The first thing out of my sister’s mouth when I was recovering from a serious illness was, “What the heck is fibromyalgia and what do you do about it?” This is only one instance where those around us let us know by their words or their actions that they have no idea what fibromyalgia (FS) is.
There is too much information about FS to offer in just one blog so I will break this up into two blogs. The first will inform what constitutes FS, the most common symptoms, how it is diagnosed, and only half of what literature offers us as treatments.
Fibromyalgia is a syndrome, not a disease. It is a syndrome because it is the data around the symptoms rather than any scientific data that is utilized to confirm a diagnosis of FS. There are no blood tests, x-rays, ultrasounds and such that can validate a diagnosis. The data is subjective in that it comes from the patient and is not something that can be visualized. This, in itself, can present an emotional and psychological problem for the patient because usual support systems often do not understand this invisible syndrome.
The most predominant complaints are pain and fatigue in muscles an
d tendons and are often accompanied by other associated conditions and symptoms. The site “Fibromyalgia Symptoms” www.fibromyalgia-symptoms.org/fibromyalgia_treatment.html offers a list of common symptoms which will not apply to all FS and CFS suffers but have the potential to:
Widespread Pain
Fatigue
Morning Stiffness
Vision Problems
Nausea
Sleep Disorders
Urinary Pelvic Problems
Weight Gain
Dizziness
Chronic Headaches
Cold Symptoms
Skin Complaints
Depression
Dysmenorrhea
Trouble Breathing
Temperature Sensitivity
Costochondritis
Anxiety
Myofacial Pain Syndrome
Aggravating Factors
Multip. Chemical Sensitivity
Temperomandibular Joint
“Fibro Fog” Memory Impair.
Muscle Twitches & Weakness
Some of these listed symptoms are painful in and unto themselves. Costochondritis is an inflammation of the cartilage that joins the ribs to the chest bone and it causes sharp chest pains inside the chest wall and can be confused with heart attacks and strokes. Muscle tension headaches, migraines and combination headaches have the potential to plague FM sufferers for hours or even days. Overexertion and stress, aggravating factors, have a tendency to lengthen and/or intensify the most common symptoms of FS, widespread pain and fatigue.
Widespread pain, of course, is the leading symptom and has long been linked to arthritis but, unlike arthritis, it affects skeletal muscles, ligaments, tendons and even the bursa and can occur anywhere at any time. FS sufferers, to be diagnosed, must experience pain in at least 11 of 18 specific tender points where tendons and muscles are joined, specifically in the neck, shoulders, ribs, waist, lower back, buttocks and knees.
The other symptoms which accompany FS are chronic fatigue and sleep disturbances. Along with these two major symptoms, people who have fibromyalgia may suffer with cognitive and memory problems, called “fibro fog,” morning stiffness, irritable bowel syndrome, painful menstrual periods, numbness or tingling of the extremities, restless leg syndrome, temperature sensitivity and sensitivity to loud noises or bright lights (Staff N. I., 2009).
Since there are no defining examinations to diagnose FS and CFS (i.e. blood tests or x-rays) patients need deal with these disease that no one can see. Family and friends often doubt the validity of the illnesses and the idea that if you cannot see it, it does not exist is apropos because most of the illness is invisible, in that persons who suffer from the chronic condition show no outward signs of physical pain or disability. No devices are required to function but the pain and exhaustion the patients feel often confine them to their homes and sometimes to their beds. Emotions and depression can be devastating.
Treatments for FS can be broken down in categories including but not limited to: Protocols and other approaches, diet and food avoidance, massage/bodywork, pool exercises, supplements, topicals, therapies, self-care treatments, drug treatments, drugs, prescription drugs, hot and cold therapy, and vitamin & mineral injections. (This author does not claim that any of these work, just that these are treatments available for the treatment of FS).
1. Protocols:
a.Guaifenesin: Dr. Paul St. Amand, M.D’s book, “What Your Doctor May Not Tell You About Fibromyalgia: The Revolutionary Treatment That Can Reverse the Disease” relates a protocol consisting of a) reading his book (to know the correct dosage, what to avoid and to know what will happen), b) taking Guaifenesin, c) avoiding salicylates, and d) a low carb diet. 2.Diet and Food Avoidance:
2. Diet
a.“The Rise and Fall of High Fructose Corn Syrup and Fibromyalgia,” by Janice Lorigan includes two recovery plans – “…one of which will end fibromyalgia pain and other fibromyalgia symptoms for almost everyone.”
