The word fibromyalgia is derived from three words: fibro, which is Latin for fibrous tissue; myo, which is Greek for muscle; and algia, also Greek and meaning pain. It is a chronic syndrome which covers symptoms including muscle pain, fatigue, and multiple tender points, and it affects 3 to 6 million people in the United States, over 90% of whom are women. It is not known exactly why there is such a preponderance of female sufferers.
Diagnosing fibromyalgia is not easy, and may take many years to properly identify. The American College of Rheumatology (ACR) defines fibromyalgia as a history of pain lasting more than 3 months in all four quadrants of the body; that is, on both your right and left sides, and above and below the waist. The ACR further details 18 tender points around the body that are characteristic of fibromyalgia, and diagnosis requires a person to have 11 or more. As well as pain and fatigue, fibromyalgia may also produce:
- Disturbed sleep
- Morning stiffness
- Headaches
- Irritable Bowel Syndrome (IBS)
- Painful menstrual periods
- Numbness/tingling in the extremities
- Restless legs syndrome
- Sensitivity to temperature
- Cognitive and memory problems (“fibro fog”)
To make diagnosis even more difficult, fibromyalgia can easily be mistaken for “myofascial pain syndrome” or “myofascitis”, as both can cause pain all over the body. However, the two conditions are very different. Myofascitis is the result of inflammation caused by overuse or injury to the muscles, is usually related to a specific activity or injury, and manifests quite suddenly. Fibromyalgia is the result of stress-induced changes to the metabolism and healing process, and appears in a slow, creeping fashion, most often starting in early adulthood. Correctly differentiating between the two is crucial as the relative treatments are nothing like the same.
What is fibromyalgia?
Fibromyalgia is a chronic condition that may never go away your entire life, although on the plus side, it does not cause any damage to your joints, muscles, or internal organs.
The most up-to-date research suggests that fibromyalgia is a stress-induced condition related to Systemic Lupus Erythematosis (usually just referred to as ‘lupus’) and Chronic Fatigue Syndrome. All of these conditions target women far more than men, and are marked by similar symptoms such as chronic fatigue, disturbed sleep, and IBS. The main difference is with lupus, which is an autoimmune reaction that attacks the healthy tissues of the body. With fibromyalgia, metabolic abnormalities are the primary issue, causing decreased blood flow to the pituitary gland in the brain. This then lowers certain important hormones, such as those responsible for releasing growth hormone and stimulating the thyroid. Muscle healing is adversely affected, memory and cognition are damaged, and full-blown hypothyroidism may even result.
Specifically, fibromyalgia causes a buildup in the muscle of a protein called “ground substance”. This is found in muscle, bone and connective tissues everywhere in the body, and serves to make these structures stronger and less prone to injury. The excessive amount of ground substance in a fibromyalgia sufferer means that the injured area does not heal properly, leading to the muscle knots characteristic of the condition.
While lupus can be definitively diagnosed with laboratory tests, there are no such surefire tests for fibromyalgia. However, there are a number of tests that can help to rule out certain other disorders, and a physical examination will identify if a person has the characteristic tender areas on the back of the neck, shoulders, sternum, lower back, hips, shins, elbows, or knees. Unfortunately, this lack of 100% certainty can lead some doctors to dismiss a patient’s suffering as “all in the mind”, or (not much better) to conclude that there is no effective remedy on offer.
This is not true. While fibromyalgia is certainly not easy to treat, a combination of chiropractic, trigger point therapy, massage, and lifestyle changes (diet and exercise) can prove effective in reducing the severity of the condition, and the duration of the associated pain and suffering. This obviously necessitates a team approach, therefore it is important that the sufferer locates professionals who understand the condition and are happy to work together.
Chiropractic treatment of fibromyalgia
Fibromyalgia causes muscles to tighten and lose their natural pliability, which triggers the spine to decrease its own flexibility, which leads the muscles to tighten even more. It is a vicious cycle that can get worse and worse, causing ever greater pain. Chiropractic care is therefore essential as it ensures that sufferers do not lose too much movement from their spine and muscles. The spine must be properly adjusted and kept moving to counter the insidious creep of fibromyalgia. Treatments should happen three to four times per month, and these sessions will be gentler than normal to take into account the muscles’ susceptibility to injury and their lack of healing ability. When seeking a chiropractor, you need to ascertain that he or she fully understands how the condition affects the muscles.
