Fibromyalgia

Fibromyalgia is a chronic disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. Approximately one in 50 Americans are estimated to have Fibromyalgia, or between 3 and 6 million people in the U.S. 

Fibromyalgia is the 2nd most common ailment affecting the musculoskeletal system after osteoarthritis. Some researchers believe that fibromyalgia amplifies painful sensations by affecting the way your brain processes pain signals.

Although fibromyalgia was not defined until the late 20th century, it was discovered much earlier. Descriptions in the medical literature date as far back as the early 17th century.  Although the syndrome has been known by other names, the term fibromyalgia was introduced in 1976. This word is derived from the Latin root fibro (fibrous tissue) and the Greek roots myo (muscles) and algos (pain).  In 1987, the American Medical Association (AMA) acknowledged fibromyalgia as a true illness and a potential cause of disability.

SIGNS & SYMPTOMS

The defining symptoms of fibromyalgia are chronic widespread pain, fatigue, and tender points that are hypersensitive to touch.  Other symptoms may include headaches, poor concentration, anxiety/ depression, tingling/numbness of extremities, stiffness, irritable bowel syndrome, and difficulty sleeping.

CAUSE

The cause of Fibromyalgia is unknown but 90% is seen in women aged 20 to 55. Possible risk factors or triggers are: musculoskeletal trauma especially of the head and neck, dental problems, emotional traumas, infection, and sleep disturbances.  These do not likely cause fibromyalgia by themselves, but they are thought to trigger the onset of the disorder in people who are already susceptible to it.

An epidemiology study, conducted with more than 2,500 patients with fibromyalgia over the internet in the form of a survey, revealed that the most common factors that patients perceived as worsening their fibromyalgia symptoms were emotional distress (83%), weather changes (80%), sleeping problems (79%), strenuous activity (70%), mental stress (68%), worrying (60%), car travel (57%), family conflicts (52%), physical injuries (50%) and physical inactivity (50%).

Current thinking centers around a theory called central sensitization. This theory states that people with fibromyalgia have a lower threshold for pain because of increased sensitivity in the brain to pain signals.  Such sensitivity is seen with Reflex Sympathetic Dystrophy (RSD) which causes symptoms such as burning, swelling, sweating, and exaggerated pain. The most common occurrence of RSD is in the upper back especially seen after a whiplash accident of the neck.

DIAGNOSIS

On average, it takes five years for a person with fibromyalgia to get an accurate diagnosis.  Some people go from doctor to doctor without receiving a medical diagnosis for their fibromyalgia symptoms. Many wonder if their painful symptoms are simply imagined.

There are no scientific measures, such as laboratory tests or X-rays that “prove” you have fibromyalgia. In the past, millions of fibromyalgia patients were misdiagnosed as having depression, inflammatory arthritis such as rheumatoid or lupus, chronic myofascial pain, or chronic fatigue syndrome. There are, of course, a few similarities between fibromyalgia and chronic fatigue syndrome and between fibromyalgia and arthritis, but fibromyalgia is different. It is a distinct condition that needs an accurate diagnosis and appropriate treatment.

In 1990, the American College of Rheumatology (ACR) established two criteria for the diagnosis of fibromyalgia:

• Widespread pain lasting at least three months
• At least 11 positive tender points — out of a total possible of 18.

Other observable diagnostic signs we have seen are: slumped/forward head posture, restriction of neck motion, TMJ imbalances, hypersensitivity in upper back, and an acidic 1st morning urinary pH.  Thermography which measures differences in body temperature can be especially helpful in evaluating inflammation and overall improvement with therapeutic intervention.

TREATMENT

Since musculoskeletal pain is the primary symptom seen a thorough evaluation for physical, dental, &/or emotional trauma should be made and treated.  Most patients are significantly helped from a combination of myofascial therapy along with spinal adjustments especially to the head, neck, jaw, and upper back. 

Treating any nutritional deficiencies such as magnesium along with selective use of medication will allow for a reduction of much of the pain and stress of the disease.

Next, it is very difficult to heal without adequate sleep restoration.  Again, natural sleep aids along with selective medication absolutely needs to be addressed.  I find that those supplements or medication that also helps with relaxation are especially beneficial.

Triggers of Fibromyalgia can be effectively addressed by looking at any factors that might be causing inflammation and therefore adding to the pain-inflammation-spasm cycle.  Common triggers I see are infections of the gut or mouth, food sensitivities, dietary imbalances, chemical toxicities, and heavy metal toxicities.   For many of these triggers an aggressive vegetable cleansing diet along with nutritional supplementation can reduce inflammation significantly.  In fact, in a survey published in the journal Clinical Rheumatology, 42% of fibromyalgia patients said their symptoms worsened after eating certain foods.

Overall, I find that patient’s outcomes are most successful when there is a physician guided individualized program that is tailored to the patient.  Such a successful program needs to have physical, mental and spiritual considerations addressed in order to treat the typically multiple root causes.

PROGNOSIS

An evaluation of 332 consecutive new fibromyalgia patients found that disease-related factors such as pain and psychological factors such as work status, helplessness, education, and coping ability had an independent and significant relationship to Fibromyalgia symptom severity and function.  Although Fibromyalgia is not a degenerative or fatal disease it has significant impact on both an individual’s health as well as those who are concerned with their wellbeing.

Therefore, success is best assured when an approach that considers both the musculoskeletal and metabolic root causes  of inflammation that are contributing to ones diagnosis of Fibromyalgia.

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