fibromyalgiadrdavidking.ca/wp-content/uploads/2015/08/fibromyalgia.pdf · why do so many people...

FIBROMYALGIA THE CHIROPRACTIC APPROACH

By Keith Wassung

What Is Wrong and What Can I Do?

www.DrDavidKing.ca

Fibromyalgia – The Extended Version

Due to the overwhelming amount of information available on fibromyalgia (some correct, some incorrect, some just plain confusing) I created the “Fibromyalgia in 1 page (or less)” report. You can click here to read it.

The following is the extended version for those who want more detailed information.

—————————————————————————————————————————— The Facts

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Fibromyalgia is by far the most common (apparent) musculoskeletal problem in relatively young people - at about the age of 50 years, osteoporosis leads - but below that age, it’s fibromyalgia which is many times more common than rheumatoid arthritis [1].

Some studies estimate that as many as 1.2 million Canadians suffer from fibromyalgia, yet many remain undiagnosed because of its elusive nature.

“Despite its prevalence, fibromyalgia remains unfamiliar to most people. Many medical doctors were not taught about this condition, because medical schools began teaching about it only recently. The lack of general knowledge, along with the lack of objective physical evidence from routine medical tests, is what leads many on a long and frustrating quest for a solution.” [2].

Although it is most common in middle-aged women (women are about ten times more likely than men to suffer) fibromyalgia has become increasingly common in children. Musculoskeletal pain represents the most common problem seen by paediatric rheumatologists. Fibromyalgia is the second most common disorder seen by rheumatologists and is more than twice as common as rheumatoid arthritis [3]. Between 25-40% of children with chronic pain fulfill the criteria for Juvenile Fibromyalgia Syndrome.

Copyright Dr. David King 2015 ~ All Rights Reserved Page � of �1 16

Up to 28% of adults with Fibromyalgia report the onset of symptoms during childhood [4].

“The average fibromyalgia patient suffers for five years and spends thousands of dollars on medical bills before receiving an accurate diagnosis. As a result of misdiagnosis, more than half of all patients undergo unnecessary surgery.” - Devin Starland, MD [5]

—————————————————————————————————————————— Fibromyalgia: Are We Getting Anywhere?

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Although the disorder has been around for thousands of years, a name was not designated for this miserable condition until 1976. Then, in 1990, the American College of Rheumatology published a formal set of diagnostic criteria. Nevertheless, medical science still struggles to understand fibromyalgia and physicians continue to argue over whether or not it is a “real” disease.

In 2012 the Canadian Guidelines for the Diagnosis and Management of Fibromyalgia Syndrome were introduced.

—————————————————————————————————————————— What is Fibromyalgia?

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Fibromyalgia is medical speak for “pain in the muscles fibres”. (Took a genius to come up with that one!)

Fibromyalgia is characterized by chronic, widespread pain throughout the body with no apparent cause or explanation. Fibromyalgia was first described in medical literature over 150 years ago and has been called fibrositis, myofascial pain syndrome, muscular rheumatism, and many other names. The diagnosis of fibromyalgia became officially recognized in 1990 by the American College of Rheumatology.

The pain can be spread over any part of your body, but the most common sites tend to be your neck, back, shoulders, pelvic girdle, and hands. Patients tend to experience a wide variety of symptoms with varying intensities that wax and wane (get worse and better for no apparent reason) over time [1].

In addition to chronic pain, other symptoms include stiffness - especially in the morning - fatigue, sleep disturbance, migraine and tension headaches, irritable bowel syndrome, TMJ, Carpal Tunnel Syndrome, and intolerance to cold weather.

It was originally thought that the symptoms of fibromyalgia were caused by stress and worry, which caused additional muscle tension. Although recent studies of people do not show that stress itself causes fibromyalgia. Stress and anxiety can make your condition worse. In fact, the pain and fatigue of fibromyalgia often cause stress and worry, which, in turn, can increase the pain and fatigue - thus creating a vicious cycle.


—————————————————————————————————————————— How do we define Fibromyalgia?

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Canadian Guidelines (2012) state:

“Fibromyalgia, a condition that can wax and wane over time, should be diagnosed in an individual with diffuse body pain that has been present for at least 3 months, and who may also have symptoms of fatigue, sleep disturbance, cognitive changes, mood disorder, and other somatic symptoms to variable degree, and when symptoms cannot be explained by some other illness” [6-9].

—————————————————————————————————————————— How do we diagnose Fibromyalgia?

