What is fibromyalgia?
Fibromyalgia is a chronic pain condition diagnosed when the patient has 11 out of 18 tender points that are tender to less than four pounds per square inch of pressure, and a chronic non-restorative sleep disturbance lasting more than four months. It is accompanied by a number of changes in the central nervous system and endocrine system that contribute to the symptoms
Are there other conditions that can be misdiagnosed as fibromyalgia?
There are a number of conditions that can be mistaken for fibromyalgia (FMS). The most common is myofascial pain syndrome. Every fibromyalgia patient has myofascial pain (MPS) but myofascial pain patients do not have fibromyalgia. The MPS patients sleep for about four hours before their pain awakens them. FMS patients wake-up every 90 to 120 minutes. The MPS patients typically have six to eight tender points. Some patients have perimenopausal sleep disturbances waking them up at 3 AM and develop myofascial pain or have arthritis.Some doctors are not careful about diagnosis and just put sleep disturbances and pain together and call it fibromyalgia.
Other conditions that can masquerade as fibromyalgia are:
- Vestibular injuries to the inner ear and balance system.
- Hypothyroidism-low thyroid can make one achy and fatigued.
- Arthritis can create muscle pain and stiffness.
- Parkinson’s can make you stiff.
- Lyme’s disease creates full body aching and pain.
Fibromyalgia seems so confusing. Why are there so many symptoms, and why doesn’t anything work in all FMS patients?
Five different types of fibromyalgia:
In our clinic we have found that FMS seems to start five different ways. The confusing picture becomes clearer when you realize that there are five different types or causes of FMS.
- Neck Trauma: This type is associated with neck injuries after an auto accident or intubation for anesthesia during surgery, or a fall/lifting accident.
- Stress and Allergies: This type is associated with chronic prolonged stress, and food or mold allergies.
- Toxicity: This type is associated with exposure to organic chemicals such as pesticides or solids.
- Genetic: This type is associated with genetic influences because so many people in the family have it. People inherit food allergies and enzyme system requirements. Enzymes help perform the chemistry your body needs to perform it’s daily functions. They help you make serotonin and allow your liver to detoxify the chemicals you encounter every day.
- Viral: Some people develop fibromyalgia after flu like illness or after being immunized to go overseas.
Where does the pain come from?
FMS patients have full body pain from two different nerve sources depending on how they acquired fibromyalgia.
Class C pain fibers:this form of pain comes from class C pain fibers that carry diffuse non-localized pain. Different kinds of the nerves carry different kinds of pain information. Class C pain fibers respond to chemical stimulation from histamine, inflammatory chemicals and tissue damage. The stress, toxicity, genetic, and viral types of fibromyalgia get their pain from these fibers.
The Spinal Cord and the Brain: in our clinic we think that patients who get FMS after an auto accident have a disc injury that irritates the spinal Cord and changes the way the brain receives pain messages.
Why do fibromyalgia patients feel so awful and have so many symptoms?
This question is a little more complicated but the answer makes sense when you put all the information together. Before this question is answered a part of the nervous system needs to be identified/defined.
One component of our nervous system is called the “Autonomic Nervous System”. This nervous system is divided into two divisions:
- Sympathetic division (fight or flight)-when our environment threatens us our body has to respond and this aspect of the nervous system kicks in. For example, if you are being chased by a tiger your adrenalin will be activated and blood flow to all parts of your body will increase. Most likely you will not fall asleep or feel relaxed while being chased by a tiger.
- Parasympathetic Division (rest and digest)-when our environment is relaxing our body will respond accordingly and this aspect of the nervous system will kick in. For example, if you had a large dinner and you sit down next to a warm fire most likely your body will rest/relax and digest.
Fight or Flight
Fight or Flight, Leaky Gut and Food Allergies:
Your cortisol (stress chemical released by the adrenal gland) levels go up so you can fight the inflammation created by the tiger’s bite assuming he caught you. Unfortunately, cortisol can make your gut thin and allow small molecules and food to leak out. 80% of the immune system is clustered around the gut and the immune system can develop antibodies to the food you eat. Immediate food reactions (IgE) make you turn bright red and fall over when you eat something you’re allergic to. Delayed allergies (IgG) reactions come from antibody complexes that are gobbled up by white blood cells (Macrophages). The macrophages essentially get indigestion and secrete histamine when they get too full of the IgG complexes.Class C pain fibers react to the histamine and it can create the pain or make it worse. Sometimes patients start with one type of FMS and end up with pain and fatigue caused by food allergies added to whatever else started the problem.
