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The aches and pains in her muscles just would not stop. After the car accident, it seemed like everything was going downhill. First she lost her job, then her boyfriend. Sleep hardly ever comes and if it does, the pain and tightness in her shoulders and neck wake her up. After countless visits to a myriad of specialists, she finally got a diagnosis. She thought that she was going crazy, but the rheumatologist said she had fibromyalgia. Learn about this mysterious ailment, the signs and symptoms, the latest theory on the cause, and some treatment options in this article. For an in-depth look at diet and supplementation that may benefit fibromyalgia see the article “Nutritional Strategies For Fibromyalgia.”

Complicated Syndrome

Fibromyalgia (FM) literally means pain in the fibrous connective tissue that surrounds joints, typically the muscle and the tendon that attaches the muscle to the bone. It isn’t a disease, but rather a syndrome, which is a collection of signs and symptoms that occur together. It is a form of soft tissue rheumatism. The American College of Rheumatology defines FM as widespread pain present for at least three months in combination with tenderness at 11 or more of 18 specific tender point sites. FM used to be called fibrositis, but that erroneous definition meant an inflammatory condition was present, and that is not the case. Because of the difficulty in diagnosing FM and the similarities that FM has to other diseases, many people are not properly diagnosed, or the diagnosis takes much time and effort. Since FM affects 2% of the United States population, with a breakdown of 3.4% in women and 0.5% in men, this is not a rare syndrome.

Signs and Symptoms

FM patients usually report that they “hurt all over” and describe their pain as stabbing, aching, or nagging. They also describe feelings of stiffness, especially upon waking up. Pain with palpation is found in 11 of 18 specific points that have been identified around the body. FM patients can suffer from fatigue, sleep disturbances, headaches, abdominal pain, bloating, constipation, diarrhea, bladder urgency and frequency, and skin sensitivity. FM seems to occur in a vicious circle. The lack of sleep leads to sore muscles and fatigue, which leads to less participation in physical activity, which results in depression and further deconditioned muscles, which leads to more pain, which leads to less sleep.

The Central Nervous System Theory

Many researchers now believe that the central nervous system (CNS) plays a large role in the development of this syndrome. The central nervous system is composed of the spinal cord and brain. What investigators think is that an event, either emotionally or physically traumatic, leads to hyperactivity in the CNS. This hyperactivity leads to sleep disturbances, like the increased number of awakenings found in FM patients. The hyperactivity also affects the ratio of excitatory to inhibitory neurotransmitters. Neurotransmitters are chemical messengers that communicate between nerves. In FM, there appears to be larger concentrations of excitatory neurotransmitters (like Substance P) and lower concentrations of inhibitory neurotransmitters (like serotonin). This irregular ratio causes the pain amplification in FM patients. FM patients’ pain perception is normal, but their sensitivity to pain is increased and their tolerance of pain is decreased. The CNS hyperactivity can then lead to problems involving all bodily systems, which explains the seemingly unrelated symptoms of FM. There is even reason to believe that FM may have a genetic component.

FM Management

A combination of medication, cognitive behavior therapy, relaxation techniques, exercise, and education is recommended as treatment for FM. Medications that help promote sleep and relaxation have been used, but studies have met with mixed results. Nonsteroidal anti-inflammatory drugs (NSAIDs) aren’t more effective than placebos and corticosteriod injections make FM symptoms worse. Trigger point injections using a local anesthetic can be helpful, but only have temporary effects, and the authors of one study that showed symptom improvement still recommended other forms of treatment. Only one high quality study suggests that real acupuncture is more effective than sham acupuncture. Cognitive behavior therapy, which involves learning affective coping strategies, and stress-reduction programs were proven to be successful in the long term treatment of FM.

Exercise programs that emphasize cardiovascular fitness seem to be the tool for breaking the circle of pain. FM patients are deconditioned from avoiding exercise. This can lead to further pain from shortened and tight muscles. Many doctors recommend a balanced program of flexibility, gentle strengthening, and aerobic conditioning. Exercise should be thought of as health training, not sports training. The intensity and duration should begin slowly, but become a part of the FM patient’s lifestyle. Pool exercises are a good place to start with a gradual progression to land exercises. Physical therapists can help design exercise and stretching programs. The Arthritis Foundation recommends also learning progressive muscle relaxation techniques in addition to exercise and stretching.

