They usually come in "hurting all over." They often are depressed, discouraged and not sleeping well. They frequently arise stiff and sore in the morning, feeling fatigued. They have suffered bouts of irritable bowel symptoms.
Conventional Wisdom
Fibromyalgia is characterized by widespread muscle, ligament and tendon pain, chronic fatigue and multiple areas of trigger-point tenderness. The condition was recognized in previous generations, but was known by other names such as muscular rheumatism, fibrocitis and tension myalgia.
Allopathic medicine does not recognize a cause for fibromyalgia. Current thinking centers on internal imbalances that cause an increase in sensitivity to pain signals. Sleep disturbance, past injury, infection, metabolic muscle changes, hormonal imbalance and stress are other considerations in the etiology of fibromyalgia. Interestingly for chiropractors, abnormalities of sympathetic nervous system function also have been postulated as a factor in its etiology.
Diagnosing fibromyalgia can be difficult, as it can mimic many other disorders. The ACR has established the criteria of at least three months of chronic widespread pain and tenderness in at least 11 of 18 specific trigger-point sites.
Medical treatment involves recommendations for aerobic exercise such as swimming and walking, heat and massage treatments, antidepressant and analgesic/muscle relaxant medications, sleep aids, physical therapy and relaxation techniques of guided imagery. Many physicians also recommend stress-management strategies, improved diet and a healthier lifestyle.
Alternative/Holistic Perspective
Many in the alternative health care community see systemic toxicity as a fundamental consideration in fibromyalgia. They believe physiological disturbances from impaired heart, liver, lung and kidney function are at the root of the problem. As we know, the liver and kidneys are the primary detoxifiers of the body. Thus, systemic toxicity (autointoxication) can be the end result of impaired function in these organs.
As specialists in neuromusculoskeletal disorders, we can forget that life itself, as we know it, is basically an electromagnetic phenomenon. In the East, they describe this essential internal energy reserve as qi. Some even see the liver and kidneys as akin to batteries of the body, with the liver serving as the positive pole and the kidneys as the negative. When these organs are deficient in functioning, the body's "battery" is said to be run down. Chronic fatigue, low vitality and organic depression are the result, features common in fibromyalgia patients.
Just as the internal composition of a regular battery can influence its charge, the inner atmosphere of the human body can influence its vitality and strength. Scientific evidence increasingly points to the fact that, for maximum health and wellness, we should be primarily vegetarians, with fruits and vegetables making up the great majority (70 percent to 80 percent) of consumed food. Good-quality grains, nuts and oils, dairy and lean meats should make up the other 20 percent to 30 percent. This has an anti-inflammatory effect and creates an alkalized internal atmosphere, which also produces the health benefit of discouraging reproduction of most pH-dependent human pathogens that are acid-loving.
Therapeutic Regimen
Systemic toxicity demands that primary attention be given to the basic processes of adequate hydration and increased eliminations. My personal observation is that very few patients consume sufficient water for bodily needs, which is estimated to be at least 64 ounces (eight glasses) daily. They tend to try and substitute colas, teas and coffee, all of which are diuretic, resulting in little or no net fluid gain. Almost all human biochemical processes require hydrogen. Without sufficient hydration, these processes slow, contributing to fatigue and accentuating the accumulation of metabolic wastes. Under- or frank dehydration also slows bowel motility, which contributes to reabsorption of toxic waste into the general circulation. "Water is medicine" is my advice to these patients, along with a cleansing diet of fresh fruits and vegetables. Enemas and laxatives also might be useful in internal cleansing, especially if a patient has been constipated. For the most severe cases of long-standing autointoxication, I recommend patients consider a series of colonic irrigations.
Manual therapy (spinal adjustment and massage) will prove very beneficial to most sufferers of fibromyalgia. Spinal biomechanical lesions and nerve "impingements" almost always reflexly stimulate some degree of associated regional muscular spasm, which leads to a relative ischemia and toxemia in and around the tissue. Chronic, long-standing myospasm creates adhesions, scarring and fibrosis.
In applying any form of manual therapy to those with fibromyalgia, one should take great care in the early stages. Since these patients have heightened sensitization to pain, overly aggressive, ham-fisted approaches to treatment often will backfire, creating such additional suffering pain as to lose a patient. In the early days, many osteopaths and chiropractors recommended sustained anti-inflammatory measures such as repetitive cold packs and a series of hands-on massages before even attempting spinal manipulation for those with severe pain syndromes.
In recommending dietary changes to patients, I have found it beneficial to discuss the "opportunity of illness." While this sounds counterintuitive, I explain that the reason for the pain signal is to alert them to the underlying condition that needs to be changed for the better. I believe most frank pathology is the result of long-term imbalance in normal physiology, often caused by errors in diet and lifestyle and exacerbated by past injury or chronic inflammation.
Some form of moderate exercise such as walking or swimming is essential to recovery from fibromyalgia. Also frequently beneficial is the discipline of yoga-type stretching. Being out in the open as much as possible while exercising has been shown to be superior to time spent inside on the treadmill. Both walking and swimming mobilize needed lymphatic flow in the body. Arm swings pump this "dirty seawater" back into the veins under the clavicle, where it eventually is cleansed. Of course, the skin and lungs play an important role in metabolic waste elimination as well, so heating a well-hydrated body (hot baths, sauna) to create increased heart rate, perspiration and aerobic breathing also is beneficial.
Finally, "the mind is the builder, or the mind is the slayer" is a well-recognized axiom that acknowledges the health or disease effect of attitude and emotion. Fear-filled, angry folk who habitually engage in what motivational speaker Zig Ziglar called "stinking thinking," eventually pay a price in their body's lack of wellness. Taking in lots of information that creates distress and inner turmoil, while feeling completely helpless to improve the situation, is what Hans Selye (who coined the term stress) called "pathologically alarming" to us human animals. Conversely, time spent in reading and positive thought of our highest purposes and ideals can contribute substantially to the healing process.
Fibromyalgia can be healed and left behind in a person's life experience. Recognizing its multi-faceted causes and taking a comprehensive approach to its treatment is essential to success in your efforts as true healer.
Dr. John Bomar, a 1978 graduate of Palmer College of Chiropractic, practices in Arkadelphia, Ark. He is a past board member of the Arkansas Chiropractic Association and a founding board member of the Arkansas Chiropractic Educational Society. Contact Dr. Bomar with questions and/or comments regarding this article via e-mail:
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