Fibromyalgia
I. The Diagnosis
What is Fibromyalgia? There are a lot of opinions on this subject and a good deal of research. When you
have read this section there is a good chance you know more about it than some of your care givers do.
It is sad that many have considered Fibromyalgia to be a wastebasket diagnosis. If they do not know what to
call your widespread pain you may well get the diagnosis! Many believe it is not treatable. If so, when you get
the diagnosis, they are off the hook! They have a name for your pain but can do nothing about it. Now, you
have to live with it. That’s ok – at least you are not crazy. You have a diagnosis!
The most common definition of Fibromyalgia references 11 of 18 locations being painful to 4 kg of pressure
and widespread pain. This is a description that actually can fit a number of conditions. It is worthy of a book
itself and many have been written. It has been found that the ability to reproduce the 4 kg of pressure needed
to make the diagnosis was rare among researchers when they were tested. This does not bode well for
patients.
The untold story behind the criteria is that the criteria were developed for the purpose of figuring out who
should be part of a study. It was not meant to be how to diagnose the condition. In fact, of the 75 points that
were studied, only 2 were part of the 19 most sensitive points. It is important to identify the other
characteristics that characterize this condition. The main point to consider about the pain is that it is
widespread and has been present for at least 3 months.
I recommend Devin Starlanyl’s Fibromyalgia & Chronic Myofascial Pain: A Survival Manual. Many patients
arrive in my office and report that it saved their lives – some of them literally. They learned about their
condition in a good deal of detail and were able to make a number of lifestyle changes.
II. Supportive Treatment
What else may be needed?
Thyroid
I can not express in mere words the importance of dealing with suboptimal thyroid dysfunction and resistance
to one’s own thyroid hormone. Most patients is see have already been tested for thyroid dysfunction and have
received normal reports. These patients often benefit from metabolic rehabilitation. It is amazing to see the
changes that occur in patients with FM who follow the protocol of metabolic rehabilitation developed by Dr.
John Lowe. His mammoth 1,300+ page Metabolic treatment of Fibromyalgia is teaching doctors worldwide
how to successfully treat most Fibromalgia. He has written a book for the rest of us entitled, Your Guide to
Metabolic Health. I highly recommend it. He is able to relieve the symptoms of Fibromyalgia in 85% of his
patients. That is pretty good for a disease that has no "cure." His books and services can be found at www.
drlowe.com. His book is a must read if you have FM. The supplements he recommends and 3 free chapters
of his self care book are available at www.thyroidscience.us.
FSM
Frequency Specific Microcurrent has been shown to be remarkably effective for post traumatic fibromyalgia.
Dr. Carol McMakin has trained doctors and therapists all over the country to use this device. She has even
created a home unit that can supplement the work of your doctor and therapist. The machine creates an
electrical frequency that causes your tissues to resonate and your pain to decrease. In one study 49 of 54
patients had complete recovery of symptoms in 9 treatment sessions!
Chiropractic
Chiropractic is often very helpful in cases of FM. There are many “flavors.” Just because one did not work
does not mean another won’t. It is a rare treatment team that is adequate when there is no DC. If you have
Fibromyalgia it is imperative that your doctor be gentle. Ask around. Don’t pick this person out of a phone
book.
III. Treatment Goals
What do you should you expect
This is the hardest question you deal with in chronic pain conditions like Fibromyalgia. You don’t know what
can be reasonably expected. Many times you have been told by friends, relatives, and even care-givers that
you just have to live with it. You are told to focus on what you can do instead of what you can’t. These people
are well meaning. They think they know what is best. They are often the biggest hindrance to pain relief.
If you receive specific trigger point therapy you can have a reasonable expectation that you can get pain relief.
This relief can be significant. Good treatment will emphasise self-treatment activities, posture, your nervous
system, and perpetuating factors.
It is imperative that you take responsibility for your own health by vigorously pursuing those activities that tend
toward health and wellness. Your therapists will give you practical and theoretical information and tools to aid
you in this journey.
Treatment goals need to be set. Those goals need to be both long and short term.
IV. Treatment Strategy
Big picture approaches – Big picture approaches are those that may not appear to be directly related to your
current complaint. Some practitioners miss this altogether during the course of treatment. Most patients
miss it regularly. Patents we tend to be goal oriented. The goal is generally immediate gratification in the
area of pain relief. Why would we accept anything else. We are Americans.
You must accept and embrace the big picture approaches because apart from them Fibromyalgia does not
get better for more than a few minutes. We need to look at the big picture and create the environment in
which your healing can take place. It is very much like sending a small child (ok a teenager – ok - its me!) into
a room to look for an item. If the room is messy it will be difficult to find the item. In the area of our health we
need an environment that is supportive of healing. The following are just a few areas that I have seen to have
a large impact on patients in their recovery of health.
`The more properly we can align our body, the better we feel. This was brought home to me in a very powerful
way in school. The teacher had 20 of us walk in a circle watching the posture of the person in front of us. I
was getting pretty bored and worrying about my teacher’s sanity when we were allowed to stop. The stop was
temporary. We were then given small pebbles to put in our shoes and to resume our walk. The resultant
postures were not only amusing, but enormously painful!
Look at those you know who are in pain. What does the position of their body say to you? Now look in the
mirror. Is your head straight? Are your shoulders and arm lengths level? Have someone view you from the
side. Does your head sit over your rib cage or does it protrude forward. Are your Shoulders at your sides or in
front of your torso? Does your belt tip forward or back?
