onset, usually beginning in early adulthood. It is very
important to diagnose each of these correctly, for they require very different
approaches to treatment. Unfortunately, fibromyalgia is a chronic condition,
meaning it lasts a long time - possibly a lifetime. However. it won't cause
damage to your joints, muscles, or internal organs.
The Basics of Fibromyalgia
The latest research indicates that
fibromyalgia is a stress-related condition that is a cousin in Systemic Lupus
Erythematosis (often referred to as simply ‘lupus’) and Chronic Fatigue
Syndrome. In all three of these conditions, there is the same predominantly
female distribution, chronic fatigue, sleep disturbances, irritable bowel, as
well as many other similarities. You can think about these three conditions as
lying on a continuum with Fibromyalgia on one end, Lupus on the other and
Chronic Fatigue Syndrome in the middle. All three of these conditions are caused
by an abnormal stress response in the body, but with Lupus, the immune system is
primarily affected, causing an autoimmune reaction that attacks your healthy
tissues. On the other end of the spectrum is fibromyalgia, where metabolic
abnormalities are primary. These metabolic changes are the result of a
stress-induced decrease in blood flow to an area of the brain called the
pituitary. This, in turn causes a decrease in a number of important hormones,
such as the growth hormone releasing hormone (somatotropin) and the thyroid
stimulating hormone. These hormonal changes lead to abnormal muscle healing,
borderline or full-blown hypothyroid, as well as memory and cognitive changes.
One of the major physical abnormalities
that occurs with fibromyalgia lies in the muscle itself, where there is a build
up of a protein called “Ground Substance.” Ground substance is normally
found in muscle, bone and connective tissue all over the body and is responsible
for making the tissues stronger and less susceptible to tearing. In a normal
person, when a muscle is injured, the muscle tissue itself is able to regenerate
and over time, completely heal itself. In a person with fibromyalgia, the muscle
is unable to completely heal itself. Instead, an abnormally large amount of
ground substance builds up in the injured area. It is the ground substance,
coupled with local muscle spasm it creates that creates the muscle ‘knots’
associated with fibromyalgia.
A number of tests may be done to rule out
other disorders and an examination can reveal whether a person has the
characteristic tender areas on the back of the neck, shoulders, sternum, lower
back, hips, shins, elbows, or knees. Unlike its cousin lupus, there are
currently no diagnostic laboratory tests for fibromyalgia. Because there are no
clinical tests for fibromyalgia, some doctors, unfortunately, conclude that a
patient's pain is not real, or they may tell them that there is little they can
do. But a combination of chiropractic, trigger point therapy, and lifestyle
changes has proven to be very effective in decreasing the severity and duration
of the physical pain and disability of fibromyalgia.
Fibromyalgia can be difficult to treat.
Not all doctors are familiar with fibromyalgia and its treatment, so it is
important to find a doctor who is. Fibromyalgia treatment often requires a team
approach, utilizing chiropractic care, trigger point therapy, massage, dietary
changes, as well as exercises and stretching.
Treating Fibromyalgia With Chiropractic
Chiropractic care is critical for those
who suffer from fibromyalgia in order to keep the spine and muscles from losing
too much movement. Because fibromyalgia causes the muscles to tighten up and
lose some of their natural pliability, it results in a global loss of movement
in the spine. The loss of movement in the spine results in a neurological reflex
that causes the muscles to tighten further. This vicious cycle will continue and
over time will lead to increased pain, increased muscle tightness, a loss of
movement, more difficulty sleeping and the development of more and more trigger
points.
The only option is to continually adjust
the spine and keep it moving. It is not uncommon for those with fibromyalgia to
be adjusted three to four times per month to keep everything mobile and relaxed.
The biggest concern in treating people with fibromyalgia is that their muscles
have a diminished healing ability. For this reason, chiropractic adjustments are
usually modified slightly to be more gentle than normal. This helps to decrease
the stress on all of the small supporting muscles of the spine, which can be
easily injured. It is important when seeking chiropractic care, to make sure
that the doctor is familiar with the muscular changes that occur with
fibromyalgia so that they can adjust their treatment accordingly.
Treating Fibromyalgia with Trigger Point
Therapy
The overwhelming characteristic of
fibromyalgia is long-standing, body-wide pain with defined tender points, and
frequently, trigger points. Trigger points are often confused with “tender
points.” They are not the same. A trigger point needs firm pressure to elicit
pain, while tender points are painful with even very light pressure. Trigger
points will refer pain to other areas of the body, whereas tender points will
not. Unlike tender points, trigger points can occur in isolation and represent a
source of radiating pain, even in the absence of direct pressure. As discussed
earlier, trigger points are purely comprised of spasmed muscle fibers, whereas
tender points are knots filled with ground substance. Those with fibromyalgia
almost always have a combination of the two – trigger points and tender points
– and can improve dramatically with light trigger point therapy.
