Treating Fibromyalgia: The Muscle Pain Epidemic
February 9, 2004
By Leon Chaitow N.D., D.O., M.R.O.
Editor’s note: The following is an excerpt.
What’s Going on in the Fibromyalgia Syndrome (FMS) Patient’s Muscles? (1, 2, 3)
A host of stress related adaptations and changes are likely to have taken place in the muscles of someone with fibromyalgia resulting from overuse, misuse, abuse or disuse (postural, occupational, leisure activity, repetitive use, trauma etc) plus a number of additional factors.
1. A biochemical imbalance which may be the direct result of disturbed sleep leads to inadequate growth hormone production and poor repair of minor muscle damage.
2. Low levels of a serotonin in the blood and tissues lead to lowered pain thresholds because of the reduced effectiveness of the body’s natural endorphin painkillers, and the increased presence of ‘substance P’ which increases pain perception.
3. The sympathetic nervous system, which controls muscle tone can become disturbed leading to muscle ischemia (oxygen lack) resulting in greater ‘substance P’ release and increased sensitivity.
4. Duna proposes that these two elements are combined in fibromyalgia. Disordered sleep leading to reduced serotonin leading to reduced natural pain killing effects of endorphins, combined with a disturbed sympathetic nervous system which has resulted in muscle ischemia and increased pain sensitivity. Both disturbances involve reduced pain thresholds and activation of latent trigger points, with muscle pain as the end result.
5. ‘Micro-trauma’ (tiny amounts of damage) of muscles occurs in FMS patients (genetic predisposition is a possible cause) leading to calcium leakage which increases muscle contraction, further reducing oxygen supply. This seems to be associated with a reduction in the muscle’s ability to produce energy , causing it to fatigue and to be unable to pump the excess calcium out of the cells. A similar mechanism is said by Travell and Simons to be involved in myofascial trigger point activity. (1)
6. James Daley, M.D., has tested just what happens in the muscles of people with CFS(ME) when they exercise. Tests involving people with FMS (by Robert Bennett, M.D.) gave similar results showing that muscles produced a great amount of lactic acid, adding to the discomfort. Some of the patients showed low carbon dioxide levels when resting, which is an indication of a hyperventilation tendency.
There is some evidence that progressive cardiovascular training (graduated training through exercise) improves muscle function and reduces pain in FMS but this is not thought desirable (and is often quite impossible anyway because of the degree of fatigue) in CFS(ME). (2,3)
The special features of fibromyalgia seem to involve a combination of circulatory and nerve imbalances which make the muscle changes even more pronounced and the symptoms more unpleasant.
Treatment (4, 5, 6)
Manual therapy, nutrition, stress reduction, breathing and postural reeducation, exercise (in some cases), acupuncture, non-specific immune system modulation such as hydrotherapy, medication (herbal, homeopathic and standard), among other things, have all been useful in encouraging recovery.
Don Goldenberg, M.D., has shown that the following methods all produce benefits in treatment of FMS.: (7)
Cardiovascular Fitness Training (8)
Regional Sympathetic Blockade (11)
Cognitive Behavioural Therapy (12)
Where a condition has multiple interacting causes it makes clinical sense to try to reduce the burden of whatever factors are imposing themselves on the defense, immune and repair mechanisms of the body, while at the same time doing all that is possible to enhance those mechanisms.
In my own practice the following are the methods suggested and used in treatment of FMS not necessarily in the order listed:
1. It is vital to get the diagnosis right. Many other rheumatic- type problems can produce widespread muscular pain such as polymyalgia rheumatica. Laboratory and other medical tests can identify most conditions which are not FMS.
2. Where muscle pain exists it is necessary to discover how much of the problem might be related to myofascial trigger point activity since the pain from trigger points is relatively easy to eliminate using methods chosen from injections, acupuncture, bodywork and postural and/or breathing reeducation.
3. It is important to assess and treat any associated conditions such as allergy, anxiety, hyperventilation, yeast or viral activity, bowel dysfunction, underactive thyroid, sleep disturbance.
4. It is useful to introduce constitutional health enhancement methods such as breathing retraining, deep relaxation methods (e.g. autogenic training ) regular (weekly or fortnightly) detoxification (fasting) days (which boost growth hormone production), hydrotherapy (neutral bath for anxiety and possibly progressive cold bathing), regular non-specific massage and acupuncture for ‘energy balancing’ and pain control.
5. Provision of suitable nutritional advice is important as well as use of supplements if necessary, such as specific amino acid supplementation for stimulating growth hormone production.
6. Specific herbal help for circulation to the brain [e.g. Ginkgo biloba] and the taking of homeopathic remedies such as Rhus tox 6C may be useful.
7. Appropriate osteopathic soft tissue treatment of the muscular condition, as well as regular (daily if possible) gentle self-treatment methods are usually helpful.
8. Regular exercise within tolerance, if possible including cardiovascular training and stretching movements (yoga and/or T’ai chi).
9. Medication under medical advice only, to enhance sleep patterns may be worth considering, antidepressant drugs in very low dosage commonly give some benefit.
10. Patients should be encouraged to join support groups, and to read about their condition and health enhancement, and to take control of their condition, even if progress is apparently slow. Stress or general counseling may help patients learn coping skills and stress reduction tactics.
1. David Simons, Fibrositis/fibromyalgia a form of myofascial trigger points? American Journal of Medicine 81(suppl 3A)pp93-98.
2. Report in Fibromyalgia Network May 1993, Compendium on First National Seminar for Patients, Columbus, Ohio. April 1990 (Robert Bennett MD presentation on muscle microtrauma - pages 23-25).
3. Report in Fibromyalgia Network (Compendium 2 pp48-49) on 2nd Los Angeles CFIDS Conference may 18/19 1991.
4. Frederick Wolfe, David Simons et al., Fibromyalgia and myofascial pain syndromes, Journal of Rheumatology 1992;19:6pp944-951.
5. Vladimir Janda Muscles and Cervicogenic pain and syndromes, from Physical Therapy of the cervical and thoracic spine, Ed. R.Grant, Churchill Livingstone, London 1988 pp153-166.
6. Gwendolen Jull and Vladimir Janda Muscles and Motor Control in Low Back Pain Physical Therapy of the low back, from Physical Therapy of the low back, Ed. Lance Twomey Churchill Livingstone London 1987 pp253-278.
7. Goldenberg D., Fibromyalgia: Treatment programs, J of Musculoskeletal Pain Vol.1 3/4 1993 pp71-81.
8. McCain G et al., Controlled study of supervised cardiovascular fitness training program Arthritis Rheum 31:1135-1141 1988.
9. Ferraccioli G et al EMG-Biofeedback in fibromyalgia syndrome, J. Rheumatology 16;1013-1014 1989.
10. Haanen H et al., Controlled trial of hypnotherapy in treatment of refractory fibromyalgia, J Rheum 18:72-75 1991.
11. Bengtsson A et al Regional sympathetic blockade in primary fibromyalgia Pain 33; 161-167 1988.
12. Goldenberg D., et al., Impact of Cognitive-behavioural therapy on fibromyalgia, Arthritis Rheum 34(suppl9):S 190, 1991.
© Leon Chaitow N.D., D.O., M.R.O. Source: Health World online at www.healthy.net.
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