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“Fibromyalgia diagnosis remains difficult because there are currently no diagnostic laboratory tests for fibromyalgia.” - American National Arthritis Foundation

This results in frustration being experienced by patients and doctors alike. Fibromyalgia used to be diagnosed based on the following criteria: 1) Pain in each of the four quadrants of the body for at least 3 months. 2) At least 11 of 18 tender points for at least 3 months.

Studies have shown that 96% of patients with fibromyalgia have more than four tender points and 94% have more than seven [5].


However, this tender point analysis is no longer considered reliable or accurate as a diagnosis test for fibromyalgia. This analysis was developed for research purposes only and has not proven useful or reliable for use in clinical practice [10-20].

As a result of this physicians must depend on patient histories, reported symptoms and clinical examination. In other words, the art of medicine.

The American National Fibromyalgia Association estimates that it takes an average of 5 years for a fibromyalgia patient to get an accurate diagnosis because so many physicians are not adequately educated about it. If your doctor seems to be brushing off your symptoms with, “It’s probably just fibromyalgia,” as if you are just bloated or something, it might be time to find a different doctor.

—————————————————————————————————————————— Classic Symptoms of Fibromyalgia

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Pain The key marker of fibromyalgia is pain, which is profound, widespread and chronic. It occupies many parts of your body, and it varies in frequency, duration and intensity. It has been described as deep muscular aching, stabbing, shooting, throbbing and twitching.

Neurological complaints add to the discomfort such as numbness, tingling, and burning. A neuropathic mechanism to the pain has be revealed in the literature [21-22].

The severity of the pain and stiffness is often worse in the morning. Aggravating factors are cold/humid weather, non-restorative sleep, fatigue, excessive physical activity, physical inactivity, anxiety and stress [23-24]. Fatigue Fatigue, reported to be present in over 90% of FM patients, is the most common associated complaint [10]. The fatigue of fibromyalgia is different from the fatigue that many people complain of in today’s busy world. It is more than being tired - it is an all encompassing exhaustion that interferes with even the simplest daily activities, often leaving the patient with a limited ability to function both mentally and physically.

Sleep Disruption Many patients have an associated sleep problem that prevents them from getting deep, restful, restorative sleep. Medical researchers have documented specific and distinctive abnormalities in Stage 4 deep sleep of fibromyalgia patients. During sleep, they are constantly interrupted by bursts of awake-like brain activity - an over aroused nervous system - limiting the amount of time they spend in deep sleep [25-27].


Cognitive dysfunction This includes poor working memory (what was I just doing?), spatial memory alterations, free recall, and verbal fluency associates with pain in fibromyalgia as well as other pain patients and is different from healthy people [28-30].

Mood disorders Such disorders, including depression and/or anxiety, are present in up to three quarters of persons with fibromyalgia, but mood disorders and fibromyalgia are likely distinct [31]. Anxiety commonly coexists with depression, but is also independently increased in fibromyalgia patients [32-33].

Pain-related symptoms Somatic (body) symptoms, including irritable bowel syndrome, migraine headaches, severe menstrual pain, lower urinary tract symptoms, myofascial facial pain, and temporomandibular pain have all been associated with FM [34-37].

Non-pain related symptoms Sexual dysfunction has recently been reported to occur in 97% of fibromyalgia patients [38]. Fibromyalgia patients may be more vulnerable to post traumatic stress disorder (PTSD), with depressed fibromyalgia patients having a three-fold increase in PTSD compared to those with chronic fatigue only [39].

Other Symptoms Other symptoms can include restless leg syndrome and periodic limb movements, skin sensitivities and rashes, dry eyes and mouth, anxiety, depression, ringing in your ears, dizziness, Raynaud’s Syndrome, and impaired coordination.

—————————————————————————————————————————— What causes Fibromyalgia?

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Fibromyalgia is a complicated condition that appears to have more than one trigger — although most researchers agree that the primary cause is a breakdown in the normal function of the Central Nervous System, which creates an abnormal perception of pain.

“The cause of Fibromyalgia must involve one or more abnormalities by which the Central Nervous System interprets pain signals” [40].

“Fibromyalgia appears to result from a Central Nervous System derangement — the peripheral tissues and tender points are secondary phenomena” [41].

“The actual cause of Fibromyalgia is likely an interaction of many processes involving neurological conditions that affect blood flow, sleep, muscle use, and the transmission of pain” [41].


