Fibromyalgia. 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 (or mistreated) as fibromyalgia. While I was in chiropractic college, it seemed like the diagnosis, treatment, and findings were inconsistent in the textbooks. 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 could possibly have 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 "widespread pain that is generated in the mind"...AKA "It's in your head"....very empathetic, huh?) These patients are often pushed from doctor to doctor, subjected to a shotgun approach of multiple medications to see if they can find enough relief to keep them quiet. They are often told that they are just depressed or stressed and told to seek counseling. Most fibromyalgia patients I meet are oftened stressed and depressed BECAUSE of the symptoms 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 is a syndrome 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 related to Chronic Fatigue Syndrome because for many the extreme fatigue is the most prevalent symptom. 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 also referred to this condition as the “yuppie flu,” a term 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. How’s that for compassion?
Regardless of the incredible misconceptions surrounding this condition, there has been some very important research done about fibromyalgia and its origins, although it is not widely publicized. Fibromyalgia has been proven to be the direct result of a dysfunctional CENTRAL nervous system, which is the "CPU" of the human body, coordinating the function of every cell, tissue, and organ (which is why sufferers also exhibit digestive, endocrine, and cognitive symptoms in addition to pain). 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 fibromyalgia was the result of individual nerves 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. A research article published in the Journal of Nuclear Medicine demonstrated that patients with fibromyalgia had significantly disturbed metabolic processes and blow flow in the brain: Fibromyalgia Brain Image Study. This proves that fibromyalgia is NOT just a pain problem, but a central nervous system processing problem. We'll get to why the CNS is not functioning properly in a bit.
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-depression, and anti-anxiety medications, to name a few. Recently, so-called “fibromyalgia medications” have come in vogue. These medications are not new. They are actually anti-seizure medications that have been recently re-branded and re-packaged to sell to the ever-growing fibromyalgia patients because these meds 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 disease, 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, fatigue and sleep disorders have been reported. 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!
Although I obviously am not a fan of the "fibromyalgia medications," I am not throwing the baby out with the bathwater, so to speak. Some of my patients continue to utilize medications on an as-needed basis to get them through the bad days. Fortunately, my patients will find that after starting upper cervical chiropractic care, the good days start outnumbering the bad, and the really bad days are few and far between. Part of the goal of treatment is to limit the dependency on pain medications as a whole. However, I 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 the weening process. In most cases, a good medical physician is all too happy to see their patients decrease their dependency on pain medications.
What about exercise? In general, exercise is a crucial part of any healthy lifestyle, but fibromyalgia patients suffer from a phenomenon called “exercise intolerance” so exercise must be handled properly. They often have flare ups of extreme pain and fatigue after activity, making vigorous exercise next to impossible. The best exercises for fibromyalgia patients are low impact activities, such as walking, light yoga, swimming and water aerobics. 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 or trainer that is well versed in fibromyalgia is advised to avoid overtraining and ensure proper muscle balance.
Nutrition is absolutely huge for fibromyalgia sufferers. I cannot stress this enough. Diet modifications are an absolute must for fibromyalgia patients. There are many factors in the Standard American Diet (SAD) that cause chronic inflammation and autoimmune responses in the body, which can be a huge factor in the symptomatology of fibromyalgia sufferers. Everyone is different, but there are some basic "rules of the road." On the whole, too much sugar in the diet has a huge impact on the symptoms of fibromyalgia. Empty calories in the form of processed sugars (table sugar, high fructose corn syrup, flour, etc.) are not good for ANYBODY, but they cause a lot of problems in fibromyalgia patients. The ratio of Omega 6 to Omega 3 fatty acids in the diet is another factor because it promotes inflammation. You can read more about that here. Food allergies are also cause for concern in fibromyalgia patients. Dairy products, gluten, and other foods can contain anti-nutritents which can lead to an autoimmune response. Other foods to avoid include artificial sweeteners (aspartame), caffeine, yeast, and really any processed food. An elimination diet for 30 days will tell you whether or not these foods are a problem. "Oh, my God! What can I eat?" Anything that grew or lived and hasn't been altered with any 14-syllable chemicals would be a great place to start! Namely, fruits, vegetables, nuts, seeds, and animal products (free range or grass fed is preferable) are good to go. Try it for 30 days and then you can add things like dairy and legumes and see if they cause any problems. Adopting an "ancestral diet" will naturally limit your intake of "franken-foods" and you can learn more about these diet approaches from www.marksdailyapple.com or www.robbwolf.com. These diets are referred to as a "paleo" or "primal diet" because they are based on what human beings were designed to eat, only including whole foods. However, if you have any mechanical dysfunction in the body, no dietary change can change that. For that, you need some bodywork, which is where we're going next.