The Good News

FM is not a life threatening disease, nor is it physically deforming. Symptoms do not usually get worse and may be lessened with appropriate interventions. Although researchers are still working on a complete explanation for the syndrome, progress is advancing rapidly. Without a definitive treatment for every FM patient, an individualized approach and experimentation with different methods should be utilized. In a study of FM patients who still had symptoms after ten years of onset, 66% of patients reported that their symptoms were a little or a lot better, 55% said they felt well or very well, and only 7% felt they were doing poorly. Of course, education about the syndrome is the first step to understanding and beginning a treatment program. For more information, visit the American College of Rheumatology website at www.rheumatology.org or The Arthritis Foundation website at www.arthritis.org. You can call Fibromyalgia Alliance of America, Inc., (614) 457-4222 and Fibromyalgia Network info line: (520) 290-5508. A newsgroup devoted to fibromyalgia can be found at alt.med.fibromyalgia.

References upon request.

Thomas Incledon, PhD(c), RD, LD/N, NSCA-CPT, CSCS, RPT has been involved in research on how to enhance health and human performance for over 17 years and is considered one of the worldwide leading experts on effective health and performance strategies. He is the Chief Executive Officer of Human Health Specialists. Tom can be reached at mailto:info@thomasincledon.com info@thomasincledon.com or (480) 883-7240. Visit our websites at ThomasIncledon.com ThomasIncledon.com, HumanPerformanceSpecialists.com HumanPerformanceSpecialists.com, HumanHealthSpecialists.com HumanHealthSpecialists.com

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One Response to “Fibromyalgia”

See your doctor, this information is educational. This is intended to complement conventional medicine, not to replace it.

What is fibromyalgia? There has been much confusion about this condition in part
because it has been given many names. It used to be called fibrositis, or myofascial
pain, myofascial pain syndrome, psychogenic rheumatism, fibromyositis,
myofasciitis, tensionmyalgia, or psychological muscle disorder.

Chronic muscular pain is just one facet of this syndrome; it runs much deeper than
just sore and aching muscles or joints. Just living with gravity and our modern day
stress can cause much of the soreness and muscle tension that most people
experience. However, when we have the condition of fibromyalgia, or myofascial
pain syndrome, all of the stress and tension is intensified ten-fold.

The chronic pain can be regional, myofascial pain syndrome (in the connective
tissue or muscles) or widespread fibromyalgia with overall aches and pains
accompanied by neurological and other problems. The condition can be very severe
and has many faces.

Since mostly women suffer from fibromyalgia, most experts think it is connected to
the hormone estrogen. It could be an estrogen insufficiency or certain hormonal
changes that affect the muscle pain. It’s usually found in women over thirty.

I have never heard of males with this condition in my thirty years of experience. I
have known only a few women that actually were diagnosed with this condition.

The pain of fibromyalgia is different in every individual and has no limits;
sometimes it’s a dull pain and other times sharp. It can be numbness on the
surface of the skin or deep, muscular aching that is dull, shooting, burning,
throbbing or stabbing, sharp pain. Most often, the pain and stiffness are worse in
the morning, and it’s not unusual to hurt in the muscle groups that are used more
often: upper neck, shoulders, low back, hips, and legs. In fact, often every joint may
hurt. Here again it varies with the person. Their activities or jobs, as well as their
mechanical postures, can dictate where they will suffer most.

The Chronic fatigue has been described as “feeling unmotivated” or “having mental
fatigue.” Some patients told me if they could get the strength to get out of bed then
they could deal with the rest of the day.

Chronic Headaches Recurrent migraine or tension type headaches are seen in about
50-60% of fibromyalgia patients and can pose a major problem. Just dealing with
the daily activities of life can be a struggle for these patients.