“An interpretive defect in the Central Nervous System may be responsible for abnormal perception of pain in the absence of recognizable tissue injury” [1].

“An oversensitive nervous system generates false alarms spontaneously or from ordinary non-painful stimuli. Physiologists now recognize that nerves and muscles can generate abnormal impulses and the technical term for this is super-sensitivity” [42].

In other words, the increased pain is caused by a problem with central nervous system processing of pain signals. The part(s) of your central nervous system that process pain and their pathways are sensitized or super sensitive. In other words you are feeling pain when there is nothing happening that should be causing you to feel pain.

A recent study found an increased prevalence of fibromyalgia among workers after a neck injury. Fibromyalgia was 13 times more frequent following neck injuries than following lower extremity injuries [43].

Why do so many people involved in car accidents or work accidents develop fibromyalgia?

In many car and work accidents there is a sudden impact that causes the body to do two things: First, the body and head will move in opposite directions, causing the head to jerk suddenly backward (hyperextension) and forward (hyper flexion). Then, the neck muscles stiffen in an effort to prevent serious injury to the spinal cord and brain, which can cause tearing of the muscles, and stretching of ligaments and muscles in the back of the neck.

I also note that fibromyalgia syndrome is often associated with repetitive strain or overuse syndrome as a result of occupational tasks [44].

In short, there is a lot of muscle trauma involved in most car accidents, particularly rear end collisions associated with whiplash.


The theory is that:

Acute flexion-extension injuries, typically seen in auto accidents, can cause whiplash trauma to the cervical spine, even in the absence of bony damage and immediate pain. These injuries are extremely common and often lead to conditions such as chronic headaches and Fibromyalgia [43].

I am not in 100% agreement with this theory. While I do believe the injuries precede fibromyalgia, we should not be quick to assume it is the muscle strain or damage that is causing it.

The whiplash action of the head/neck causes a shaking of the brain, stretching/shearing of the cranial nerves that exit the skull as well as stretching/shearing/twisting of the brainstem and spinal cord as it leaves the skull and enters the neck.

I believe that this type of assault on the brain and central nervous system is primarily what leads to sensitization of the pain processing centres and pathways that eventually manifests itself as fibromyalgia.

Disturbances to the nervous system are referred to in scientific literature by several names including neuritis, dysponesis, nerve dysfunction, double-crush phenomenon, neuropathophysiology and subluxation (spinal joint dysfunction), all of which cause disturbances the nervous system.

I would like to note that a primary cause of nervous system disturbance is found in the spinal column. When the relationship between two vertebrae becomes compromised, irritation and dysfunction occur in the nerve pathways. In the chiropractic field, nerve dysfunction caused by spinal joint compromise is called a "subluxation”.


—————————————————————————————————————————— What are the triggers of Fibromyalgia?

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Some researcher believed they have found the cause of fibromyalgia when, in reality, they were only finding triggers. Now we know what mechanisms are “out of whack” in fibromyalgia - the central nervous system pain processing pathways.

Usually the trigger is some sort of stressful event or events that you experience. Things such as emotional trauma, infections with certain viruses, accidents, illnesses, surgery or development of another disorder such as rheumatoid arthritis, lupus or hypothyroidism.

It’s important to understand that these triggering events do not cause fibromyalgia; rather, they might awaken an underlying physiological abnormality that is already present. The trigger just stresses your body to its “tipping point” where it responds pathologically.

The trigger can be any type of significant stress.

This is why some researchers have mistakenly thought they had found the “cause” of fibromyalgia when they have really only found a common trigger for developing the disease. The underlying cause is in the nervous system.


—————————————————————————————————————————— What is the typical treatment for Fibromyalgia?

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The cure for fibromyalgia is not in a pill. (No surprise there). However, we are talking about treatment here, not a cure.

Symptom management does just that, (attempts to) manage symptoms, for a while. Eventually the pain comes back, new symptoms surface, and/or you end up experiencing side effects from the medication.

The treatment you receive is your decision. In making this decision it is important that you consider what your goals are. Essentially, there are two roads to take on this journey:

1. Cover up the pain and masking the symptoms. 2. Fix the root cause of the pain.

There are many different ways to cover up the pain. And let’s face it, when you are suffering with fibromyalgia all you really want is for the pain and suffering to end! Who can blame you?

Currently, even without fully understanding fibromyalgia, we have much more knowledge about treating the symptoms than we’ve ever had before. However, the one thing you must realize when you decide to go down this road is that in doing so you are not addressing and eliminating the root cause of the pain. That’s all.

