Fibromyalgia Demystified

Fibromyalgia. The very word frightens some and puzzles most.

What is it? What causes it? How is this condition diagnosed? Does it even exist?

I have never come across a condition that is as misunderstood (and mistreated) as fibromyalgia. While I was in chiropractic school, it seemed like you got a different answer depending on which professor you asked or which book you read. Nothing seemed to agree. Every other neuromusculoskeletal condition had a specific set of symptoms, positive lab values, etc. Fibromyalgia was pretty much understood as something that was diagnosed by exclusion. If it’s NOT rheumatoid arthritis, multiple sclerosis, etc. and nothing else seems to fit, the patient had fibromyalgia.

Unfortunately, this lack of understanding is still pervasive throughout the medical community at large. Many physicians do not understand this condition at all while some still contend that it only exists in the patient’s mind (which is why it used to be called “psychogenic rheumatism,” which translates to "pain that is generated in the mind"). These patients are often shuttled from doctor to doctor and subjected to a shotgun approach of multiple medications to see if they can find enough relief to get through the day. They are often told that they are just depressed or stressed and told to seek counseling. Most fibromyalgia patients I meet are often stressed and depressed BECAUSE of fibromyalgia, not the other way around. They have lost friends, spouses, and jobs because of the debilitating effects of this condition, while their doctors tell them that there pain is not real. Wouldn’t that make YOU depressed?

Fibromyalgia Defined
To understand fibromyalgia, we must first understand what the word means. Broken down, it translates to fibro = fiber, myo = muscle, algia = pain, so muscle fiber pain (for some reason they dropped the second "o"). Fibromyalgia is characterized by widespread, chronic pain throughout the muscles and soft tissues of the body. The pain is severe and is often accompanied by digestive troubles, sleep disorders, mental impairment, headaches, and extreme fatigue. It is also commonly referred to as Chronic Fatigue Syndrome because the extreme fatigue is the most prevalent symptom for some. This condition affects more than 6 million people nationwide, a number that is steadily growing. For reasons unknown, women make up 80 to 90 % of fibromyalgia sufferers. For years, medical doctors referred to fibromyalgia and chronic fatigue syndrome as the “yuppie flu.” This term was used to describe what some doctors thought were a bunch of bored housewives whose pain was the direct result of depression and a lack of attention from their well-to-do husbands. How’s that for compassion?

Current Research
Regardless of the incredible misunderstanding surrounding this condition, there has been some very important research done about fibromyalgia and its orgins. Fibromyalgia is the direct result of a dysfunctional central nervous system. Patients exhibit an increased sensitivity to physical stimuli. What a normal patient may perceive as light touch or pressure, a fibromyalgia patient may perceive as excruciating pain. The role of the central nervous system also explains why the pain moves around so much. If it were a single nerve being irritated (like sciatica or carpal tunnel syndrome) the pain would stay in the area surrounding the innervation of that nerve. However, with fibromyalgia, the pain changes from day to day, both in location, severity, and type of pain (burning, aching, stabbing, etc.)

According to research done by the University of Michigan, fibromyalgia patients also show increased senstivity to pressure and sound, as well. This proves that fibromyalgia is NOT just a pain problem, but a central nervous system processing problem. Fibromyalgia patients have shown dramatically increased levels of substance P, a hormone released when you feel pain. Fibromyalgia sufferers exhibit substance P levels 3 times higher than normal!

Diagnosing Fibromyalgia
Since there is no gold standard test to indicate the presence of fibromyalgia, the condition is primarily diagnosed by the patient's symptoms. All lab tests and imaging studies will be negative for diseases such as multiple sclerosis, mononucleosis, and Lyme's disease. In order for a patient to be diagnosed with fibromyalgia, they must have chronic widespread pain for at least three months. The pain must be transient, passing into all four quadrants of the body. Many physicians make the diagnosis by palpating 18 pre-determined tender points. If 11 of those points are tender and all other criteria are met, the patient is diagnosed with fibromyalgia.

Treatment
Most patients who have been diagnosed with fibromyalgia are on a myriad of prescription medications, including pain meds, anti-inflammatories, muscle relaxers, sleeping pills, anti-depressants, and anti-anxiety medications, to name a few. Recently, so-called “fibromyalgia medications” have come in vogue. These medications are not new, by any means. They are actually anti-seizure medications that have been recently re-packaged to treat fibromyalgia patients because they literally “turn down” the patient’s brain function (sounds great, huh?). This may improve some symptoms in some patients, but side effects are common and varied. I have done several workshops on fibromyalgia and have met literally hundreds of patients with this diesease, yet everyone I know who has tried a fibromyalgia medication was forced to quit because the side effects were not worth it. Weight gain, dizziness, drowsiness, headaches, memory loss, suicidal thoughts, weakness, and sleep disorders, to name a few. For those of you keeping track at home, you will notice that some of the side effects are the same symptoms that fibromyalgia patients are suffering from in the first place! If that doesn't sound bad enough, there is a new drug that has been cleared by the FDA to treat fibromyalgia. The chemical name for the drug is amma-Hydroxybutyric acid. You know it better as the "Date rape drug." That is not a joke.


Obviously, with some of my patients, they are in such pain initially that they need some sort of pain medication to get through the “bad days.” Part of the goal of our treatment is to limit the dependency on pain medications as a whole. I would NEVER tell any of my patients to up and quit their medications cold turkey, even if they are not working. They must work with their medical physician in regards to weaning themselves off of prescription medications.



Forgive me if I sound a bit harsh when it comes to the medical treatment of fibromyalgia. Please understand that I truly believe that the medical doctors are doing everything they can to bring some relief to these patients. The only problem is, they are not treating the cause of the patient's problem, which is why any benefits from medications are usually short term, at best. They are merely covering up the symptoms. Before I talk about our treatment for fibromyalgia patients, let me address some other crucial factors in the management of any fibromyalgia case.