3. Massage/Bodywork:
a. Acupressure: Pain and stress relieving method that was used in ancient China. It involves putting pressure on certain “acupoints” of the body.
b. Bowen Therapy: In sets, the practitioner uses thumbs and fingers to gently move muscles and tissues. In between each set of moves, the practitioner leaves the
c. Massage by Partner: Massage therapy can get costly. It is suggested that receiving a massage from a spouse or significant other can save money, help with fibromyalgia and allow you to fall asleep.
d. Self-Massage: If your body is not too stiff, massaging around the fibromyalgia tender points on the legs, arms, and front torso may give some relief. Even with chronic myofascial pain syndrome it may be helpful. The book, “The Trigger Point Therapy Workbook” by Clair Davies explains how to massage the tenderpoints.
e. Massage by Therapist: It is suggested to find a therapist who specializes in the chronic illness of fibromyalgia. This will ensure a more gentle massage. Because FS sufferers have a hypersensitivity to pain, the deep tissue massage may be too rough and actually cause more pain for a few hours to a few days.
f. Fibromyalgia and Myofascial Release: This is a highly specialized, hands-on technique of applying gentle sustained pressure into the connective tissue to eliminate pain and restore motion. http://www.myofascialrelease.com/fascia_massage/public/default.asp
g. Myotherapy: When a trigger point meets with either excess emotional or physical stress it often responds by throwing a muscle into spasm. Spasm, in turn, causes pain. The myotherapist erases the spasm by pressing on the appropriate trigger points and then re-educates the affected muscle to its normal resting relaxed condition with special exercises designed for each individual problem. The correct exercise is requisite to success. http://www.bonnieprudden.com/
h. Shiatsu: The Japanese massage technique that focuses on applying finger, hands, thumbs, elbows and knee pressure to the twelve body meridians throughout the body, in order to restore the body’s energy levels, relieve pain, improve circulation, bring about flexibility to muscles, and facilitate one’s digestive system.
4. Heated Pool Exercises: Exercise programs that stretch muscles, in a heated pool, have been explored by Ernest H. Choy, MD, FRCP, and been found to give some relief, especially in combination with specific analgesics and antidepressants (2006).
5. Alternative Therapies:
a. Acupuncture: A 5000 year old Chinese practice that involves the insertion of a very slim needle into the skin of the tenderpoints. The University of Michigan, Ann Arbor’s study showed that acupuncture was more effective for FS patients who were not depressed (Kim, 2004).
b. Electro Acupuncture: One study, in Switzerland, was run to determine the efficacy of electro acupuncture in patients with FS. Conclusions: “Differences between the groups were significant for five of the eight outcome measures after treatment…Electro acupuncture is effective in relieving symptoms of FS. Its potential in long term management should now be studies” (Deluze, 1992, ).
c. Alexander Technique: “A method of getting a person to change their habitual bad daily movements, into movements that are more proper, more balanced, more supportive, and much more easier on the body. The ultimate goal is to release muscle tensions that has built up over time.” http://www.alexandertechnique.com/articles2/fibro/, http://www.alexandertechnique.com/articles2/fibro2/
d. Traditional Chiropractic: This author found one study by a private practice doctor in Quebec which suggests “a potential role for chiropractic care in the management of fibromyalgia and that a randomized clinical trial should be conducted to test this hypothesis.” http://www.prohealth.com/library/showarticle.cfm?libid=3756
e. Upper Cervical Chiropractic: Upper cervical chiropractic theory suggested by B. J. Palmer, beginning in the 1930s, states that “vertebral subluxation can only occur in upper cervical vertebrae. Therefore this technique places great importance on the anatomical structures of the atlanto-occipital joint…The potential instability predisposes people to an “adaptational imbalance” in the head/neck region. This method of chiropractic relies on very specific 3-D or digital x-rays and accurate calculations to conclude information used in treatment. (Note: From this author’s experience with NUCCA and Blair upper cervical alignments, I have achieved great relief. This author suggests that all FS sufferers research and investigate this method further for themselves). http://www.blairchiropractic.com/about_dr_blair.htm, http://www.nucca.org/
f. Trigger Point Dry Needling: A relatively new treatment utilized by physical therapists (PTs) which includes introducing a dry acupuncture needle into specific trigger points. The practice is allowed only by advance practice PTs where dry needling is accepted as within a PTs scope of practice. For complete resource see reference (Dommerholt, 2006).
