Dr. Anderson's Guide to Treating Fibromyalgia
Introduction to Fibromyalgia
Fibromyalgia is a fairly common syndrome characterized by symptoms such as muscle pain, painful areas of the body called tender points, and fatigue.
The overall extent and nature of symptoms vary widely from person to person, and the symptoms may be chronic, or they may come and go over time, sometimes making it challenging to get an accurate diagnosis.
The term fibromyalgia stems from the Latin “fibra,” for fibrous tissue, the Greek words “mys” for muscle, and “algia” for pain. Before the 1980s, the condition was called fibrositis.
Fibromyalgia does not harm organs and is almost never life-threatening, though it can significantly impact one's quality of life. The focus of treatment is to manage the pain and symptoms.
Fibromyalgia is a Rheumatic Condition
Fibromyalgia shares some symptoms with arthritis, including chronic pain and fatigue. Like arthritis, it is considered a rheumatic condition because it has an impact on the muscles, joints, and bones. The condition, however, is different from chronic pain and arthritis in important ways such as:
Fibromyalgia does not damage joints or muscles, and inflammation does not play a significant role, though many of the tender points are near the joints.
There are no outward signs of inflammation in adults. Children may experience some brief swelling.
Fibromyalgia is not a degenerative condition. Patients’ symptoms may improve following a proper diagnosis and treatment.
Rheumatologists often treat fibromyalgia, but many people also see internists, family practice physicians or other qualified health professionals to manage their condition.
Due to the range of symptoms associated with fibromyalgia, an interdisciplinary health care team is generally beneficial. In addition to the main treating physician, who is usually a rheumatologist, a physical therapist, chiropractor, neurologist, pain specialist, physiatrist, and psychologist or psychiatrist may also be involved.
The Cause of Fibromyalgia Is Unknown
When an individual has fibromyalgia, the brain overreacts to pain signals, intensifying feelings of pain in different parts of the body. It is not known what sets off this reaction, though in some cases it appears to be tied to a stressful or traumatic event, illness, injury, or another disease. The condition runs in families, but a specific gene for fibromyalgia has not been found.
Fibromyalgia is More Common in Women
According to the American College of Rheumatology, it is estimated that about 2% to 4% of adults have fibromyalgia. About 80% to 90% of people with fibromyalgia are women, typically between the ages of 40 and 75, and the symptoms tend to be more severe in women.
In recent years, more men have been diagnosed than in the past, possibly as a result in shifts of the diagnostic criteria beginning in 2010. In children, the condition is most often diagnosed in adolescence and is known as juvenile-onset fibromyalgia.
Under-diagnosis of Fibromyalgia is a major concern. It is believed that up to 75 percent of those with fibromyalgia have not been diagnosed.
Symptoms of Fibromyalgia
Fibromyalgia symptoms typically intensify, or flare, periodically. These flares can be unpredictable- what was an invigorating walk one day could be excruciatingly painful the next. Symptoms may ease considerably or even disappear for days, months, or longer, only to re-appear again later.
The number and type of fibromyalgia symptoms vary with the individual, but chronic pain and stiffness, fatigue, sleep problems, and cognitive impairment are common.
Musculoskeletal pain. The body pain can range from a dull ache to a burning or shooting pain, and parts of the body may feel sore. Some individuals compare the body pain to that of the flu. The pain may be worsened by a variety of factors, such as physical activity, cold or damp weather, stress, or the time of day.
Tender points. A characteristic sign of fibromyalgia is the small, sensitive spots around the body known as tender points. Tender points are discreet areas of tenderness in the muscular and tendinous tissue in the body. Pain radiates out from these points, and some individuals have pain in all 19 tender points. These points are painful when minor pressure is applied, as when a doctor presses his or her finger on the area during a physical examination. The pain is felt in the body’s soft tissues, such as muscles and ligaments.
Stiffness. Many patients report stiffness, which is generally widespread and diffuse. As is typical of other rheumatic diseases, the stiffness is usually worse in the morning and may improve as the day progresses. It is usually exacerbated the day after physical exertion or exercise.
Fatigue. Patients sometimes report feeling exhausted or weighed down by fibromyalgia. It is common to experience short periods of energy (such as for 24 to 48 hours), only to rebound into feeling fatigued and tired again. For some, fibromyalgia fatigue is more of a disability than the muscle pain itself, as it can substantially impact quality of life. Fatigue can make it difficult to sustain or progress in a career, make social plans, and participate in life's milestones, such as family events. Lack of social interaction can in turn contribute to a feeling of isolation or depression.
