Fibromyalgia and Chiropractic
Do you feel like you have the flu all of the time, with achiness and pain all
over? Is the pain worse in the morning, often with increased muscle stiffness?
Do you feel fatigued every day, even after a full nights sleep, Headaches,
irritable bowel syndrome, premenstrual syndrome, dysmenorrhea (menstrual
cramps), chest pain, an intolerance to cold or damp weather, or TMJ syndrome?
Do you often feel anxious or depressed? 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 very real but little understood condition that is neither
disfiguring nor life threatening syndrome known a Fibromyalgia!
What is fibromyalgia?
Fibromyalgia is a common and disabling disorder affecting 2-4% of the
population, women more often than men. Despite the condition's frequency, the
diagnosis is often missed. Patients with fibromyalgia usually ache all over,
sleep poorly, are stiff on waking, and are tired all day. They are prone to
headaches, memory and concentration problems, dizziness, numbness and tingling,
itching, fluid retention, crampy abdominal or pelvic pain and diarrhea, and
several other symptoms. There are no diagnostic lab or x-ray abnormalities, but
a physician can confirm the diagnosis by finding multiple tender points in
characteristic locations. Fibromyalgia often runs in families, suggesting an
inherited predisposition. It may lie dormant until triggered by an injury,
stress, or sleep disturbance. It is closely related to the chronic fatigue and
irritable bowel syndromes. Some have suggested that these are all just
different facets of the same underlying disorder.
What causes it?
Fibromyalgia has mistakenly been thought to be either an inflammatory or a
psychiatric condition. However, no evidence of inflammation or arthritis has
been found, and patients with fibromyalgia are now known to be no more
depressed or anxious than those with other chronic, painful, debilitating
conditions. It is now believed that depression and anxiety when present are
more often the result than the cause of fibromyalgia. There is some evidence
that fibromyalgia may be due to an abnormality of deep sleep. Abnormal brain
waveforms have been found in deep sleep in many patients with fibromyalgia.
Fibromyalgia-like symptoms can be produced in normal volunteers by depriving
them of deep sleep for a few days. Low levels of somatostatin, a hormone
important in maintaining good muscle and other soft tissue health, have been
found in patients with fibromyalgia. This hormone is produced almost
exclusively in deep sleep, and it's production is increased by exercise.
I should point out though that while this is my personal favorite among the
theories of the cause of fibromyalgia, there are several others, and at this
time there is probably not a majority of fibromyalgia researchers that supports
any one theory.
How is it treated?
Fibromyalgia is difficult to treat, not because treatment isn't usually
successful (it is), but because it will take a lot of work, education, and
involvement on your part for it to be successful. Simply starting the right
medication will have little effect. Successful treatment of fibromyalgia
requires:
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Regular sleep hours and an adequate amount of sleep.
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Medication to improve deep sleep.
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Daily gentle aerobic exercise.
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Avoidance of physical and emotional stress.
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Treatment of any coexisting sleep disorders.
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Gentle Chiropractic and massage therapy.
If any of these five are omitted, significant improvement is unlikely.
Regular sleep
Patients with FMS must get to bed by the same time every night and sleep as long
as they need to. Staying up just one hour late may precipitate an exacerbation
that lasts for several days. Many patients with fibromyalgia have exacerbations
triggered by the change over to or from Daylight Savings time. Try to make the
switch in fifteen minute increments every few days instead of by one hour
overnight. I have had no success getting patients truly feeling well who work
off shifts that prevent them from having a consistent bedtime.
Exercise
Daily gentle aerobic exercise is very important. While patients who do too much
exercise too soon or of the wrong kind will make themselves temporarily worse,
most patients who don't begin a daily aerobic exercise regimen will notice
little improvement in their fibromyalgia symptoms. Aerobic exercise is defined
as exercise that gets your heart rate up to a target heart rate for the
duration of the exercise period. Heart rates are measured in beats per minute.
It is accurate enough for our purposes just to take your pulse for 6 seconds
and multiply by 10. The aerobic target heart rate is calculated from the
following formula:
(220 - age - rhr) x .6 + rhr
Where age is your age in years and rhr your resting heart rate, determined by
taking your pulse when you wake up but before getting out of bed. A good place
to feel your pulse is at the wrist turned palm up, next to the large bone on
the thumb side at the end of your forearm. If you are exercising hard enough
you should be able to feel your heart beating and can just count that. For most
people, the aerobic target heart rate is at about the point where they can no
longer sing but can still talk comfortably.
