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Fibromyalgia (FM) is a condition that is characterized by widespread, generalized pain “all over” the body that does not follow any specific anatomical pathway like the course of a nerve, muscle, or blood vessel. It is often diagnosed only after all other conditions have been eliminated by using various testing approaches such as blood tests, x-ray, CT or MRI Scans, and others. Controversy exists between health care providers (HCP’s) as some believe that FM either doesn’t exist at all or if it does, it’s grossly over diagnosed while others feel most patients have some form or degree of FM. Because of this common split in beliefs, patients may be treated poorly by those non-believing HCP’s, which often alienates them from seeking further care for FM.
Recent literature suggests FM is disorder of “central pain processing” or, a specific situation where the pain threshold (the point where pain is felt) is reached sooner than what is normal. Fibromyalgia has been classified into 2 separate groups – primary and secondary FM. Primary FM is diagnosed when no known cause can be identified while secondary FM is related to a specific cause such as a disease or condition. Conditions that have been reportedly associated with FM include irritable bowel syndrome (IBS), TMJ (jaw disorders), chronic low back pain, and headaches. There are genetic as well as environmental factors associated with FM. Researchers have found that there is a strong familial component with 1st degree relatives where an 8 fold greater risk of developing FM compared to the general population exists. These people are also more likely to have one of the other associated conditions previously mentioned (IBS, TMJ, headaches). Environmental factors can lead to FM in 5-10% of the cases. Some of these include physical trauma such as car accidents, following infections such as parvovirus, Epstein-Barr virus, and Lyme disease. Psychological stress, hormonal alterations such as hypothyroid, drug side effects, vaccination reactions and certain catastrophic events such as war are included in the “environmental factors” category. Gender differences include woman being 2-3 times more likely to suffer from FM than men.
So, what are the treatment options for FM? Typically, if you go to a medical doctor, you can expect various forms of drug therapy – possibilities include anti-depressants, anti-anxiety meds, and sleep aids but with these, watch out for grogginess, side effects and some habit forming/dependency problems. Pain killers or analgesics – opioides are NOT appropriate but often prescribed and narcotics can also be habit forming. Tylenol is perhaps the safest but is not very effective. Anti-inflammatory include aspirin, ibuprofen but watch for stomach irritation and blood thinning problems. Dr. Christopher Morris, MD reports that drug treatments for FM have, “…very limited success in providing significant improvement in most patients.” He recommends behavior modification for sleep improvement, exercise (walking, water exercises, strength training, yoga, tai chi, Qi Gong), as well as cognitive behavioral therapy, massage therapy, chiropractic, acupuncture, biofeedback, hypnosis, and dietary modification. Examples of dietary changes include avoiding foods with certain additives including MSG (monosodium glutamate) and aspartame where in one study, “complete resolution” of FM symptoms was reported.
Patients with FM NEED a “quarterback” to guide them in their management of FM and chiropractic is the PERFECT choice as many of these holistic approaches are utilized or can be coordinated through our office.
“…I was told by my doctor that I have fibromyalgia and I don’t know what to do. I’ve noticed that over the last couple of years that I’ve been having a progressively harder time doing simple tasks that I used to take for granted like folding laundry, ironing, cooking, cutting up vegetables, sewing, driving a car, holding a book, and even sleeping has become very challenging. I have to take many breaks while I’m doing these tasks and even take a nap in the middle of the day. I never used to have to do that! My family doctor initially seemed interested in helping me. He listened to me, took some blood, took some x-rays, and then said ‘….everything looks fine.’ His conclusion was that I must have fibromyalgia – I’ve never even heard of that! He prescribed many different drugs. One was to help me sleep but all it did was knock me out to the point where I couldn’t get up in the morning and felt so groggy that I couldn’t function. Then, he tried this other one and I felt like I wanted to crawl out of my skin! I’ve tried 3 or 4 different drugs and the side effects were all worse than what I’m dealing with, without the drugs. He finally concluded, ‘…you’ll just have to learn how to live with it.’ Well, thank you very much, doctor! Tell me HOW to do that?”
That feeling of helplessness and not knowing what to do next is a common complaint among fibromyalgia (FM) sufferers and the fact is, many patients with FM simply CAN’T just “…learn to live with it,” and need guidance.
One such patient recently presented in such situation. After a detailed history, the chiropractor checked her vital signs, performed a physical exam that included observation, palpation, range of motion, physical performance testing, orthopedic and neurological tests and then sat down to discuss the findings and what specific things chiropractic could offer her. The chiropractor laid out a treatment that consisted of the following:
Her doctor reports she is doing very well, independent of regular doctor visits, and is for the first time in a long time, happy with her ability to control her FM condition.
Do you wake up feeling tired, washed out, and dragged down? Do you have generalized pain throughout your body that doesn’t seem to respond to anything you’ve tried? Do you wake up multiple times a night and fight getting back to sleep? These are classic symptoms of fibromyalgia (FM). However, when caught early and treated appropriately, FM can resolve or at least be controlled. Chiropractic care and management of FM is very effective and is becoming increasingly popular among FM sufferers. The goal of managing FM is to return you to a productive, enjoyable lifestyle allowing you to function and perform all of your desired activities.