I have been know to make the following statement: “Drugs Work!” Yes, you read that correctly. Drugs are designed to alter how you feel. Pain killers do just that, kill pain. They are not designed to fix the problem causing the pain. So, if covering up your pain is what you want to do then chances are you can find a medication (eventually) that will cover up the pain, at least


for a period of time. The downside is that eventually they will stop working and you will most likely experience other (side) effects of taking them.

“There is little evidence that we can treat Fibromyalgia patients effectively with drugs. A recent study of patients with long-standing Fibromyalgia demonstrates that expensive medical care does not result in symptom improvement or better function.” - Frederick Wolfe, MD [45].

“The medications used to treat pain and inflammation for most rheumatic disorders is not of great help in Fibromyalgia. Aspirin and NSAIDS (non-steroidal anti-inflammatory drugs), such as Ibuprofen, do little to reduce pain. Even more powerful drugs such as corticosteroids do not seem to help the pain, stiffness, and fatigue of Fibromyalgia.” - American National Arthritis Foundation [46].

Natural remedies for pain relief also work, if you find the right one. There are many to choose from. However, in the case of fibromyalgia, they do not fix the problem. You are just swapping a substance which must be prescribed by a physician for a substance that you can get without a prescription. There really is no difference.

Got it? Good.

There are also many things you can do to help alleviate the pain and suffering of fibromyalgia. I recommend many of these to my patients, while we are working on eliminating the condition.

—————————————————————————————————————————— What you can do for yourself

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Let’s have a look at the different components that support the central nervous system that you should consider addressing in your day to day life. I could write a dissertation on these. Many have. I am not going to go into the details here because there needs to be individualized recommendations for individuals. Realize that you can do many things on your own. You may need help with some. But that’s okay, we all need a little help sometimes…

Eat Well “You are what you eat. So don’t be fast, cheap, easy or fake. You’re worth more than that.” - Unknown. I love that statement. You need good building blocks and fuel to build and maintain your body. So, in the case of fibromyalgia, there are two foundational concepts: 1. Eat foods that support your brain and body. 2. Do not eat foods that create inflammation and have the potential to be toxic to your brain and body.

Reduce Stress When you are stressed your body moves into a sympathetic also know as a “fight or flight” state. This is the opposite of a parasympathetic or “rest and digest” state. When we need to


heal from an illness or injury our body should move into a “rest and digest” state. That’s why we become so tired. Our body is using it’s energy to heal so it slows us down.

If we are too stressed we may become stuck in a sympathetic state. If we are stuck there too long our central nervous system and our body slip into exhaustion. This may manifest itself as any number of conditions. One of these is fibromyalgia.

Deal with Emotions Emotional stress is just that - stress. Your central nervous system generates the “fight or flight” (sympathetic) response regardless of whether the stress is emotional or physical. It does not discriminate.

If you have experienced a severe or recurrent emotional stress in the past then there is a good chance that there is now a sustained stress response occurring within you. This sustained response needs to be “broken” or “interrupted” and healthier neurological responses need to be generated in order to facilitate the healing process from fibromyalgia. There are many simple ways to do this. (Simple does not mean easy.) The right doctor will be able to help you in this process.

Get Moving We all know that exercise is good for us. It keeps our muscles strong, heart healthy and lungs working well. What you may not know is that the benefits of exercise go beyond what you may see. Exercise and movement is very important for maintaining a healthy brain and nervous system. It is imperative.

The great thing is that the world of brain study has advanced so much in recent years that we now know so much more than we ever did about how different movements affect and activate multiple brain pathways simultaneously. Using this knowledge we are able to choose exercises and movements that heal.

Detox The question to ask is no longer “Are you toxic?” It is now “How toxic are you?” We live in a world that is placing a large burden on our detoxifying ability. There are some people who downplay the role that toxic exposure plays in our lives. The truth is that we can not and should not ignore this. It plays a big part in why you are unwell. As this is the case, it is important to determine when how you should detoxify.

The first important step is to do what you can to reduce the toxins you take in. Avoiding artificial sweeteners is probably one of the most important steps to take. Aspartame has been shown to trigger and increase fibromyalgia symptoms. I suggest that this is due to the damaging effect is has on the central nervous system.

Supplements First I want to make it very clear that there is no “one size fits all” when it comes to supplements for fibromyalgia. I have seen advice and recommendations from numerous


sources on the internet, in health food stores and from other practitioners that have not been personalized.