Fight or Flight and Progesterone:
When your stress level has been high for a while the hypothalamus and the brain secretes a chemical called CRH (corticotrophin releasing hormone). This chronic stress hormone directly inhibits the brain hormones that tell your ovaries to secrete progesterone. Progesterone allows you to become and stay pregnant. Why would your brain want you to become or stay pregnant if a tiger has been chasing you for months at a time? When you are not pregnant and you do not get enough progesterone compared to estrogen you get fatigued, depressed, crave sweets, do not sleep well, and gain weight. Does this sound like FMS?
Fight or Flight and Thyroid:
When CRH is secreted in chronic stress it directly inhibits thyroid stimulating hormone (TSH), so even if you were hypothyroid your thyroid stimulating hormone could not go up to tell your thyroid to make more thyroid hormones. The CRH also inhibits the conversion of the Therefore, they are cold and fatigued all the time, gain weight, and have dry skin and are constipated. Does this sound like FMS? inactive T4 hormone to the active T3 hormone by inhibiting the enzyme that does the converting. If you have all this fight or flight stimulation to your heart and adrenal stimulation to your organs you do not want your thyroid stimulating everything at the same time so the brain tries to quiet the thyroid in times of chronic stress. In summary, FMS patients feel and act hypothyroid but their TSH levels do not go up or cannot go up because TSH is held down by CRH.
Fight or Flight and Thyroid:
When CRH is secreted in chronic stress it directly inhibits thyroid stimulating hormone (TSH), so even if you were hypothyroid your thyroid stimulating hormone could not go up to tell your thyroid to make more thyroid hormones. The CRH also inhibits the conversion of the inactive T4 hormone to the active T3 hormone by inhibiting the enzyme that does the converting. If you have all this fight or flight stimulation to your heart and adrenal stimulation to your organs you do not want your thyroid stimulating everything at the same time so the brain tries to quiet the thyroid in times of chronic stress. In summary, FMS patients feel and act hypothyroid but their TSH levels do not go up or cannot go up because TSH is held down by CRH.Therefore, they are cold and fatigued all the time, gain weight, and have dry skin and are constipated. Does this sound like FMS?
Fight or Flight and Sleep:
When you are under stress your adrenal glands put out more cortisol so you can deal with the stress. Therefore, the production of serotonin, which helps you sleep, is impaired. I will explain why…In FMS the stress can be from pain caused by a neck injury or from prolonged life stresses. If a tiger were chasing you through the woods you would not need to sleep. You would need extra proteins and niacin to repair the tissues in danger from the tiger. As a result, your body diverts the amino acid tryptophan away from serotonin production and towards protein synthesis. Tryptophan is only 1% of the amino acids you consume. The reaction that makes tryptophan into 5-hydroxytryptophan (5-HTP) and then into serotonin is just three steps and needs B-6 and an enzyme, but stress and elevated cortisol can impair the conversion.
Fight or Flight and Growth Hormone:
CRH inhibits the production of growth hormone directly by inhibiting the production of growth hormone releasing hormone from the brain. In an adult 85% of growth hormone is produced during deep sleep. You need adequate serotonin to get deep sleep. But what happens if you do not get enough serotonin? If you do not get serotonin you do not get deep sleep, if you do not get deep sleep you do not get growth hormone. In an adult growth hormone is only secreted during stage four sleep and fibromyalgia patients never get to stage four sleep.
Growth hormone allows the muscles to import amino acids for tissue repair from the wear and tear created during daily activities. If you do not get serotonin, you do not get deep sleep, you do not get growth hormone, you do not get tissue repair. This results in soreness from any level exertion or muscle work. Does this sound like FMS?
Are there any treatments that work?
The medical community uses pain medication; sleep medication to treat the symptoms, antidepressants to improve mood, and serotonin thereby reducing pain perception. Many FMS patients are held by these drugs but continue to have problems with function and quality of life even with drug therapy. Fibromyalgia is not a Prozac deficiency!