Most have a sleep disorder called the alpha-EEG anomaly. This means that they
don’t get to the deeper levels of sleep and they are constantly interrupted by
awakening brain activity. Thus, when they wake up they feel that they didn’t get any
rest and the body did not get a chance to recover. This condition creates added
stress, which keeps them in the vicious cycle. One of my patients said she felt like
she’d been run over by a truck when she got up every morning. Another one is
Myoclonus or PLMS (nighttime jerking of the arms and legs), restless leg syndrome,
and bruxism (teeth grinding).

Temperomandibular Joint Dysfunction Syndrome (TMJ) is connected with the
headaches or face pain in 25-30% of FMS patients. Research indicates that
as many as 90% of fibromyalgia patients may have jaw and facial tenderness that
could produce the same symptoms of TMJ.

Irritable Bowel Syndrome (IBS) It’s common for many of these women to have bowel
problems, constipation or diarrhea. Frequent abdominal or chest pain is also not
uncommon. These symptoms are found in 60% to 70% of fibromyalgia patients,
according to the research, in addition to PMS and painful menstrual periods
(dysmenorrhea).

Other common symptoms include muscle numbness and or tingling sensations;
muscle twitching; swollen extremities, dry skin or skin sensitivity, dry eyes and
mouth; dizziness and impaired coordination. Often patients experience sensitivity to
weather or wind, rain, and changes in temperature. Hormonal fluctuations
(premenstrual and menopausal states), depression, anxiety and overexertion can all
contribute to symptom flare-ups.

The holistic approach seeks to approach the problem on all levels– mental,
nutritional, and physical. Each aspect of these problems needs a specific modality or
therapy. We recommend the use of conventional medicine with nutritional, herbal,
biochemical nutrients, bio-mechanical body therapy, and mind-body methods
designed to enhance the body’s own natural healing systems.

We know that the best way to approach a vague disease is to use conventional
holistic practices such as good nutrition, lower fat intake (especially the saturated
fats), less sugar and fewer junk foods. Increase water intake for flushing the system
and increase intake of anti-oxidants Vitamins C, E, beta carotene, and a good multi-
vitamin, with increased doses of cell salts and selenium. Some medical experts say
phosphatigylserine, which is a lipid (fat processor) and gingko biloba can also help
ease the condition. Also, adding fish oil capsules.

From a natural perspective, GABA itself is available from the health food stores over
the counter. Again, I just want to caution anyone self-medicating, even with natural
substances.

Magnesium-calcium and selenium supplements also may help by acting on some of
the same neural and muscle receptor sites that GABA influences.

About 80% of our chronic pain patients are deficient in magnesium. That’s because
physical pain (and also mental anguish) cause the muscles to overwork and the
muscles use up much more magnesium than normal. This is a reason why many
athletes need extra magnesium as well.

Ironically, the muscles really need that magnesium to function and not having
enough of it increases muscle spasm and pain, as well as the general vulnerability to
stressful stimuli such as loud noises, chemicals, and emotional distress. So this
hyper-sensitivity puts people in that kind of vicious cycle.

Many of these patients have hypoglycemia or blood sugar control problems as well.
This is normally due to the stress of their illness on the glucose/insulin system.
Excess stress causes the body to be on high alert. Consequently, the dietary
guidelines described above could be very helpful in conjunction with a few quick
and helpful nutritional tricks. A small supplementation of olive oil, chromium, or
glutamine can usually reverse this common complication.

Natural remedies to help sleep are valerian root, 5-hydroxy tryptophan, passion
flower, GABA, and melatonin. Relaxation or meditation training and other natural
approaches can do much to restore good sleep. This is a bit more complicated than
it sounds; we advise that you consult with a professional. Of course, some
medicines can also help with sleep as long as care is taken to not create a habit or
dependence on these drugs. Reducing alcohol as well as reducing caffeine and
sugar will help the body sleep better.

The most interesting recent research is that the kinds of medicine that work best for
fibromyalgia and myofascial pain are not the traditional narcotic pain suppressors
such as vicodine, codeine, or the highly potent, non-steroidal, anti-inflammatory
medicines such as Celebrex or muscle relaxers such as Flexeril.