I see supplements falling into 2 different categories.

The first is made up of supplements that provide us with the nutrients that we are not getting enough of to function normally. High quality multivitamin and mineral supplements fall into this category. I will save the details for another day.

The second category are those that are required to help you heal from an illness or condition. Once an organ or system has been compromised to the point that it needs extra help - more help than a simple multivitamin can provide. There are multitudes of supplement blends for different organs - adrenals, thyroid, liver, pancreas, stomach, muscle, brain and the list goes on. The key is to know which organ and/or system actually needs the help. Sometimes an apparent thyroid problem is actually a liver or kidney problem. It’s not always as clear cut as it seems. That’s where a good doctor practicing the art of health care comes in.

Sleep How much should you sleep? - As much as you need. I know, you are exhausted and could sleep all day. When you are not well your body is using all the energy just to “keep your head above water”. The key is to get the most effective sleep that you can.

Some things that have been shown to improve sleep are daily exercise, no screen time before bed, habitual bed times, rhythmic diaphragmatic breathing, complete darkness, room temperature below 21*C, hot shower/bath before bed, etc. There really is so much to consider. With a little help from an attentive doctor you can implement a sleep plan that works for you.

—————————————————————————————————————————— How do I treat fibromyalgia?

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“It’s about time we started treating people and stopped treating conditions” is my motto. In order to fix you the focus must be on you and not the labelled condition.

As with most disease, the key to treatment lies in supporting your body’s own abilities to heal itself through good nutrition, restorative sleep, moderate exercise, lowering stress and normalizing central nervous system function. The key to curing fibromyalgia is not a pill. No surprise there.

Over the years, medical science has tried many fibromyalgia patients on many different drugs using a “shot in the dark” approach, hoping something would stick. Nothing has. Most drugs create more symptoms than they relieve.

So, there really needs to be a multi-faceted approach to eliminating this condition. Yes, I said “eliminating”. I truly believe that you are able to restore normal central nervous system function


and take care of the other systems that support the central nervous system and eliminate fibromyalgia.

By examining the function of your nervous system, how it is integrating with the rest of your body and regulating what you feel, along with reviewing your health history, it can be determined what is not working correctly. Integrating neuroscience, biochemistry and neurologically based chiropractic is the logical choice for addressing your fibromyalgia pain.

—————————————————————————————————————————— Your must decide

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Cover up the pain or fix the root cause of the pain? - The choice is yours.

In order to fix the problem you need to address the cause. Everyday it becomes more and more clear that the underlying cause of fibromyalgia rests in the dysfunction of the central nervous system. So, if you want to truly fix the problem you need to address this cause.

—————————————————————————————————————————— Great - Now how can we do this?

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Along with addressing all the factors that influence and support the central nervous system, we must also treat the central nervous system itself. We must provide appropriate input and stimulation into the central nervous system so that it functions more effectively and efficiently. This will ultimately fix your problem.

“The quality of healing is directly proportional to the functional capability of the central nervous system to send and receive nerve messages.” - Janson Edwards, MD, PhD

"There is little doubt that fibromyalgia pain is due to an intrinsic nerve-system dysfunction.” Dr Manual Martinez-Lavin [47]

“Hyper functional or hypo functional neurons along a neural chain prevents normal nerve transmission causing disturbances in the homeostasis of the cells, tissues, and organs.” - Academy of Pain Research [48]

“Subluxations (dysfunctional spinal joints) are very real. We have documented them to the extent that no one can dispute their existence. Vertebral subluxations change the entire health of the body by causing structural dysfunction of the spine and nerve interference.” - Chang Ha Suh, M.D. PhD [49]


Properly applied, gentle and non-manipulative (no “cracking”) chiropractic treatment has proven to be a safe and effective method of resolving neurological conditions such as fibromyalgia and should be considered as a “first choice” by patients suffering with this condition.

The health and function of the human being and it’s relationship to the health and function of the spine and central nervous system has always been and continues to be my focus. By asking the right questions we will get the answers that will guide us in creating the right plan and performing the correct treatments to restore healthy nervous system function. The result? - You will not only feel better, you will function better. That’s what being healthy is.

There you go. Fibromyalgia - the long version… !

If you have any questions about fibromyalgia or any other condition please call the office on 613-230-0909 or email me at [email protected].

Be well.

David King, D.C. 40-838 Somerset Street W. Ottawa, ON K1R 6R7 613-230-0909 www.drdavidking.ca

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