Fibromyalgia

Fibromyalgia syndrome (FMS) is a chronic disorder associated with widespread muscle and soft tissue pain, tenderness, and fatigue. A person with FMS will experience pain when up to 18 specific areas called tender points are pressed.

Who is affected?

• Approximately 4 million people in the United States have fibromyalgia
• Women are affected far more then men (although men & children can also get FMS)
• FMS can occur at any age; however, the chances of getting this disorder increase with age Those who are most likely to be diagnosed include:
• Women in their mid-30s to late 50s
• People who also have an autoimmune disorder, such as lupus or rheumatoid arthritis
• Those who have recently had an infectious disease, such as Lyme disease

Tender Points

There are 9 pairs of tender points. Each pair has one point on each side of the body, for a total of 18 points. These pairs are located:

1. Just behind the ear where the neck muscles attach to the base of the skull.
2. About halfway between the base of the neck and the tip of the shoulder.
3. At the spot where the back muscles attach to the shoulder blade, just below the 2nd tender point.
4. On the front of the neck above the collarbone.
5. Just to the right and left of the breastbone (sternum) about 2 in. (5.08 cm) below the collarbone.
6. On each forearm just below and to the outside of the crease of the elbow.
7. Just above and to the outer right and left of each buttock.
8. On the outer upper leg just behind the bony part of the hip (this point is easier to find when standing).
9. On the inside of each knee.

To clearly diagnose fibromyalgia, a person must have pain at 11 or more of the 18 tender points. In practice, however, many people with fibromyalgia have less than 11 tender points.

Symptoms

• pain severe enough to disrupt daily work and activities
• can sometimes feel like the flu
• body aches, tiredness, and intestinal discomfort, such as diarrhea
• pain especially bothersome at night, waking you from sleep, and stiffness in the morning
• symptoms may last from days to months
• the initial site of your pain may expand if symptoms last a long time
• long periods when symptoms become worse (especially following physical or emotional stress) and periods without any symptoms
• problems sleeping
• waking up feeling tired
• fatigue that interferes with daily living activities
• morning stiffness
• anxiety or depression

Less common symptoms include:

• headache
• difficulty concentrating
• constipation or diarrhea
• Raynaud's syndrome (affects the small blood vessels of the skin; an attack affects the hands and fingers (commonly) or feet, nose or ears, turning them pale, white, cold, numb, and or swollen)
• muscle pain that is made worse by cold or damp weather, poor sleep, fatigue, stress, overexertion and anxiety
• the skin may also be ultrasensitive, tingling, numb, or "pins and needles"

FMS is not a psychological condition, although it has some psychological components. As with many conditions that cause chronic pain, anxiety and depression are common in people with fibromyalgia and may make symptoms worse.

Fibromyalgia can be difficult to diagnose because its symptoms are similar to many other disorders and diseases. FMS sometimes occurs with other muscle or joint diseases or chronic pain conditions, further complicating the diagnosis. There are no lab tests to diagnose FMS. It is usually diagnosed only after other conditions have been ruled out. A person with widespread pain (above and below the waist and on both sides of the body) for at least 3 months with at least 11 of the 18 specific tender points is generally considered a viable candidate.

Cause

The cause of fibromyalgia is not known. Patients experience pain in response to stimuli that are not normally perceived as painful. Researchers have found elevated levels of a nerve chemical signal, called substance P, and nerve growth factor in the spinal fluid of FMS patients. The brain nerve chemical serotonin is also relatively low in these patients. Also, patients with fibromyalgia have impaired non-Rapid-Eye-Movement, or non-REM, sleep phase (which likely explains the common feature of waking up fatigued and unrefreshed in these patients). The onset of fibromyalgia has been associated with psychological distress, trauma and infection.

Other Possible Causes of Fibromyalgia-like Symptoms

The symptoms of fibromyalgia (primarily chronic fatigue and chronic pain) can result from a variety of conditions other than FMS. It is important to eliminate all other possible causes of your symptoms before accepting the diagnosis of fibromyalgia. Other possible causes include:

• Adrenal insufficiency caused by the overuse of stimulants or excessive stress
• Allergies
• Anemia (low levels of iron or vitamin B12)
• Candidiasis (which is often misdiagnosed)
• Cardiovascular causes
• Chronic ill-health (many chronic diseases have fatigue and chronic pain as symptoms)
• Depression
• Diabetes
• Headaches
• Hypoglycemia (low blood sugar)
• Infections
• Nutritional deficiency
• Obesity
• Premenstrual Syndrome (the connection will be obvious if it occurs at the same time of the monthly cycle)
• Thyroid problems
• Toxicity

Treatment

While there is no specific cure for fibromyalgia, several treatment options are available to anyone suffering from FMS. Taking an active role in your treatment is very important to managing your condition.