The best medicines acrording to Dr. Podell to use instead are those that act on our
nervous system and neurochemistry to reduce and reverse allodynia, the body’s
abnormal increased sensitivity to that pain.

The most surprising news is that many of the best new medicines are actually old
standbys that have been used for many years for other conditions. Because of the
complexity of fibromyalgia, we are just re-discovering the beneficial effects for
helping the neuro-chemistry. Some of the common medicines used are Baclofen,
Elavil, Flexeril, Gabatril, Klonopin, Neurontin, Paxil, Sinequan, Serzone, Xanax, and
Zofran.

The above medications, of course, can cause some side effects in some people, so
see your doctor for any questions you may have.

Biochemistry and Metabolism

Since every body is very individual there are laboratories specializing in diagnosis
that can help us detect metabolic imbalances and dysfunctions.

1. Essential fatty acid analysis which often shows a deficiency of omega-3 essential
fatty acids. Certain amino acids analysis often shows a deficiency of the chain
relationship of amino acids, with glutamine, taurine, tryptophan or tyrosine being
the most common.

2. Other theories pertaining to alterations in neurotransmitters like serotonin and
nor epinephrine. As mentioned before, substance P has an immune system function.
Substance P is a pain neurotransmitter that has been found by repeat studies to be
elevated three-fold in the spinal fluid of fibromyalgia patients. Two hormones that
have been shown to be abnormal are cortisol and growth hormone (HGH).

3. A comprehensive digestive and stool analysis can point to digestive enzyme
deficiencies, yeast, candida or Epstein-Barr, bacterial overgrowth, or even parasites,
which most people will have. The key is your immune system can usually handle it
and when it can’t then you succumb to worse problems.
I feel that enhancing or strengthening the immune system is the best way to
improve health with any disease.

4. Food allergies can be tested for as well or detected by going on an elimination
diet. “Sensitive” food allergies can be identified that can make pain symptoms
worse. Be careful with cleansing diets as I have found most people need building
foods first due to poor eating habits. Urine tests for milk- or wheat-derived opioid
peptides can pinpoint digestive abnormalities that lead to toxic by products. We
have found most people are allergic to dairy products as well as to gluten found in
wheat products.

5. We used to do hair analysis or DMSA provoked urine testing to detect high levels
of toxic metals like mercury or lead. Now we have many other systems for
diagnosing and finding problems of that nature.

6. Checking the liver functions and enzyme levels is another way to find problems
as the liver is a key organ for cleansing the body.

7. Ordering a screening T4/TSH is a good first approach as well. Many of the
symptoms of fibromyalgia mimic hypothyroid muscular disease. Your doctor should
order a screening thyroid test as part of the initial workup of fibromyalgia.

8. Checking for hyperthyroid is also done quite easily in the laboratory. Just make
sure you are working with someone that takes the time to eliminate other potential
problems that could appear as FMS.

Body-Therapy and Mind-Body Therapies

Great relief may come with just getting massage, however, it can also aggravate
your condition so usually gentle massage is recommended and not deep tissue
work. One of the best techniques for these painful bands is DTF (Deep Transverse
Friction), made popular by Dr. James Cyriax. You should see a professional massage
therapist trained in this technique.

Trigger point therapy is another technique that helps reduce the stress in the
tissues and also should be done with great care. As you will find, within these taut
bands of muscle are extraordinarily sensitive pain points.

There is in the realm of body-mind techniques several that have proven effective in
neurological balancing. The most popular and widely used are Traggering and
Feldenkrais created by two extraordinary people who were pioneers in body-mind
therapy. Milton Tragger was an M.D., a neurosurgeon who created a movement type
of treatment that is gentle and achieves deep levels of relaxation through rocking
motions. He was a friend and I got to know him in Honolulu and experience his
work directly. We exchanged a few sessions with each other. It is very great, gentle
system of work, soothing to the nervous system.