Getting the Right Kind of Exericse
Exercise is an important factor in fibromyalgia patients, but it must be handled properly. In general, exercise is a crucial part of any healthy lifestyle, but fibromyalgia patients suffer from a phenomenon called “exercise intolerance.” They often have flare ups of extreme pain and fatigue after activity, making vigorous exercise next to impossible. However, the goal is to maintain muscle tone and range of motion in the joints and soft tissues, as well as cardiovascular health. The best exercise plan for fibromyalgia patients consists of low impact activities, such as walking, light yoga, swimming and water aerobics. Weight training with a light weight / high repetition approach may be beneficial, as well. Since symptoms are often inconsistent, patients are often tempted to do way too much on a good day and often end up bedridden for days afterwards. Working closely with a therapist that is well versed in fibromyalgia is advised to avoid overtraining and ensure proper muscle balance.

Nutrition
Good nutrition is absolutely essential for people suffering from fibromyalgia. I cannot stress this enough. Diet modifications are an absolute must. There are many factors in the Standard American Diet (SAD) that cause chronic inflammation in the body, which complicates the symptoms of fibromyalgia.

For starters, the average American consumes way too much carbohydrate in the diet, especially in the form of refined sugars. Newer research is proving that an abundance of sugars, not fat, in the diet is contributing to many of the diseases of civilization, including type 2 diabetes, heart disease, and obesity. Ever since the powers that be told us to go on a high-carb, low-fat diet, we have seen the rates of these diseases skyrocket.



An imbalance of the ratio of Omega-6 to Omega-3 fatty acids in the diet is another key contributor to chronic inflammation. Omega-6 and Omega-3 fatty acids are essential in the diet, but like most things in life, balance is key. The "optimal ratio" of Omega-6 to Omega-3 is 4:1. The average American's ratio is upwards of 20:1! The reason for this is the abundance of processed food in the SAD diet, since processed foods use oils that are rich in Omega-6. Omega-3 fatty acids are found in oily fish, flaxseed, and fish oil supplements. Sadly, Omega-3 fatty acids used to be more prevalent in meat and dairy products, but the common practice of feeding grains to livestock has caused the meat to produce more Omega-6, which further adds to our imbalance! If you can acquire grass fed beef and free range chickens, you can help balance your Omega-6 to Omega-3 fatty acid ratio, plus you help out some forward thinking farmers! For more information on this topic, click here: Omega-3 and Omega-6 fatty acids.



The biggest thing to keep in mind is food quality. Eating real food is the best way to limit your intake of refined sugar, processed fats, and harmful artificial additives. How do you know if you are eating real food? Check the ingredients. If the ingredient list is "egg," chances are you are eating real food. If the ingredient list is packed with words like "partially dehydrogenated" and "monosodium dihexaglutamic fluxcapacitor benzoate," you are probably eating something that is not fit for human consumption.



Other things to be avoided in a fibromyalgia-friendly diet include: refined sugars, artificial sweeteners (aspartame), MSG, caffeine, yeast, gluten, dairy, and baked goods. I could write an entire post on my own journey regarding nutrition and what I have discovered about the Standard American Diet and how I have not only lost weight and improved my overall health, but that will have to wait...


Why Chiropractic Care?
There is a link between fibromyalgia and previous trauma, especially to the central nervous system. Remember that I mentioned before that research has proven that fibromyalgia is a central nervous system processing problem. The central nervous system is contained within the head and spinal column. Injuries to the head and spine cause irritation and dysfunction to the brain, spinal cord, and nerves, which can potentially affect every organ, tissue, and cell in the body.

Because of this, many patients have sought out chiropractic care for help with the symptoms of fibromyalgia since we specialize in finding and correcting nervous system dysfunction. If a misalignment of the spine exists, specific adjustments to the vertebral column, especially the Atlas (C1) vertebra, can help alleviate the symptoms of fibromyalgia by relieving pressure on the delicate structures of the nervous system. We do not treat the symptoms. We do not cover up the pain, or artificially turn down the function of the brain. We remove nervous system interference so the body can work the way it was originally designed to. It is just that simple.

Renowned rheumatologist Frederick Wolfe, MD in his research on fibromyalgia concluded that chiropractic was “among the best” treatments for fibromyalgia patients. Peer-reviewed journals have also published studies that indcate the effectiveness of chiropractic for fibromyalgia sufferers. Of course, chiropractic has never been as mainstream as allopathic medicine so, unlike the plethora of Lyrica ads the average American will likely see on a regular basis, our message is just not getting out there.


Chiropractic Success Story
One great case of note is that of Brig. General Becky Halstead (click for her story), the first woman general in the U.S. Army to command in Iraq. General Halstead suffered from fibromyalgia during her service. "Traditional medicine did not work for me," she said. I would love to see an MD diagnose HER with the “yuppie flu!” After getting nowhere with the military physicians, she decided to give chiropractic a try, and she has fought hard to make sure that that the armed forces continue to make chiropractic care available for our soldiers. “The adjustments and nutritional advice I received from my chiropractor helped in treating the fibromyalgia and made me feel better on a day-to-day basis. Chiropractic care provided me with a better quality of life.”

We have seen some incredible results with fibromyalgia in our own practice. This depends on the patients’ own circumstances and overall healthcare picture. By and large, if we can achieve and maintain the stability of the upper cervical spine and relieve the extra stress on their nervous system, patients absolutely can do better while under our care. Only a doctor of chiropractic can tell you whether spinal misalignments are a contributing factor in your fibromyalgia. It may be the one missing piece to the puzzle.

Just like any condition, the earlier we can get to the problem, the better.