The kind of exercise is unimportant. Just make sure to pick something that
doesn't make you hurt worse. It may take trying several different kinds before
finding one or more types that agree with you. Popular kinds include walking,
regular or exercise bicycles, ski simulators, rowing machines, rebounders,
swimming, and *gentle* aerobic dance. Jogging, vigorous aerobic dance, and
weight lifting tend not to very good choices. If your pain is mainly in your
legs or back, consider exercising just your arms with a Thighmaster or similar
equipment. While many patients insist that they get plenty of exercise at work,
doing housework, or in their yard, this is rarely the case. These types of
exercise are rarely helpful, as they don't result in a sustained elevation of
the heart rate, and often increase pain and make patients feel worse. You need
to set aside a time specifically for daily exercise. Particularly if you are
out of shape, start out with just 3-5 minutes of exercise and gradually
increase as tolerated, shooting for twenty to thirty minutes. Take a few
minutes to stretch your muscles, then start out slowly, increasing to full
speed after a minute or two. Slow down again for the last minute or two and
repeat the stretches. There are five recommended stretches, each done for 20
seconds a side. They should be gentle and painless. Hold onto a tree or post
for support for #s 3-5:
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Shrug your shoulders in a circular motion.
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Reach your arm over your head and bend to the opposite side.
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Bend forward with your legs straight.
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Pull your foot towards your buttock while standing on the other leg.
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With your feet flat on the ground and one foot ahead of the other, lean
forward, bending just the front knee.
Exercise is more effective if done in the late afternoon or evening. If you
absolutely can't do it then, exercising earlier in the day is better than not
exercising at all, but you will probably need to exercise longer for the same
effect. Some patients find that exercise provides an immediate benefit, making
them feel more alert and comfortable for several hours. If you experience this
effect, you may want to try exercising three times a day instead of just once.
Patients who can do this are the ones most likely to eventually be able to get
off medication. Exercise seems not to work through conditioning of muscles but
rather through a direct, possibly hormonal effect on pain and sleep. Patients
who have been exercising regularly and then miss a day usually find that their
fibromyalgia symptoms are significantly worse the next day.
Avoid physical and emotional stress
Exercise is an indispensable component of successful treatment, but too much
physical activity of the wrong kind can precipitate a relapse. Rather than
doing housecleaning, yard work, or other physical activity all on one day,
break up the task so that you do a half hour or an hour every day until it is
done. While it is difficult to learn to do this, it is essential that you be
able to sense when you have reached your limit and stop. You need to be able to
say no to family and friends when you are not up to some outing or other
activity. Don't take on extra stressful responsibilities if you don't have to.
If you have ongoing problems with depression or anxiety, consider seeking help
for them from your family doctor or psychiatrist in an attempt to lower your
overall stress level. Relaxation techniques or a chronic pain program can also
help lower your stress level. Fibromyalgia patients must learn to manage their
physical and emotional resources.
Treat other sleep disorders
Several other sleep disorders besides insomnia may aggravate fibromyalgia.
Almost half of men with fibromyalgia and some women have obstructive sleep
apnea. In this condition the patient snores loudly and has periodic pauses in
breathing after which he starts breathing again with a snort. Periodic limb
movements of sleep is a condition in which patients twitch every 30 to 90
seconds for long periods during the night. Patients may be completely unaware
of either of these conditions until the spouse complains. Not only will it be
difficult to get fibromyalgia symptoms to improve without treating these
disorders, but if sleep apnea is left untreated it may lead to accidental death
or injury as well as early strokes or heart attacks.
Other common sources of repeated sleep disturbance are a spouse's snoring and
young children. If the spouse drinks alcohol in the evenings or is overweight,
then avoidance of alcohol after supper or weight may eliminate snoring.
Sleeping propped up on the side will often help. At the very least, the patient
can wear earplugs. Children are harder to put off but fortunately most soon
outgrow their need for care at night. It is important to avoid prescription
tranquilizers and sleeping medications of the benzodiazepine group. While these
may help you get to sleep, they suppress deep sleep and therefore often make
fibromyalgia worse.
Alcohol and Narcotic Pain Medications
Taken in the evenings they have the same effect on deep sleep and should be
avoided. Try not to exercise just before bed, as this may make it harder to
fall asleep. Patients with fibromyalgia should probably give up caffeine
completely as even one cup in the morning can sometimes disrupt sleep at night
and may also directly increase muscle pain and headaches. If you are drinking
more than a cup a day you should gradually taper yourself off
caffeine-containing beverages over two weeks or so to minimize caffeine
withdrawal symptoms such as headaches. It is also helpful to refrain from
protein consumption in the evening.
Gentle Chiropractic and Massage Therapy
Many patients report that chiropractic adjustments, gentle massage as well as
heat and rest help relieve their symptoms. Others find that, as with migraine,
certain foods can precipitate their symptoms. Specific chiropractic adjustments
can give considerable relief by getting the nerve-muscle-joint component
working properly and to help the body to metabolize waste products, thereby
decreasing the patient's pain sensitivity and eliminating the tender nodules.
It often takes two weeks or more before the beneficial effects of chiropractic
adjustments take effect. Patients should be warned that despite optimum
treatment and good initial results, brief relapses are common.
Support and Education
For best results, you need to be actively involved in your treatment and to have
as clear an understanding of this complicated disorder as possible. I recommend
that you keep this handy and re-read it periodically. Patients with
fibromyalgia often elicit less sympathy and support from family, friends, and
employers than they deserve because of the lack of outward evidence of disease.
Many patients have been told by other physicians that there is nothing wrong
with them or that it is "all in your head" which can be very demoralizing.