Where Does Chiropractic Come In?
Research has shown that fibromyalgia patients have elevated nitric oxide (NO) levels in their bloodstream. Nitric oxide levels are also increased in individuals who have sustained a physical trauma, primarily to the central nervous system (yup, the CNS keeps popping up, doesn't it?). Studies on fibromyalgia patients have also uncovered a link between fibromyalgia patients and a history of previous trauma, especially to the (drum roll please).....central nervous system! Because of this, many patients have sought out chiropractic care for help with the symptoms of fibromyalgia since we have found our niche in finding and correcting nervous system dysfunction. Misalignments of the spine cause irritation and dysfunction in the nervous system, resulting in pain, muscle tightness, and diminished range of motion, etc. This has been well established, however many fibromyalgia sufferers who start their diagnosis/treatment journey start out in the medical system and never make it out of the constant loop of pills and more pills.
A recent seminar I attended showed an amazing research study with pre and post MRIs that demonstrated diminished blood and cerebrospinal fluid flow to the brain and spinal cord in patients who had sustained upper cervical (C1) misalignments in whiplash injuries. This research is currently in review and expected to be published this year in a leading medical journal. In the study, the patients received specific adjustments to the Atlas (C1) vertebrae, using the Atlas Orthogonal chiropractic protocol. The patients' blood flow was restored and of course their symptoms improved, which ranged from neck and back pain, extremity pain, and headaches, etc. So if we KNOW that fibromyalgia is A CENTRAL NERVOUS system issue, and we KNOW that upper cervical chiropractic care is successful in relieving nervous system dysfunction, it would stand to reason that upper cervical chiropractic care should be the FIRST intervention in the management of fibromyalgia case, since it is free of harmful side effects. Proper diet will also help keep inflammation down and aid in the healing process. Drugs and surgery should be an absolute LAST resort.
We have seen great results with patients suffering from fibromyalgia by restoring the proper alignment of the Atlas (C1) vertebrae by using the Atlas Orthogonal method. The Atlas Orthogonal method is especially suited to fibromyalgia patients because it is very gentle, which is important because most FM patients are unable to tolerate more aggressive treatments.
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 (I saw one last night during the NFL championship game), our message is not getting out there. However, there are some great case studies that have gotten some publicity and given people hope.
One great case is the one of Brig. General Becky Halstead, the first female general in the U.S. Army to command in Iraq, who suffered from fibromyalgia during her service. 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, now that the armed forces have been integrating chiropractic into the health care program for soldiers. “The adjustments and nutritional advice I received from my chiropractor helped in relieving the fibromyalgia and made me feel better on a day-to-day basis.” Since finding success through chiropractic care, General Halstead has lead the charge as an advocate ensuring that chiropractic care establishes a larger presence in the overall healthcare program of our nation's service men and women.
We have seen some incredible results with fibromyalgia in our own practice. This depends on the patients’ own circumstances and overall healthcare picture, of course. By and large, if we can get the patient's spine stable and relieve the extra stress on their nervous system, they absolutely do better while under our care. Just like any condition, the earlier we can get to the problem, the better.