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 http://www.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.