Non-restorative sleep. Most individuals with fibromyalgia have sleep problems and feel tired upon waking no matter how long they sleep. Pain is often one cause, but individuals with fibromyalgia are also more likely than average to have sleep-related problems such as restless legs syndrome and sleep apnea, which causes breathing to stop briefly while sleeping. These sleep disruptions may prevent an individual from getting the deep sleep that allows muscles to relax and tissues to rebuild. Some doctors think the lack of quality sleep may contribute to fibromyalgia’s mental sharpness and fatigue issues. Sleep deprivation has been shown to make pain worse even for those without chronic conditions.
Difficulty focusing. Difficulties with focusing, paying attention, and retaining new information are sometimes referred to as “brain fog” or “fibro fog.” Patients may also have trouble using the right words when they talk or have short-term memory loss. These cognitive issues tend to occur most when the individual is feeling tired, stressed, or anxious. The lack of sharpness varies from person to person, and can last hours, weeks, or longer. For some people, the problem can be serious enough to affect job performance. Driving is unsafe if the impairment is severe.
Modulating Factors That Influence Fibromyalgia
While the timing of some symptom flares is unpredictable, the following situations typically lead to an exacerbation of symptoms:
Cold, damp weather
The reverse is also true. Patients feel better with warm weather, hot baths, or even vacations from home or work. Non-steroidal anti-inflammatory medications (NSAIDs), such as ibuprofen and naproxen,
usually do not alleviate symptoms.
Criteria For Diagnosing Fibromyalgia
Before being considered for a diagnosis of fibromyalgia, symptoms must have been experienced for at least three months and all other causes for the symptoms ruled out.
If that is the case, the diagnosis is then based on scores in two major areas, widespread pain and symptom severity, experienced by the patient during the past week. To be classified as widespread, the pain must be on the upper part of the body as well as below the waist. It must also be felt on both sides.
Widespread Pain Index: Patients are typically asked if they have pain in any of 19 potential tender points. Each tender point where pain is experienced counts as 1 point, with the score on this index ranging from 0 to 19.
Symptom Severity Score: Fatigue, waking unrefreshed, and cognitive symptoms are ranked by severity in this assessment. The extent of additional symptoms typically associated with fibromyalgia is recorded, but these are not ranked by severity. Possible scores are between 0 and 12.
A major step in the diagnosis is met when the scores match one of these categories:
A Widespread Pain Index score of 7 or more, and a Symptom Severity Scale of 5 or more.
A Widespread Pain Index score of 3 to 6 and a Symptom Severity Scale of 9 or more.
Conditions Similar to Fibromyalgia
The non-specific nature of many fibromyalgia symptoms, such as fatigue, can lead to an incorrect diagnosis. The diagnosis may be confused with other conditions, including, but not limited to:
Chronic fatigue syndrome (myalgic encephalomyelitis)
Depression and anxiety
Myofascial pain syndrome, a regional pain syndrome
Multiple sclerosis, myasthenia gravis, and other neurological conditions
Other rheumatic conditions, such as rheumatoid arthritis, osteoarthritis, Sjogren’s Syndrome, and systemic erythematosus lupus
Underactive thyroid, or hypothyroidism
While symptoms for these conditions may overlap, treatments generally do not. Getting a correct diagnosis is the first step in learning what treatments and lifestyle changes may make life easier with fibromyalgia.
Multi-Specialty Fibromyalgia Treatment
Treatment for fibromyalgia is generally multifaceted, in part because no single medication or approach is likely to address all the symptoms. For example, low-impact exercise, nutritional adjustments, physical therapy, and biofeedback are some typical approaches that can increase daily functioning. Other forms of care that may also improve function for the fibromyalgia patient include acupuncture and/or chiropractic adjustments. Dr. Anderson utilizes the following modalities for patients suffering from fibromyalgia:
Manual manipulation. Typically rendered by chiropractors and osteopaths, the use of a high velocity, low amplitude (HVLA) thrust, which results in a cavitation or “crack” as gas is either released or created from a specific spinal or extremity joint. Another common manual manipulation approach is called “mobilization” where no thrust is used and typically, cavitation is not produced.
Acupuncture. Patients with arthritis may benefit from acupuncture, 1 an ancient Chinese practice based on the following beliefs:
Within each person flows essential life energy, called chi (or qi), which serves as the foundation of physical, mental and emotional well-being.
Chi can become blocked and unbalanced, causing illness or pain.
Blocked chi may be released and energy balance restored by inserting thin needles—about 0.1 to 0.3 mm wide—into specific points on the body.