Chiropractic care is the most popular and sought after form of alternative care or complementary medicine as 20% of American men and women utilize chiropractic care at some point in their lives. Of all the health care options, few have been found to be as satisfying to their patients as chiropractic with 80% of those seeking chiropractic treatment reporting significant pain relief, better functioning and an increased sense of wellbeing. Still, many ask questions such as, what is the science behind chiropractic and, what exactly does a chiropractor do?
The original hypothesis or theory of chiropractic that led to its founding in 1895 is that skeletal or bone misalignments cause nerve interference resulting in pain, loss of function, and a host of other symptoms related to the nervous system. The entire body is connected through bones, joints, muscles, ligaments, tendons, with their supporting circulatory or blood flow system and nervous system. When the skeletal structure is in good alignment, the body can handle the many stresses and challenges we all face on a daily basis. When there is a breakdown in this system, symptoms manifest and when left untreated, these symptoms can develop into chronic pain, including conditions such as fibromyalgia. Chiropractors focus to reduce pain and the many other symptoms by correcting the imbalances in the skeletal system with the objective of reducing nervous system dysfunction. Many of the techniques utilized in chiropractic care include manipulation of not only the bony structures, but also the muscles, tendons, and ligaments through various forms of manual or hands-on therapy, stretching, posture correction methods, exercise, lifestyle modification recommendations including diet and nutritional management, and activity modifications. Chiropractic care also includes discussions and instructions for modifying methods of performing tasks including bending, lifting, pulling, pushing in both at work and home activities. Work station modifications are also thoroughly investigated, especially when symptoms are consistently worse after the work day.
Patients with fibromyalgia classically have generalized pain and tender spots throughout their body and often present with back pain, neck pain, headaches, as well as arm and/or leg pain. Chiropractic care can effectively reduce the pain associated with FM by reducing bony misalignments, restoring muscle tone, and improving posture. Proper exercise training has been found to be very important in maintaining long-term control of FM and is included in the management of FM. Diet and nutritional counseling may also be beneficial. Research has been very supportive of chiropractic care for patients suffering from FM.
Fibromyalgia (FM) is one of the most commonly diagnosed soft tissue conditions in most branches of health care, including chiropractic. A paper was recently published with the primary purpose to review the existing literature / published research to determine what aspects of chiropractic treatment are the most commonly used and, to determine the quality of those treatment approaches. The emphasis of the study was to look at non-drug, conservative forms of therapy, rather than medication based approaches.
Commonly utilized chiropractic treatment options found to be beneficial include massage, muscle strengthening exercises, acupuncture, spinal manipulation, movement/body awareness, vitamins, herbs, and dietary modification. Cognitive behavioral therapy, not typically a chiropractic specific form of care, was also reported to be of significant benefit, as well as aerobic exercise. This study places chiropractic in a very favorable position in the management of FM.
Chiropractic is unique in that it encompasses many non-drug, non-surgical forms of treatment, making it appealing to many who do not want to risk the chances of drug related side effects and post-surgical complications. Patients with FM require a multi-dimensional treatment approach and a health care provider versed in whole-body, holistic concepts is in the best position to help this population.
Fibromyalgia can be primary where the specific cause is not well understood or secondary to an underlying injury or condition. Sometimes, it is difficult to determine the exact cause as other conditions can be present and/or arise simultaneously with FM making it difficult to differentiate between primary and secondary. When other conditions are present, sometimes attending those specific conditions will improve the status of FM and focus on treatments that address all of the patient’s physical and emotional health issues yields the most patient satisfying results.
How can a spinal problem possibly contribute to your fibromyalgia symptoms? As with many disorders, especially pain, the nervous system is involved. The nervous system can get affected thorough structural changes in the spinal column. The classic one is the disk bulge producing a painful sciatic nerve. But, there are also other ways to interfere with the function of nervous system.
When viewing the neck from the side, there should be a forward curve with your head above your shoulders, not in front of them. When forward head carriage is present or when there is a reduction in this forward arch, this may cause additional strain to the upper cervical spine or spinal cord, allowing delicate nerves to be compromised. Chiropractic care should improve your posture if this forward head carriage is present.
The upper neck can also be influenced by malalignment/subluxation of the upper vertebrae, such as the atlas. This small bone supports the weight of the skull and is necessary for the great rotational range of motion of the neck.
During neck trauma, the head and neck can be put through a violent range of motion that causes the soft tissues (muscles and ligaments) to tear. Blows to the head, childhood or sports injuries and even poor sleeping posture, can cause the upper neck vertebrae to displace, injuring the soft tissues of the joint. Swelling and inflammation can also be a source of irritation to the nervous system. Scar tissue can develop after trauma, which may affect the precise movements of the upper neck.
The atlas surrounds the spinal cord and as it displaces, it can also pull or tether the spinal cord through attachments of delicate ligaments (dentate). This could cause irritation to the nervous system.
The disorders of poor posture and displaced vertebrae can be assessed through x-rays. Range of motion tests are necessary to see how your function may be affected. In some patients, fibromyalgia symptoms can improve substantially. However, most people will need a comprehensive approach that also incorporates an exercise program and nutritional or weight loss support. Chiropractic care is a natural alternative for those who wish a drug-free and non-invasive approach. It carries few risks of side effects and is balanced by the potential to help patients who also have spinal disorders contributing to their poor health.
(Most article content courtesy of Dr. B. Altadonna)