In our clinic we tailor the treatment to the type of fibromyalgia. In general we use specific supplements to help the body produce more energy and repair the injured and damage tissues. We use nutritional supplements to help the enzyme pathways function better and actually force them to work in the ways we want them to work, and help the tissues repair themselves.
FMS from neck trauma: we use physiotherapies to calm the spinal cord and relieve the pain. Once the pain is gone the body reacts as if the tiger is sleeping at the end of the driveway and begins to repair itself. Recovery takes about 4 to 6 months depending on how long you have had the condition. Not everyone recovers but most patients improve. We use supplements to help speed the recovery time.
FMS from stress: we perform blood testing for IgG food allergies and send the blood via FedEX to a laboratory operated by an immunologist in North Carolina. Patients avoid the IgG allergic foods for about 4-6 months and then can eat them once every four days. The macrophages stop getting indigestion because the IgG antibodies go into storage. The fatigue and aching caused by the histamine released from the macrophages just goes away. We use microcurrent to speed up this process because it gives the body free energy that it does not have to work for. We use supplements and microcurrent to help the adrenals and the gut to recover.
Genetic FMS: one inherits their body chemistry, your enzyme systems and food allergies. We help the body chemistry to function better with supplements and use them to actually push it in the right direction. We use microcurrent to help this process as well.
Toxicity Exposure FMS: organic or fat-soluble chemicals can dissolve themselves into the fat that lines the nerves. The C class pain fibers become irritated and cause pain. We help the nerve recover by using microcurrent to re-polarize the membrane and some supplements that help the nerve detoxify and rebuild. Lipoic acid is an antioxidant that crosses the blood brain barrier and helps the brain and liver recover from toxic insult. We use 200 mg twice a day and it seems to be very helpful. The body uses essential fatty acids to build the walls of new nerves. Most Americans do not get enough of the right kind of essential fatty acids. Fried foods, red meat and cream have the wrong kind of fatty acids that tend to cause inflammation or make the wrong kind of membrane. Cold-water fish and olive oil (uncooked) make the right kind of fats to decrease inflammation and make new nerves properly. We use EPA/DHA (fish oils) to do this.
Immune or Viral Type of FMS: this is the one type we do not see much and it is one that we have but most difficulty treating. There are ways of improving function and comfort but the recovery has been difficult to achieve.
Sleep: 5-HTP is the shortest safest way to get serotonin. 100 mg of 5-HTP before bedtime helps with sleep digestion and stops bruising. The studies done on 5-HTP show it to be as effective as the major antidepressants but with fewer side effects. We can only use 5-HTP when the patient is not on an SSRI antidepressant, such as, Zoloft, Paxil or Prozac.
Progesterone: most fibromyalgia comes on in women who are of perimenopausal menopausal age. Many physicians forget that women need progesterone to help them make energy and feel good. Lack of estrogen causes hot flashes and sleep disturbance. Lack of progesterone causes fatigue, depression, water retention and weight gain. After salivary hormone testing we use progesterone cream to help women feel better and get their hormones in balance. You need progesterone even if you have had a hysterectomy, although your M.D. may not know this. Sometimes we work with the medical physician or naturopathic physician to determine the hormone regimen that works best for you.
Exercise: exercise helps your body to fight stress, fatigue and depression. We recommend walking and warm water swimming or anything you can arrange/tolerate or enjoy.
Relaxation: visualization and relaxation exercises help to reduce chronic stress and lower the stress hormone levels. Any method that works for you whether it is formal meditation, listening to tapes or watching a relaxation video is just fine.
Avoid: repetitive exercises, swimming and cold water, cold in general, overhead arm use, immobility, sustained yoga postures, and emotional distress.
Take it easy. Simplify your lifestyle. Pace yourself. Take time to meet your own needs. Use your available time to do things you find rewarding or satisfying.
- Be persistent!
- Be positive!
- Be determined!
- Accept the diagnosis!
- Reject the verdict!
Fibromyalgia does not come from space and jump on you. It comes from some very predictable sources that can be addressed and helped.
The most important thing you need to know about fibromyalgia is that it is curable. Not in every case. Not in every patient. But is curable often enough that a cure should be the intended goal of therapy.
Do you suffer from pain? Professional stress and pain relief are just a call away.
Visit us! Schedule your chiropractic appointment today at our Fort Myers office.