1. Improving your sleep patterns.
   • Practice good sleeping habits. Go to bed only when you are sleepy, and get up at the same time each day, whether you are rested or not.
   • If you lie awake in bed for longer than 15 minutes, get up, leave the bedroom, and do something quiet (read or listen to music) until you are sleepy again.
   • Avoid alcohol, caffeine, and tobacco for 4 to 6 hours or longer before bedtime. These can lead to poor sleep.
   • Keep your bedroom at a comfortable temperature.
   • Make sure your mattress provides good support. Use a neck support pillow to stabilize your head and neck during sleep.
   • Eliminate or block out all sound and light that may disturb your sleep.
   • Get regular exercise. However, avoid vigorous exercise for at least 2 hours before bedtime because it may keep you awake.
2. Exercise therapy to help with muscle aches and stiffness.

   A mild to moderate exercise program is appropriate for most people with this condition. Regular exercise will strengthen your muscles and reduce the risk of tiny injuries to the muscles, and may also help you sleep better.

   Low-impact activities such as walking, biking or swimming are best. Stretching exercise and conditioning exercises (such as low-impact aerobics) are important for fibromyalgia.

   Tips:

   • Start slowly. Many people with fibromyalgia have been inactive for a long time because of fatigue and pain and should not start a vigorous exercise program.
     • If 3 to 5 minutes of activity are all you can manage at first, just do that.
     • Increase by 1 minute per session every 3 to 4 days until you can exercise for 20 to 30 minutes.
     • Try to exercise 3 to 4 times a week.
   • When you can comfortably exercise for 30 minutes, increase the intensity slowly by pedaling or swimming harder or by walking faster for the same period of time. Try to increase your exercise program gradually, eventually working out 5 to 7 days per week.
   • Stretch before and after exercising to improve flexibility, maintain good posture, and prevent injury. Stretch slowly and gently. Do not bounce, but maintain a gentle pull on the muscle.
   • When you have a flare-up of your symptoms, do not stop exercising. Instead, cut back slightly. Try to get back to your regular routine as soon as possible so that you don't lose any of the benefits you've gained.
3. Relieving the pain.

   Nonprescription pain relievers are not very helpful for people with fibromyalgia. Small doses of acetaminophen (such as Tylenol), aspirin, ibuprofen (such as Advil or Motrin), naproxen sodium (such as Aleve), or ketoprofen (such as Orudis KT) may offer short-term relief of muscle pain when your symptoms flare up. Daily long-term use does not seem to be effective.

   Nondrug methods of relieving pain may be helpful. These can include:

   • Applying heating pads or taking warm baths or showers.
   • Using a cold pack on the painful area. Do not apply a cold pack for longer than 20 minutes at a time.
   • Gentle massage of painful muscles.
   • Regular exercise to help strengthen muscles, which will make them less likely to be injured
4. Reducing stress.

   Many people with fibromyalgia find that stress can make their symptoms worse. Reducing stress may help reduce your pain.

   • Identify stressful situations at home and at work that seem to trigger your symptoms. Work on ways to make those situations less stressful or to make them occur less frequently.
   • Cancel unnecessary activities that cause stress.
   • Set priorities and learn to cope with your physical limitations. If you can't do an activity because of pain, find a less painful way to do it or try a different activity.
   • Think about seeing a counselor if you are unable to deal with severe stress or need help finding ways to cope with stressful situations.
   • Learn to use stress reduction, visualization, meditation, or relaxation techniques.
   • Join a fibromyalgia support group.
5. Medication

   Medications do not cure fibromyalgia. However, some medications may help improve fibromyalgia symptoms, especially muscle pain and frequent waking during the night.

   Antidepressants and pain relievers are often used to treat symptoms of fibromyalgia.

   Often, medications may be combined (such as fluoxetine and amitriptyline) for the treatment of symptoms of pain and sleep disruptions.