g. Homeopathy: Nutritional supplements, dietary monitoring, special types of exercise, and other natural approaches may be used along with “remedies.” Arnica, Bryonia, Calcarea Carbonica, Causticum, Cimicifuga (Actae Racemosa), Kalmia latifolia, ranunculus bulbosus, rhus toxicodendron, ruta graveolens are all possible remedies and are suggested by a homeopathic physicians. http://www.truestarhealth.com/Notes/2225004.html
h. Meditation: Stress has the potential to exacerbate FS symptoms and meditation, in it’s purpose to free the mind of attachments to negativity in people, things, places, beliefs, and experiences, can be very useful. The goal is to detach one’s self from the world while freeing the mind and body from all problems, relaxing/shutting the body down for a period of time, thus rejuvenating the body. Australian rheumatologist Dr. Daniel Lewis, author of “Living Well With Fibromyalgia: finding Your Balance” states, “…a regular meditation practice can produce a beneficial shift in the way we think, feel, and respond to everyday life events. Hence it is a powerful and positive epigenetic influence (Lewis).”
i. Qi Gong: The Chinese practice using breathing, relaxation, and physical movements to increase flexibility, promote blood flow, and reduce stress. At least one study showed positive results with this intervention
j. Reflexology: Reflexology is a technique involving massage to specific points on the feet and hands that correlate to specific places and organs throughout the body. The trained reflexologist determines which areas on the hands and feet to provide the therapy.
k.Tai Chi: Tai Chi Chuan is a martial art that involves a series of gentle moves combined with breathing techniques to achieve a meditative state. There are numerous Tai Chi videos that can be utilized or most YMCA’s teach it.
l. Yoga: A health practice that incorporates both physical and mental exercises which typically involve to build strength, increase endurance, and achieve deep mental and spiritual relaxation and is comprised of three main parts, postures, breathing and meditation.
This will end this weeks’ blog information. Next week I will continue to cover fibromyalgia and touch on other treatments such as: Supplements, topicals, therapies, self-care treatments, drug treatments, drugs, prescription drugs, hot and cold therapy, and vitamins and mineral injections. It will then cover suggestions for overcoming the frustrations that FS sufferers may feel related to this syndrome that is, to the untrained eye, invisible.
Until then, stay safe and stay connected to God and your support group.
Bibliography
New recommendations for fibromyalgia relief: heated pool therapy, certain medications among new treatments. (2006). Health News, http://www.accessmylibrary.com/article-1G1-157589865/new-recommendations-fibromyalgia-relief.html.
Deluze, C. B. (1992, ). Electroacupuncture in fibromyalgia: results of a controlled trial. Geneva, Switzerland: BMJ.
Dommerholt, J. (2006). Trigger point dry needling. http://www.dgs.eu.com/uploads/media/Trigger_Point_Dry_Needling.pdf
The Journal of Manual & Manipulative Therapy.
Kim, T. F. (2004). Acupuncture not effective in depressed fibromyalgia patients. (Rheumatology). Internal Medicine News, http://business.highbeam.com/4288/article-1G1-127205026/acupuncture-not-effective-depressed-fibromyalgia-patients.
Lewis, D. (n.d.). Fibromyalgia and Meditation. FMOnline, p. http://www.fmaware.org/News28b55.html?i=g6jyL5vriNaHZxABsr2ZKA..
Staff, M. C. (n.d.). Fibromyalgia symptoms or not? Understand the fibromyalgia diagnosis process. Mayo Clinic. http://www.mayoclinic.com/health/fibromyalgia-symptoms/AR00054.
Staff, N. I. (2009). Fibromyalgia, questions and answers. http://www.niams.nih.gov/Health_Info/Fibromyalgia/default.asp
National Institute of Arthritis and Musculoskeletal and Skin Diseases