During treatment, patients typically lie on a padded table and rest with the inserted needles for 20-30 minutes, often in a dimly lit room listening to relaxing music.
Easing into Gentle Exercises. Considered one of the most effective treatments for relieving symptoms, gentle exercise improves muscle tone, lowers stress, produces endorphins (the body's natural analgesic), leads to sounder sleep, and helps prevent weight gain. Unfortunately, exercise can be difficult for individuals who are already in pain and experiencing a great deal of fatigue. The key is to start slow, take a day or two off in between exercise sessions at first, and focus on low impact moves. Aerobic exercise is best, and the near-weightless feeling of water exercises in a warm pool—called water therapy—may be better tolerated than land-based exercises.
Nutritional Supplementation. Supplements may be used to treat fibromyalgia-related symptoms that have not been relieved by medications. A supplement regimen may ease one especially challenging aspect of the condition—such as disrupted sleep—or have a more wide- ranging impact. Supplements commonly used to support fibromyalgia patients include:
Magnesium. People with fibromyalgia are more likely than others to have low magnesium, and many doctors advise fibromyalgia patients to take this supplement. Magnesium, a mineral, occurs naturally in the body and in many foods and is important to human functioning. Foods high in magnesium include yogurt, dark leafy green vegetables, nuts, fish, and whole grains.
Melatonin. This hormone is produced by your body and is important in regulating your sleep/wake system. Sleep difficulties are a frequent problem with fibromyalgia. Patients often sleep but miss out on the deep sleep (described as "rapid eye movement", or REM sleep) needed to wake up feeling refreshed.
Probiotics. These live cultures, sometimes called "good bacteria,"; can help digestive health as well as overall health. Like the bacteria that already exists in the gut, probiotics can be helpful in counteracting harmful bacteria. Probiotic supplements may address several health problems that often occur in fibromyalgia, including irritable bowel syndrome (IBS), vaginal yeast infections, depression, and anxiety.
Coenzyme Q10. This antioxidant, used to convert food into energy, has shown some promise in treating fibromyalgia symptoms. One small study of people who took 300 mg daily of coenzyme Q10—also called CoQ10—for 40 days showed a marked easing of fatigue, morning tiredness, and pain.
The goals of fibromyalgia treatment may vary depending on the individual's specific symptoms. For many, finding effective symptom relief is a process of trial and error and may involve both traditional Western medical approaches as well as complementary and lifestyle approaches. Dr. Anderson customizes each treatment plan specific to the needs of each fibromyalgia patient. If you are suffering from the debilitating effects of fibromyalgia, schedule an appointment today to start feeling better again.
The Mystery Disease
How one pain patient discovered their fibromyalgia diagnosis.
Kathryn was tired of feeling lousy all the time and not knowing why, her back ached, her stomach was always upset, and she was incredibly fatigued.
The pain had come on suddenly three months ago, she assumed she was sick and it would go away. After months of pain she started to realize there was something more at play.
"The pain had come on suddenly three months ago, she assumed she was sick and it would go away. After a month of pain she started to realize there was something more at play."
Kathryn went to her primary care physician looking for answers, she explained the long list of painful and sometimes debilitating symptoms that came from her new ailment. Her PCP suggested she try a rheumatologist.
She visited her rheumatologist and explained the same symptoms, they spent the next month doing blood tests and ruling things out. She didn't have rheumatoid arthritis, M.S., or lupus, so what could it be?
After dozens of negative tests the rheumatologist suggested Kathryn have fibromyalgia and suggested physical therapy, pain medication, and therapy. Kathryn figured there had to be more to treat her condition.
Unsatisfied with her answers, Kathryn searched other fibromyalgia treatments and stumbled upon chiropractic. She figured it was worth a try as she was reluctant to take pain meds.
The next day, after another unrestful night's sleep, Kathryn found a walk-in chiropractic clinic and went for a treatment. The chiropractor explained how he would perform the adjustment and how it would help relieve the joints to reduce the pain.
"The next day, after another unrestful night's sleep, Kathryn found a walk-in chiropractic clinic and went for a treatment. "
She felt a little relief right away, but the chiropractor explained it would be a process to reach a manageable level of pain. Kathryn came in for 6 more visits and finally noticed significant results- her pain finally felt manageable. After that, she continued weekly maintenance visits to sustain her progress.
Kathryn was beginning to worry she would never feel better, but her trip to the chiropractor gave her back a life she loved living.
Dr. Anderson has changed my life. His care has shown me that I can largely live without traditional medicine. He not only has helped me with chiropractics, but with nutrition and overall body health. I am so glad to have found him!!