These positions are determined by the length of your muscles and the length of your muscles depends
largely on your activity to keep them lengthened or strong. Treating the muscles that created postural
abnormalities allows your body to have less interference with the nervous system, less abnormal muscular
tension, and greater ability of your body to balance itself in all other areas.
Biochemical
Our biochemistry is determined by a number of factors that are in our control (breathing, food, air, water,
stress). I received a phone call from a good friend. She had not slept through the night in several months
due to allergies that affected her breathing. An air purifier got her sleeping once more.
Breathing properly is especially important for maintaining the proper Ph level. 10 minutes of abdominal
breathing has been known to lower the Ph level. This in turn will aid in decreasing the irritability of your trigger
points.
Food intake can be very important. Dr. John Lowe in his book Your Guide to Metabolic Health recommends
what he calls the Cave Man Diet. He wrote about it in the 80s. A very similar program is put forth in the Zone
Diet. Read those sources for dietary information.
Water intake is another very important part of therapy. Water is needed by the body for a number of vital
functions. Your Bodies Many Cries for Water is an excellent summary of a number of these. An especially
important reason for water intake is to hydrate the muscles so that they function better. Water will help to
flush the byproducts of metabolism and the inflammatory chemicals away from your nerve endings. This
helps to decrease pain.
Neurological
Approaching Fibromyalgia from a neurological perspective is another big picture approach that is essential in
its treatment. Pressure on spinal nerves increases the irritability of all of the muscles that nerve supplies. It
perpetuates and perhaps even causes trigger points to be activated. Decreasing this pressure is essential
your Myofascial Trigger Point Therapist can help in this area.
Psychosocial
This is an area that most people feel to be completely beyond their control. It is certainly multifaceted. It
seems to be the domain of mental health professionals. That makes it especially touchy. Depending on your
social circles it is either the thing to do or the death of your respectability to obtain the services of a mental
health professional.
Worse yet, it is not uncommon to be told you have a mental condition when your health care provider is not
familiar with trigger points or Fibromyalgia. You have probably tired of being told it is all in your head!
Mental health is important. There are many ways of getting there. Some better – some worse. Dealing with
stress and nutrition are huge steps forward in dealing with these types of issues. Dealing with head injuries
is a must. I recommend Daniel Amen’s book, Making a Good Brain Great, it is a great starting place.
A healthy soul is essential to good mental health. I can not imagine trying to face any long term illness apart
from God and his people. In the church I have seen the grieving comforted, people counseled, meals
prepared for those who could not, vehicles purchased, and rent paid. I have seen alcoholics stop drinking,
gang members become gentle, and the unlovable, loved. God changes hearts, people, and behavior. The
most real healing I have seen or experienced is in the church among caring people. I have learned to mend
relationships, treat my family in a loving manner, and deal with my own sin instead of worrying about
someone else’s. Psychosocial issues have historically been handled very well in church. It’s free and is
probably in your neighborhood!
Detail Approaches – these are where you need an exceptional therapist. Good therapists spend a great deal
of time outside of office hours learning more about their craft. Fibromyalgia is a subject we have spent time
learning about in books, at meetings with researchers, and in the “trenches” with our patients. We know how
to locate and treat the specific muscles causing or perpetuating your pain. We know what makes them
overactive and can look for problems that we have seen or that are located in the research literature.
V. Treatment Tactics
Light touch vs heavy touch
There is a good deal of controversy amongst therapists regarding the amount of pressure to use when
pressing on a trigger point. Many believe that painful pressure is needed, especially on chronically gnarled
up gristle like tissue. I have yet to see this approach lead to appreciable recovery in patients with a sensitive
nervous system. If you have Fibromyalgia you have a sensitive nervous system.
In the presence of chronic pain (or often with trauma) the spinal cord receives a massive volley of pain
signals that changes the function of that segment of the spine. It makes the area more susceptible to painful
stimuli. Things that would not hurt before now cause significant pain. Painful amounts of pressure can make
a sensitive muscle worse. It may feel good for a while but the relief is very temporary. Light pressure that is
just below the threshold off pain is what you need if you have a sensitive nervous system. If you use so much
pressure that your muscles tighten to protect you, if you hold your breath, if you need to breathe through the
pain, then you or your therapist are pressing too hard. Lighter pressure will allow you to release your trigger
points and will allow you to heal. Those without a sensitive nervous system can often tolerate more painful
pressure and even find it enjoyable. I am one of these. I don’t know what’s wrong with me!
Movement vs stretching
Many people with Fibromyalgia are also hypermobile. This makes stretching a bit difficult, if not unwise. If
you are hypermobile over stretching your joints and damaging them is a real possibility. If you are in this
category you would do well to spend your time doing more self treatment rather than stretching over
hypermobile joints. It may be that some joints are not hypermobile and can benefit from stretching. Stretch
these muscles to their normal range of motion. Those who are hypermobile often benefit from movement
disciplines such as Feldenkrais or Alexander Technique. I like the book Relaxercise by David Zemach-Bersin
as an introduction to Feldenkrais therapy. It also has a VHS and audio tape available.
Your ball is your friend
You ball, backknobber, (from the Pressure Positive Company on our links page) or other treatment devise
should become your new best friend. We will teach you self treatment techniques to help control your own
pain. If you live in Pittsburgh there are caring therapists who can help you!
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