FIBROMYALGIA

Do you feel like you have the flu all the time, with achiness and pain all over? Is the pain worse in the morning, often with increased muscle stiffness?  Do you feel fatigued everyday, even after a full night's sleep? Do you have restless sleep, headaches, irritable bowel syndrome, premenstrual syndrome, dysmenorrhea (menstrual Cramps), chest pain, intolerance to cold or damp weather, or temporomandibular joint syndrome (jaw pain)? Do you know someone who complains about similar symptoms? Have you started to wonder if you are crazy? Don't!

     What is described above is a VERY REAL but little understood condition that is neither disfiguring nor life threatening. Called fibromyalgia, meaning pain is the tendons and ligaments (fibrous tissue) and muscles, this disorder is not specifically a disease but rather a grouping of symptoms. Cases of fibromyalgia symptoms have been documented for at least the past century, but it was only in 1990 that specific criteria for the diagnosis of fibromyalgia were developed and in 1992 the World Health Organization added fibromyalgia patients are generally Caucasian, middle- class women aged 20-55, through men and women of other races, ages, and economic levels are not immune to it. But what causes fibromyalgia and what will help relieve symptoms.

What Causes Fibromyalgia ?

     No one knows! Neither researchers nor doctors know what causes fibromyalgia, and therefore, there is no known cure. Some patients report having an illness (viral, bacterial, or parasitic infection) or some kind of trauma, like a car accident, prior to the onset of symptoms. But because this is not true of all sufferers, it cannot be the cause.

     Other diseases, such as arthritis, thyroid disease, and connective-tissue disease, have symptoms similar to fibromyalgia, making diagnosis difficult. There is no test available that points directly to fibromyalgia, so it is often a diagnosis of elimination. Tests are usually done to rule out Lyme disease, arthritis, heart problems, neurological disorders, and other conditions.  But testing normal for these does not mean you have fibromyalgia. There are specific symptoms, namely acheness and pain "all over the body" and at least 11 of 18 tender points (areas that when touched causes pain) that must be present to accurately diagnose fibromyalgia. Other symptoms include some, but not necessarily all, of those listed in the opening paragraph.

Diagnosis of Fibromyalgia

Pain, on digital palpation, must be present in
at least 11 of the following 18 sites:

Occiput: Bilateral, at the suboccipital muscle insertions.
Low cervical: bilateral, at the anterior aspects of the intertransverse   spaces at C5-C7.
Trapezius: bilateral, at the midpoint of the upper border.
Supraspinatus: bilateral, at origins, above the scapula spine near the medial border.
Second rib: bilateral, at the second costochondral junctions, just lateral  to the junctions on upper surfaces.
Lateral epicondyle: bilateral, 2 cm distal to the epicondyles.
Gluteal: bilateral, in upper outer quadrants of buttocks in anterior fold of muscle.
Greater trochanter: bilateral, posterior to the trochanteric prominence.
Knee: bilateral, at the medial fat pad proximal to the joint line.

Digital palpation should be performed with an approximate force of 4 kg. For a tender point to be considered "positive" the subject must state that the palpation was painful. "Tender" is not to be considered "painful."

The most distinctive feature of fibromyalgia, however, is the existence of certain "tender points" - nine pairs of specific spots where the muscles are abnormally tender to the touch

Can Symptoms Be Controlled ?

     There are treatment methods that may offer some relief from pain and other symptoms. Research and experience have found that spinal manipulation, exercise, dietary changes, nutritional enhancement, postural changes, physical therapies (heat, ice, light massage, etc.), and stress management can improve symptoms. And this is what makes the Doctor of Chiropractic an excellent choice for the management of fibromyalgia.