Trigger point therapy to treat fibromyalgia
Trigger points are tint knots in the muscle fibers, and they can easily be confused with “tender points”. They are not the same, though.
- A trigger point is painful under firm pressure, whereas it takes only very light pressure on a tender point to elicit pain
- Trigger points refer pain to other areas of the body, where tender points do not
- Trigger points can be painful without any pressure exerted on them, as they refer their pain elsewhere
- Trigger points are comprised of knotted muscle fibers that have gone into spasm, whereas tender points are knots filled with ground substance
Fibromyalgia sufferers will almost always have both trigger and tender points, and can benefit greatly from trigger point therapy, albeit a lighter form to ensure that the muscles are not injured.
Cold Laser Therapy for fibromyalgia
Laser therapy helps to stimulate tissues into healing and decreases pain sensations, and so is an important part of any fibromyalgia treatment plan. A study of 846 fibromyalgia sufferers carried out in 1997 and reported in the Journal of Clinical Laser Medicine and Surgery revealed that two-thirds of the group enjoyed less pain and more mobility following cold laser therapy. Another study in Rheumatology International in 2002 reported significant improvement in pain, fatigue and morning stiffness after cold laser therapy.
Self-care for fibromyalgia
Sufferers should not forget that lifestyle choices play a key role in how fibromyalgia affects them. Those who take care of themselves show hugely better outcomes than those who don’t. They suffer far less pain and manage to stay much more active, both of which have a great impact on quality of life. If you have fibromyalgia, the following advice should help:
- Get Sufficient Sleep: Getting enough good quality sleep is very important in combating the pain and fatigue of fibromyalgia, although this may be difficult when several symptoms of the condition prevent restful sleep. Insomnia is very common among sufferers. Alcohol may seem like a quick fix in getting you off quickly, but it is known to badly disturb a healthy night’s sleep pattern. 5-hydroxy tryptophan (5-HTP) is very useful for some people, and others may benefit from the prescription anti-depressant amitriptyline. The latter is not an ideal choice, but it may come down to the lesser of two evils: prescription meds or lack of sleep.
- Exercise: Although it may cause some pain, fibromyalgia sufferers should exercise to improve their fitness. Aerobic exercise has been shown to reduce symptoms, and, generally, exercise guards against the gradual slowing down of physical activity the condition can impose. Low impact exercises such as walking and swimming are the best ways to start out, gently easing sore, tight muscles into action. Anything more than this could create problems. When seeking to push further, always be careful and listen to your body.
- Look at Your Working Life: Fibromyalgia does not stop most people working, but changes may have to be made. Working hours may need to be reduced due to fatigue, a more flexible schedule may be needed, and less physically strenuous activities undertaken. Office ergonomics will also become important so that no undue stress is placed on the muscles, and an understanding employer will make all this very much easier to achieve.
- Eat Well: Food is fuel for the body, thus it follows that the wrong foods can degrade your system and stop it working optimally. For a fibromyalgia sufferer, eating well is even more important to feed the healing process. Foods that stress the body include dairy, eggs, wheat, corn, products containing monosodium glutamate (MSG), and those containing nitrates or nitrites, which are common in processed foods. Fish should be avoided for the environmental toxins it may contain. The best choices are fresh, raw, organically grown foods, which means plenty of whole foods such as brown rice, legumes, oats, spelt, rice milk, soy, hormone-free chicken or turkey, roots, nuts and berries.
- Supplement Your Nutritional Intake: So far, nothing touted to remedy fibromyalgia has proven its credentials in the long term. However, there are certain supplements that some find beneficial, including magnesium malate, ginkgo biloba, and various other herbal concoctions. Always be sure to consult your doctor of chiropractic before taking any supplement to make sure it is safe and will not impede your other treatment.
For Your Health,
Dr. Patrick Chenoweth