Trigger point therapy for fibromyalgia is
much like trigger point therapy for low back pain, neck pain or headaches. The
points are the same. The difference is just intensity. Since the muscles in
patients with fibromyalgia are easily injured and take longer to heal, it is
necessary to use less pressure on their trigger points.
Treating Fibromyalgia with Cold Laser
Therapy
Since poor healing of muscle tissue and
chronic pain are characteristic traits of fibromyalgia, laser therapy is an
important part of any treatment plan. Two of the major benefits of cold laser
therapy is stimulation of tissue healing and decreased sensations of pain.
A 1997 study of 846 people with
fibromyalgia reported in the Journal of Clinical Laser Medicine and Surgery
demonstrated that two-thirds of the patients experienced improved pain and
mobility with cold laser therapy. Another study published in Rheumatology
International in 2002, showed that those who received laser therapy had a
significant improvement in pain, fatigue and morning stiffness.
Self-Care for Fibromyalgia
Your day to day lifestyle choices have a
tremendous impact on how much impact fibromyalgia will have on your life. The
difference between those who take care of themselves and those who do not is
tremendous. Those who make lifestyle changes to help their fibromyalgia suffer
much less pain, are able to remain more active and have a much higher quality of
life than those who do not. If you have fibromyalgia, here are some of the main
things that you can do on a daily basis to help your body:
Getting enough good sleep
—Getting enough sleep and the right kind
of sleep can help ease the pain and fatigue of fibromyalgia, but is something
that can be hard to get. Many people with fibromyalgia have problems such as
pain, restless legs syndrome and brain-wave irregularities that interfere with
restful sleep. Insomnia is very common. Although alcohol may help you to relax,
it is not recommended before bed as it has been shown to interfere with restful
sleep. Some of those with fibromyalgia have found 5-hydroxy tryptophan (5-HTP)
very helpful, as well as the prescription anti-depressant amitriptyline.
Typically, we don't recommend taking perscritpion drugs, but in this case, it is
difficult to heal without enough sleep.
Exercising
— Improved fitness through exercise is
recommended. Studies have shown that fibromyalgia symptoms can be relieved by
aerobic exercise. Though pain and fatigue may make exercise and daily activities
difficult, it's crucial to be as physically active as possible. The best way to
begin a fitness program is to start with low impact exercises, like walking and
swimming. Starting slowly helps stretch and mobilize tight, sore muscles.
High-impact aerobics and weight lifting could cause increased discomfort, so pay
attention to your body. The more you can exercise, the better off you will be.
Making changes at work
—Most people with fibromyalgia are able
to continue working, but they may have to make big changes to do so. It may be
necessary to reduce the number of hours at work, find a job that will allow you
to have a flexible schedule, or switch to a less physically demanding job. Many
people with fibromyalgia require specially designed office chairs, adjustable
desks or other adaptations in order to continue working. If you face obstacles
at work, such as an uncomfortable desk chair that leaves your back aching or
difficulty lifting heavy boxes or files, your employer may make adaptations that
will enable you to keep your job.
Eating well
—Foods, just like anything else, have
the ability to either stress your body or to help your body heal. Foods that
tend to be stressful on the body include: dairy, eggs, wheat, corn, as well as
anything with monosodium glutamate (MSG), nitrates or nitrites (as are found in
processed foods). Several environmental toxins may also contribute to the
overall physical stress on your body, therefore fish should be avoided as well.
It is important that you eat as much clean, organically grown fresh foods as
possible. Base your diet around whole foods such as: brown rice, legumes, oats,
spelt, rice milk, soy, hormone-free chicken or turkey, roots, nuts and berries.
Nutritional supplements
—There are dozens of nutritional
products that claim to be ‘the answer’ for fibromyalgia. To date, none of
them have proven to be of much long-term benefit for anyone. However, there are
some people who have used magnesium malate with good results, some people who
have used ginkgo biloba with good results and others with various herbals. The
bottom line with nutritional supplements is that, do date, there is nothing that
works for everyone. If you come across something that you would like to try, by
all means do so, as long as you check it out with your chiropractor first to
ensure that it won’t interfere with any of your other treatment.
It's Your Life... Live it
in Health!
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