     The chiropractic office is one in which many of the therapies for the management of fibromyalgia symptoms are commonly used. A recent survey of Doctors of Chiropractic in rural areas of the U.S. found that 100% provide guidance on exercise to their patients, 88.1% provide nutritional counseling, 80% provide information on stress management, and 93.8 % counsel on lifestyle modifications, like smoking cessation and weight loss (Foundation for Chiropractic Education and Research, 1994). These statistics show that for the management of fibromyalgia symptoms a chiropractic office is an excellent place for treatment.

     Your Doctor of Chiropractic will begin your treatment with a through clinical examination and a complete health history. If you had medical tests done in connection with your symptoms, inform your chiropractor of the results to avoid unnecessary duplication of tests. With all of this information, a treatment plan will be designed specifically for you. The chiropractor is very well educated in the body as a whole and will know which therapies hold the most promise for you with your specific symptoms and tender points.

What Can Help ?

MANIPULATION- Reduction of muscle tension, reduction of stress, correction of postural dysfunction - these and perhaps other reasons may be why manipulation can be effective for fibromyalgia symptoms appeared following a trauma may find manipulation especially helpful and should see a chiropractor immediately.	Massage: When the body is unbalanced, the range of motion is  restricted. These imbalance and restricted motion resulted from too little use of the muscles, especially over a long peroid of time.  To relieve the problems,  Massage therapy reduces trigger point pain often seen in fibromyalgia. It also allows  for a wider range of motion and more energy. Massage therapy is a great tool for healing and recovery. It also helps maintain the alignment you receive from your chiropractor .
EXERCISE- Some research has shown that exercise can reduce fibromyalgia symptoms and also keep them from worsening. Muscle strengthening will provide stronger support of the spine (improving posture) and will increase blood levels of endorphins, the body's natural pain killers. Although it may be difficult to get motivated to exercise when your whole body aches, exercise is believed to be one of the best methods of symptom control. Follow your Doctor if Chiropractic's advice when exercising to avoid increased pain of frustration. Proper stretching and warm-up will not only be beneficial for your condition, but will decrease your chance of injury. You should start VERY slowly, gradually increase both time and intensity. Low or non-impact exercise is the most comfortable, so let your doctor know is swimming, bicycling (even stationary biking), or walking are options for you.  Most of my patient's have responded best to exercises in water.  Check your city to see if there are indoor heated facilities that offer swimming or aquatic exercise classes.	SLEEP- One of the most common symptoms of fibromyalgia is lack of deep sleep. But before taking sleeping pills, which can cause unwanted side-effects, try natural methods of improving sleep. Sleep on your back with a pillow under your knees and your neck supported, or sleep on your side with your knees slightly bent and with your arms at your sides. Avoid sleeping on your stomach. Do not consume food or drink (especially alcohol, nicotine, or caffeine) several hours before going to bed to reduce your chances of waking to go to the bathroom. Keep the room temperature comfortable. Keep the room quiet or provide "white noise" like a fan or air conditioner (not pointed directly at you) to drown out noise. Keep family and pets from interrupting your sleep
STRESS CONTROL- Stress, both physical and emotional, has been shown to aggravate symptoms, whether from tensed muscles or from chemical changes in the body. Learning relaxation techniques may help you avoid aggravating symptoms. Your Doctor of Chiropractic can provide you with some information on stress relief that will work for you.	AVOID COLD DAMP PLACES Change in weather and climate have been associated with increased fibromyalgia symptoms
DIET- Some have found that food intolerances can cause symptoms similar to fibromyalgia. Keep a food diary in which you record what you eat and drink and whether fibromyalgia symptoms improve, worsen, or remain the same. If you are unsure what a good diet consists of, ask your Doctor of Chiropractic, who can examine your food diary and may recommend nutritional supplements.	Fibromyalgia is a complex condition in which no two people will have the same symptoms and signs. Your Doctor of Chiropractic, who can provide you with natural, non-invasive methods of symptom control. One of the most important factors for the management of your symptoms is your active participation, Your chiropractor is there to help you feel well. Use his or her knowledge to your health advantage.