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WHAT IS FIBROMYALGIA? Fibromyalgia is a syndrome. A syndrome is defined as a number of characteristic symptoms occurring together. The primary symptom seen in fibromyalgia is widespread pain and tenderness throughout the body for a long duration. Other symptoms include Chronic Fatigue, Morning Stiffness, Headache, Urinary Urgency, Anxiety or Stress, Irritable Bowel Syndrome, Sleep Disturbance, Tingling and/or Numbness, and Excessive Menstrual Bleeding.1 Almost nothing is known of the factors leading up to someone getting fibromyalgia, however the diagnosis of fibromyalgia has been on the rise in the past 15 – 20 years with its incidence rated at up to 4.8% of the public in 1995 and climbing.2 The syndrome affects more women than men. Descriptions of fibromyalgia appear in medical literature as far back as the writings of Hippocrates (460-377 BC).3
WHAT IS THE CRITIERIA FOR A FIBROMYALGIA DIAGNOSIS?
Unfortunately, fibromyalgia has often become a wastebasket diagnosis for poorly characterized or poorly understood musculoskeletal pain. This is unfortunate and leads to a lot of confusion. The American College of Rheumatology established the following criteria in 1990 for a fibromyalgia diagnosis.1
1. A history of widespread pain for at least 3 months duration. Widespread pain is defined as pain in the left side, the right side as well as pain above the waist and pain below the waist and axial skeletal pain. Pain in all these areas must be present to satisfy the definition of widespread pain.
2. Pain in 11 of 18 tender points when pressure is applied by the examiner. The 18 specific tender points are shown below. The points are not precise anatomical locations, pain and tenderness may occur in a radius of about 1 cm from the specific site.
It is also suggested that if only 40% to 60% of the tender point sites are present and the patient has at least three of the following symptoms – fatigue, sleep disturbance, anxiety, irritable bowel syndrome, headache, and parathesia (numbness and tingling) – a clinical diagnosis of fibromyalgia can be made. 1
WHAT IS FIBROSITIS?
Fibrositis is another name used in the past for fibromyalgia. Other names that have been used include psychogenic rheumatism, generalized tension myalgia, generalized nonarticular rheumatism, and generalized soft tissue rheumatism.3
What is Myofascial Pain Syndrome or Trigger Points?
Myofascial pain syndrome or trigger points is a syndrome characterized by painful tender areas when touched. They are commonly associated with a muscular twitch or jump sign when touched and also an area of referred pain. Myofascial pain syndrome in not chronic and is localized as opposed to fibromyalgia and usually have a specific triggering event associated with the occurrence.3 Janet Travel MD did extensive work with trigger points and was responsible for helping President John F Kennedy’s low back problems. Doctors of Chiropractic work with their hands to apply pressure (Nimmo technique) to remove the trigger points that they find.
Who gets fibromyalgia?
Fibromyalgia affects at least 6 million Americans. Roughly 4 million of the total are women. It frequently occurs in midlife however it can be seen at any age.4
What causes fibromyalgia?
Little is known about the exact cause of fibromyalgia. Sometimes fibromyalgia patients remember a specific triggering event such as a physical or emotional stress associated with the onset of the symptoms. The following table shows factors that have been reported as causing or being associated with fibromyalgia.5
 Fibromyalgia has also been recognized in whiplash injuries. Whiplash occurs in accidents where the human body is rapidly accelerated and decelerated causing the neck and head to be whipped about beyond its normal control. The most common whiplash injuries are from vehicle accidents. Fibromyalgia has been found to be 13 times more common in neck injury patients than in leg injury patients, which indicates a connection to the nervous system as playing a role in the problem. 6
Research focusing on central nervous system disturbances in fibromyalgia patients has reported a generalized hypervigilance and hyperactivity of the sympathetic nervous system.6
What can I do if I have Fibromyalgia?
There is no known specific cure for fibromyalgia, however; several areas can be addressed to help alleviate the symptoms of fibromyalgia.
1. 1) Chiropractic adjustments of the spine to relieve nervous system interference has been shown to be effective in improving fibromyalgia symptoms. When compared with rest, narcotics, NSAIDS such as Advil, tranquilizers, steroid injections, and amitryptyline, Chiropractic adjustments gave the most relief, second to rest, see the table below.5
 2) While exercise rates fairly low in the table above and most fibromyalgia patients do not want to exercise because of pain and fatigue but if they do their prognosis is improved. Mild aerobic exercise has been found to be effective at improving fibromyalgia symptoms.7 Research has shown that as little as a 10-minute walk is enough to increase ones energy, alter their mood and produce a positive outlook for up to 2 hours.8 3) Specific nutrition has been shown to be effective in improving fibromyalgia. These include Malic Acid9, Magnesium9, Vitamin E10, Vitamin B6 - Pyridoxine11, Manganese9, Thiamine – Vitamin B111. However minerals and vitamins work in conjunction with one another. One cannot be taken alone without having an effect on the other.12 Too much of a specific mineral or vitamin can have detrimental effects on another. A balanced nutritional program should be included in any nutritional program. Dosages of 1200 to 2400 mg of malic acid with 300 to 600 mg magnesium have been used with success9 and up to 200 IU Vitamin E, 25 mg Vitamin B6, 25 mg Manganese, and 25 mg Vitamin B1 have been used in conjunction with a balanced nutritional program. 4) Aluminum toxicity may play a role in fibromyalgia patients. Aluminum toxicity is widely known to disturb metabolic processes. Adequate magnesium is necessary to help prevent the toxic effects of aluminum. Malic Acid is also a potent aluminum detoxifier and is effective at decreasing aluminum toxicity in the brain.9 Significant pain relief was experienced by all fibromyalgia patients in a study on the combined effects of malic acid and magnesium.13 Dosages of 1200 to 2400 mg of malic acid with 300 to 600 mg magnesium have been used with success.9
4 Soderburg, S., Norberg, A., Metaphorical Pain Language Among Fibromyalgia Patients. Scand J of Caring Science, 1995, 9:55-59.
5 Wolfe, F. MD. The Clinical syndrome of Fibrositis. The American Journal of Medicine. 1986; 81:7-14
6 Melton, M.R., The Complete Guide to Whiplash, Body-Mind Publications1998, pp31-34
7 Wigers, S.H., Stiles, T.C., Vogel, P.A., Effects of Aerobic Exercise Versus Stress Management Treatment in Fibromyalgia. Scand J Rheumatol 1996; 25: 77-86
8 Inlander, C.B., Moran, C., 63 Ways to Relieve Tension & Stay Healthy, pg 48
9 Sahley, B.J., Malic Acid and Magnesium for Fibromyalgia and Chronic Pain syndrome. Pain and Stress Publications 1999
10 Steinberg, C.L. BS MD, The Tocopherols (Vitamin E) in the Treatment of Primary Fibrositis. J Bone Joint Surgery 1942; 24(2):411-423
11 Percival, M. Fibromyalgia Nutritional Support. Clinical Nutritional Insights 1997 pg3
12 Bergner, Paul, The Healing Power of Minerals. 1997 Prima Publishing p263
13 Russell, J., Michalek, J.E., Flechas, J.D., Abraham, G.E., Treatment of Fibromyalgia Syndrome with Super Malic®: A Randomized, Double Blind, Placebo Controlled, Crossover Pilot Study. The Journal of Rheumatology, 1995; 22:953-958 |