   Medications that may provide pain relief and improve sleep:

   • Tricyclic antidepressants (can be more effective when taken with selective serotonin reuptake inhibitors, also called SSRIs, such as fluoxetine (for example, Prozac), paroxetine (Paxil), or sertraline (Zoloft)
   • cyclobenzaprine (Flexeril), a muscle relaxant
   • nonprescription pain relievers, such as acetaminophen (for example, Tylenol), or nonsteriodal anti-inflammatory drugs(NSAIDs, such as ibuprofen or aspirin) may reduce severe pain from flare-ups

   Keep in mind that medications are not very useful for the long-term treatment of fibromyalgia. They may break the cycle of pain and sleep problems when symptoms flare-up, but should be part of a larger treatment plan including exercise and other types of treatment. Also, nonprescription pain relievers are not very helpful in treating day-to-day symptoms and should be monitored as they may harm your stomach, kidneys and liver. SSRIs may cause nausea, loss of appetite, diarrhea, anxiety, loss of sexual desire/ability and headaches. Often, even when medical treatment does work, many people find the side effects of these medications unacceptable.

6. Dietary Supplements & Vitamins

   A healthy diet is crucial to building the immune system and coping with fibromyalgia. Concentrate on high-nutrient, high-protein, complex carbohydrate foods-vegetables, grains, beans, fish, and poultry (avoid mercury toxins in high and antibiotics in poultry). Try to drink eight to ten glasses of water a day.

   Dietary Recommendations:

   Supplement	Benefit	Naturally Occurring in…	Recommended Dosage
   Magnesium	Important for muscle relaxation	Wild rice, dark leafy greens, spinach, avocado, barley, almonds, buckwheat, sunflower seeds, oysters, pumpkin seeds
   Vitamin C	Boost immunity & increases levels of norepinephrine (helping you to concentrate)
   Trytophan (an essential amino acid)		Poultry, fish, eggs, dairy, nuts, seeds and soybeans
   Complex Carbohydrates		Whole grains, starchy vegetables (corn, potatoes, sweet potatoes), peanuts, nuts, avocado, banana, melons, figs, dates
   Supplement	Benefit	Additional Info.	Recommended Dosage
   coenzyme Q10	Increases energy to muscle cells; best when used with NADH	Naturally produced by the body. Abundant in high-energy-demanding cells, like the heart.	50 mg twice a day Like most supplements, use caution if you are pregnant or breast-feeding (the effects of many supplements have not been tested on these groups yet)
   magnesium/malic acid	When used with St. John’s wort and 5-HTP, they can raise serotonin levels and pain tolerance.	Critical for energy production & nerve function. Promotes muscle relaxation.	150-250 mg of magnesium and 400-800 mg of malic acid 3 times/day Consult your doctor if you have kidney or heart disease.
   St. John’s wort	An effective anti-depressant, especially when used with 5-HTP		450 mg twice a day or 300 mg 3 times/day with food
   5-HTP (5-hydroxytryptophan)	Give the St. John’s wort/5-HTP at least 6 weeks to see results.	Increases the body’s production of serotonin.	50 mg 2-3 times a day; if no change after 3 weeks, increase to 100mg 2-3 times/day. If you experience drowsiness, take it at bedtime initially.

    

   Supplement	Benefit	Additional Info.	Recommended Dosage
   DHEA	Bringing the often-depleted levels of DHEA back to normal may increase energy.	This adrenal hormone can be measured by a blood test.	5mg (women) 25 mg (men) each morning
   GABA (gamma-aminobutyric acid)	Promotes relaxation and sleep. Can play a role in alleviating chronic pain.	An amino acid produced in the brain that acts as a neurotransmitter.	250-500 mg 3 times a day, as needed
   NADH (nicotinamide adenine dinucleotide)	Increases energy to muscle cells; use with coenzyme Q10. Add the herb kava if muscles become tense.	A coenzyme made from vitamin B2 or niacin. Stimulates the production of ATP.	2.5 mg twice a day for 14 days then 5 mg twice a day Take one month off after four month of taking NADH.
   phosphatidylserine (PS)	Improves poor concentration and short-term memory.	An amino acid-like substance	100 mg twice a day
   rhodiola	An alternative to Siberian ginseng		200-400 mg in the morning on an empty stomach
   SAMe	An anti-depressant	Note: an expensive and highly publicized alternative	400-600mg twice a day
   Siberian ginseng	Improves overall energy levels.	Favorably affect the adrenal glands. Believed to boost the body’s capacity to handle physical stresses.	200-400 mg each morning, on an empty stomach. Don’t take if you have high blood pressure, or are pregnant or menstruating. Can cause irritability and nervousness.