Feldenkrais was once associated with Ida Rolf, the mother of Rolfing. Rather than
doing deep body work on the fasciae like Rolfing, Feldenkrais worked with certain
body postures and movements to free up the patterns in the body since it often falls
into poor posture and pain. Using movement and re-education of the body was his
approach. His theory was to break up the neurological patterns of pain and
restrictive movement.

There are a few others that are similar: Aston patterning, Alexander Technique, and
certain types of polarity therapy can all be helpful. Often it’s not the technique as
much as the belief of the effectiveness of the therapy by the patient.

More Mind Techniques

Of course, one of the best mental treatments for chronic pain and chronic illness,
which takes a psychological toll on the mind as well as the body, is bio-feedback
training, or some kind of relaxation or meditation techniques. These systems have
been around for thousands of years, and only in their application do we think they
are new.

There is a very useful technique call Neuro-Linguistic Programming or NLP, another
mental tool that changes the physiology by focusing on a positive new pattern
rather than on the old problem. And all of Tony Robinson’s work is very powerful for
transformations. I was lucky to have met him in the old days when I gave him a
treatment and took all his seminars.

Just good old-fashioned deep breathing can do wonders for the pain and the stress
level of any individual. Yoga and all the many forms of movement as we talked
about before, tai chi or ballroom dancing, for anyone for that matter, may be
helpful.

What To Do If You Have FMS

In the long term, the most important thing you need to understand is that the first
step is to understanding your fibromyalgia syndrome. We know that it can be
chronic, but the symptoms or your episodes may flare up – or mellow out. This, we
feel, can depend on your stress level, as well as what you have been doing to work
on improving your condition. The impact that FMS has on daily living as well as
activities is going to be different with each individual. It is commonly accepted that
FMS can be as serious as rheumatoid arthritis in disabling people from working
fulltime jobs.

Many patients have felt helpless or hopeless, and generally get very little relief or
poor results. We must remember the best results come from using all the tools and
methods available. It takes knowledgeable people as well as your commitment to
becoming informed to begin getting better. Know that FMS is not a life-threatening
disorder, although we can’t say it’s harmless. Some on the far end of the spectrum
may feel like they can’t live like this, but on the other side, some people can do well
and live a good life.

Get your doctor to do the laboratory tests to rule out other possible maladies that
can overlap or appear as FMS. One is hypothyroidism; it can be over-diagnosed but
most commonly it’s misdiagnosed. Fibromyalgia patients must have a good and
thorough clinical diagnosis. Qualified medical doctors or osteopaths must make this
diagnosis and ideally rule out other possibilities.

This disease can be confused with or be similar to MS (multiple sclerosis), lupus,
osteoarthritis, rheumatoid arthritis, and even heart problems. You may have TMJ
(temperomandibular joint syndrome), candida, Epstein-Barr syndrome, or CFS
(chronic fatigue syndrome), or even Lou Gehrig’s disease, a brain tumor, spine
disease or a whole bunch of other problems. The only way to know it’s FMS is to
rule out some of these others, and only a qualified medical or osteopathic doctor
can do this.

Fibromyalgia Network for a listing of patient contacts and physician referrals.
www.fibromyalgia.com The phone number is: (800) 853-2929.

For Othon see molinamassage.com for more information and other
articles.

May health be with you in all ways. . .

Othon Molina Ph.d. c LMT has been involved in the health field as a manual therapist
and personal trainer for over thirty five years. He has studied with some of the top
doctors and healers of our times. His specialty is treating sports injuries, back
problems, and teaching others how to improve their health or athletic competition
using nutrition and fitness technologies.

One of his specialties is Kinesiology, and sports training. He has been a runner all
his life, and competed in many triathlons, 5k’s, 10k’s and marathons. Competing at
an elite level gave him the experience to help train others. Recently he coached and
worked with the female champion of the German team of triathletes.

Some of his clients include: Bob Hope, Jane Seymor, Essam Kashoggy, Jim Nabors,
Tony Robbins, Mark Victor Hansen, Carol Burnett, San Francisco Ballet, Allvin Alley
Dance troupe, some of the top Olympic and international elite athletes, team doc
and new trainer for the German professional triathletes. He also trains massage
teams as well as health professionals worldwide.

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