Over the past 25 years that I have been in practice there has been a slow but steady increase in the number of patients that upon entering my office relate that they have fibromyalgia also known as fibromyalgia syndrome or FMS. Some of these patients have been diagnosed by a healthcare professional and some have relied on self-diagnosis, which can be dangerous as I will discuss below. There has been a lot of controversy over FMS from is it a real entity, what exactly is wrong, how to diagnose it and to how to treat it. As a chiropractic physician the question put to me is “how can chiropractic help me with my fibromyalgia?”
Let’s first discuss a bit about what FMS is considered to be. FMS was first recognized by the American Medical Association as a diagnosis in 1987 even though it has been around for much longer than that. The name “fibromyalgia” implies pain and inflammation of the muscles and connective tissues of the body but this is an inaccurate label because there aren’t any actual problems in these particular structures, they just happen to be where the patient “feels” the pain and discomfort. On biopsy of these tissues in a patient considered to have FMS they do not show any inflammatory changes. Also, FMS symptoms do not respond well to anti-inflammatories e.g. prednisone as again these structures are themselves not inflamed. Much like having a pinched nerve in the neck or lower back that sends the pain down the arm or leg; the pain is only felt there, the problem is in the spine itself. The “problem” in FMS appears to be in the central nervous system. The problem in the central nervous system is in the area that controls the bodies sensitivity to pain. The ability to filter or dampen the nerve impulses for pain is impaired and thus stimuli that would not normally be interpreted by the body as painful are. No one knows for sure why this breakdown occurs but it is thought that this part of the central nervous system becomes “burned out” from the body dealing with significant stressful situations. This can be in the form of physical and/or emotional stress. Physical traumas such as auto accidents, which have seemingly been the trigger for some of my patients, or having to deal with stressful family or personal situations over a long period of time can be the underlying cause of this “burn out” situation in the central nervous system. Thus, FMS can be considered to be a post traumatic stress disorder or PTSD.
Patients that have FMS usually have a wide range of symptoms the most common of which are- hurt all over, insomnia, fatigue, depression and anxiety. Many also complain of difficulties with concentration and memory and may experience what many refer to as “fibrofog”. The list of symptoms that have been associated with FMS can be quite lengthy and can almost seem like any symptom you have can be attributed to FMS. Herein lies the biggest problem with a fibromyalgia diagnosis. Because that list of symptoms is so wide ranging someone who has been labeled as having FMS will just assume that any symptom they have is due to it. This can be dangerous as those symptoms may well be from some other underlying illness that is now going to be ignored as the patient assumes that they already know the reason for it. Even the more common symptoms associated with FMS may well be from some other illness or condition. Thus a diagnosis of FMS is usually arrived at through the process of elimination of all other possible causes of the patient’s problems. Other conditions that could give similar symptoms include- hypothyroidism, anemia, Lyme disease, rheumatoid arthritis, hormonal imbalances, allergies as well as numerous other illnesses. That is why it is extremely important to rule out other conditions first as they may be treatable and would therefore go untreated ultimately leading to other health problems if it is just lumped in as a “fibro” symptom. Thus, the person who self diagnoses as having FMS, is doing the worst injustice to themselves as they may have some other treatable condition that is just going to worsen over time. Once all other possible causes are eliminated then a diagnosis of FMS can be considered. The standard accepted criteria for diagnosing FMS, after the elimination process, is having widespread pain in all four quadrants of the body for a minimum of three months and must also have pain in at least 11 of 18 tender points in specific body locations on the application of pressure.
Now, lets get back to the original question, “how can chiropractic help me with my fibromyalgia?” First of all, as stated above, a patient should not just assume that any symptom they have is due to FMS. I have many patients say “there is nothing you can do for me my pain is from fibromyalgia”. Even though you may have FMS you are still entitled to good old-fashioned neck and back pain that may be from sprain/strains, disc related problems or even arthritis. All of which have nothing to do with FMS and can most certainly be treated in my office. They may also have an underlying carpal tunnel syndrome, tennis elbow, bursitis, and many other pain producing conditions not related to FMS that also respond well to chiropractic care. If it is determined that the problems with which the patient presents are indeed related to fibromyalgia and not from other causes then here is what I can do to help them. First of all, as a chiropractor, my number one form of treatment is spinal or extremity manipulation. Manipulations help to restore mobility to joints that may have been lost or reduced due to the tightness of the surrounding muscles as a response to the underlying pain feelings that the patient has. All joints are designed to move and to lose even some of that mobility can cause them to experience discomfort which just adds to that experienced from FMS. I usually also recommend 5-Hydroxytryptophan to help with sleep. Loss of sleep from FMS is the proverbial chicken or the egg scenario. It’s not really known if the lack of good sleep is a trigger for FMS or if having FMS affects the patient’s sleep. Regardless of which comes first to help the patient to have improved restorative sleep is certainly a plus. Also, along the lines of nutrition I recommend taking Magnesium and Malic acid as well as Omega-3 fatty acids all of which has shown some promise for relieving FMS symptoms. Further, a change in diet shifting from processed foods to eating whole foods and preferably organic (without additives, pesticides, hormones or antibiotics) is helpful not only for FMS but for your general overall health. Exercise is also important. Typically, a lot of physical exercise can be aggravating to a FMS patient so I usually recommend low impact type exercises e.g. water exercises, Pilates or especially Yoga which is very good for helping the joints of the body to keep mobile.
In summary, you always want to make sure that you have eliminated all other possible causes of your symptoms before accepting a diagnosis of FMS. Then, once it is established that you have true fibromyalgia, then it would behoove you to seek out natural treatment alternatives such as chiropractic. All you really have to lose is your pain.
David D. Godwin, D.C.
Salisbury Chiropractic
www.salisburychiropractic.us
Salisbury, NC
704-633-9335