   
   

   Tips

   • Eat smaller, more frequent meals - it is important to make sure that your aching muscles are getting enough nutrients - eat five or six small meals through the day to provide a steady supply of protein and carbohydrates to your muscles.
   • Try a warm glass of milk along with a piece of toast or some other complex carbohydrate right before bed may help with sleep.
   • cut back on caffeine, alcohol and sugar (they take away more energy than they give)
   • Try a food elimination diet - many FMS sufferers have noticed that eating certain foods (often dairy, corn or wheat) aggravate the pain and increase the fatigue.
7. Homeopathic Remedies

   To follow are just a few of the possible remedies for fibromyalgia. Homeopathy matches the symptoms to the remedy to find the right solution. Consulting a professional practitioner is recommended to ensure a safe and effective treatment.

   • Arnica - for muscles that feel bruised, sore and overused
   • Bryonia - even the slightest motion aggravates the pain, warmth makes things worse
   • Calcarea carbonica - muscle soreness and weakness that are worse from exertion and from getting cold
   • Causticum - soreness, weakness and stiffness worse from being cold and from overuse -stiff forearms -worse when the weather is dry
   • Cimicifuga - soreness and stiffness accompanied by shooting pains
8. Other Forms of Treatment

   A variety of other treatments have been used for conditions that cause chronic pain. Studies show that certain relaxation techniques may be effective in relieving pain caused by fibromyalgia, including:

   • Biofeedback
     • a method of consciously controlling a body function that is normally regular automatically by the body (such as skin temperature, muscle tension, heart rate or blood pressure) and can be used to control problems related to stress, blood flow, headaches and chronic pain
     • when you are first learning biofeedback, sensors are attached to your body for monitoring purposes and a biofeedback therapist teaches you physical and mental exercises to help you control the function
   • Acupuncture - often used to relieve pain
   • Meditation - to reduce stress (Cognitive-behavioral therapy to help change unhealthy lifestyle patterns which may be contributing to illness)
   • Counseling - to help deal with chronic pain
   • Transcutaneous Electrical Nerve Stimulation (TENS) - electrical current delivered through electrodes to the skin for pain relief
   • Physical Therapy - treatment to decrease pain and improve function by physical or mechanical means, such as through exercise, heat, or electrical current
   • Message Therapy
   • Injection of trigger points with a numbing drug (anesthetic)
   • Reflexology, which is the practice of applying pressure to points on the body that benefit other parts of the body.
9. Chiropractic Care

   If you suffer from fibromyalgia, a chiropractic spinal check up is one of the best things you can do. Chiropractic's safe, gentle methods have helped millions of headache sufferers over the years. Doctors of chiropractic free your body from the vertebral subluxation complex that has the power to destroy your health. When freed of subluxations, your body works more efficiently to use its natural energies to heal itself.

   Chiropractic is not only about the well being of your spine, but of your entire body--your overall wellness.

   Chiropractic care is a commitment to yourself!

   It is a commitment to getting and staying healthy!

   If you are suffering with fibromyalgia, it is time to take back your life. Learn more about your condition and treatments available to you. Come in for a complementary consultation with Dr Jeffrey Needham and discuss your future!

   References

   Remedyfind. (2000-2005). Fibromyalgia. Retrieved from: http://remedyfind.com/hc-Fibromyalgia.asp.

   MayoClinic.com. (1998-2005). Signs and symptoms of stress: Prompt recognition is crucial. Retrieved from: http://www.mayoclinic.com/invoke.cfm?objectid=96E57CAC-F3E9-468B-8824304CCE012FD1

   NationalFibromyalgiaAssociation. (1999). Managing Your Fibromyalgia. Retrieved from: http://fmaware.org/patient/coping/managingfm.htm.

   ImmuneSupport.com. (2004). Fibromyalgia Information. Retrieved from: http://fibromyalgia.ncf.ca.

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