The word fibromyalgia comes from the Latin term for fibrous tissue (fibro) and the Greek ones for muscle (myo) and pain (algia). Fibromyalgia syndrome is chronic disorder of widespread muscle pain, fatigue, and multiple tender points that affects 3-6 million people in the United States. For reasons that are yet unclear, more than 90% of those who develop fibromyalgia are women. It is not currently known whether the predominance of women who suffer from fibromyalgia is a phenomenon of the socialization of women in the American culture or whether it is some combination of the female reproductive hormones and other genetic predispositions.
According to the American College of Rheumatology (ACR), fibromyalgia is defined as a history of pain in all four quadrants of the body lasting more than 3 months. Pain in all four quadrants means that you have pain in both your right and left sides, as well as above and below the waist. The ACR also described 18 characteristic tender points on the body that are associated with fibromyalgia. In order to be diagnosed with fibromyalgia, a person must have 11 or more tender points. In addition to pain and fatigue, people who have fibromyalgia may experience:
- sleep disturbances
- morning stiffness
- irritable bowel syndrome
- painful menstrual periods
- numbness or tingling of the extremities
- restless legs syndrome
- temperature sensitivity
- cognitive and memory problems (sometimes referred to as "fibro fog")
Fibromyalgia is often confused with another condition called "myofascial pain syndrome" or "myofascitis." Both fibromyalgia and myofascitis can cause pain in all four quadrants of the body and tend to have similar tender point locations, but the two conditions are worlds apart. Myofascitis is an inflammatory condition due to overuse or injury to your muscles, whereas fibromyalgia is caused by a stress-induced change in metabolism and healing. Myofascitis tend to come on rather suddenly and is usually associated with a particular activity or injury, true fibromyalgia has a slow, insidious onset, usually beginning in early adulthood. It is very important to diagnose each of these correctly, for they require very different approaches to treatment. Unfortunately, fibromyalgia is a chronic condition, meaning it lasts a long time - possibly a lifetime. However. it won't cause damage to your joints, muscles, or internal organs.
The Basics of Fibromyalgia
The latest research indicates that fibromyalgia is a stress-related condition that is a cousin in Systemic Lupus Erythematosis (often referred to as simply 'lupus') and Chronic Fatigue Syndrome. In all three of these conditions, there is the same predominantly female distribution, chronic fatigue, sleep disturbances, irritable bowel, as well as many other similarities. You can think about these three conditions as lying on a continuum with Fibromyalgia on one end, Lupus on the other and Chronic Fatigue Syndrome in the middle. All three of these conditions are caused by an abnormal stress response in the body, but with Lupus, the immune system is primarily affected, causing an autoimmune reaction that attacks your healthy tissues. On the other end of the spectrum is fibromyalgia, where metabolic abnormalities are primary. These metabolic changes are the result of a stress-induced decrease in blood flow to an area of the brain called the pituitary. This, in turn causes a decrease in a number of important hormones, such as the growth hormone releasing hormone (somatotropin) and the thyroid stimulating hormone. These hormonal changes lead to abnormal muscle healing, borderline or full-blown hypothyroid, as well as memory and cognitive changes.
One of the major physical abnormalities that occurs with fibromyalgia lies in the muscle itself, where there is a build up of a protein called "Ground Substance." Ground substance is normally found in muscle, bone and connective tissue all over the body and is responsible for making the tissues stronger and less susceptible to tearing. In a normal person, when a muscle is injured, the muscle tissue itself is able to regenerate and over time, completely heal itself. In a person with fibromyalgia, the muscle is unable to completely heal itself. Instead, an abnormally large amount of ground substance builds up in the injured area. It is the ground substance, coupled with local muscle spasm it causes that creates the muscle 'knots' associated with fibromyalgia.
A number of tests may be done to rule out other disorders and an examination can reveal whether a person has the characteristic tender areas on the back of the neck, shoulders, sternum, lower back, hips, shins, elbows, or knees. Unlike its cousin lupus, there are currently no diagnostic laboratory tests for fibromyalgia. Because there are no clinical tests for fibromyalgia, some doctors, unfortunately, conclude that a patient's pain is not real, or they may tell them that there is little they can do. But a combination of acupuncture, trigger point therapy and lifestyle changes has proven to be very effective in decreasing the severity and duration of the physical pain and disability of fibromyalgia.
Fibromyalgia can be difficult to treat. Not all doctors are familiar with fibromyalgia and its treatment, so it is important to find a doctor who is. Fibromyalgia treatment often requires a team approach, utilizing acupuncture, massage, radical dietary changes, as well as meditation, exercises and stretching.
Treating Fibromyalgia With Acupuncture
Acupuncture is critical for those who suffer from fibromyalgia in order to relieve inflammation, increase circulation and maintain the blood flow to all of the effected muscles. Because fibromyalgia causes the muscles to tighten up and lose some of their natural pliability, it results in a global loss of movement in the spine. The loss of movement in the spine results in a neurological reflex that causes the muscles to tighten further. This vicious cycle will continue and over time will lead to increased pain, increased muscle tightness, a loss of movement, more difficulty sleeping and the development of more and more trigger points.
Acupuncture provides immediate relief for most people as it assists the body in its healing process. It
is not uncommon for those with fibromyalgia to require treatment weekly in the beginning to maintain adequate circulation and relax the muscles. The
biggest concern in treating people with fibromyalgia is that their
muscles have a diminished healing ability. Chinese medicine improves the body's ability to heal through the use of gentle acupuncture or superficial point stimulation, appropriate herbal therapy, and addressing the effects of stress on the digestive system as well as the endocrine system. Very few therapies are as successful as acupuncture at relieving stress of body and mind. Because stress is at the root of the problem, fibromyalgia cannot be effectively treated without addressing how the person reacts to stress.
Treating Fibromyalgia with Trigger Point Therapy
The overwhelming characteristic of fibromyalgia is long-standing, body-wide pain with defined tender points, and frequently, trigger points. Trigger points are often confused with "tender points." They are not the same. A trigger point needs firm pressure to elicit pain, while tender points are painful with even very light pressure. Trigger points will refer pain to other areas of the body, whereas tender points will not. Unlike tender points, trigger points can occur in isolation and represent a source of radiating pain, even in the absence of direct pressure. As discussed earlier, trigger points are purely comprised of spasmed muscle fibers, whereas tender points are knots filled with ground substance. Those with fibromyalgia almost always have a combination of the two - trigger points and tender points - and can improve dramatically with light trigger point therapy.
Trigger point therapy for fibromyalgia is much like trigger point therapy for low back pain, neck pain or headaches. The points are the same. The difference is just intensity. Since the muscles in patients with fibromyalgia are easily injured and take longer to heal, it is necessary to use less pressure on their trigger points.
Self-Care for Fibromyalgia
Your day to day lifestyle choices have a tremendous impact on how much impact fibromyalgia will have on your life. The difference between those who take care of themselves and those who do not is tremendous. Those who make lifestyle changes to help their fibromyalgia suffer much less pain, are able to remain more active and have a much higher quality of life than those who do not. If you have fibromyalgia, here are some of the main things that you can do on a daily basis to help your body:
• Getting enough good sleep-Getting
enough sleep and the right kind of sleep can help ease the pain and
fatigue of fibromyalgia, but is something that can be hard to get.
Many people with fibromyalgia have problems such as pain, restless legs
syndrome and brain-wave irregularities that interfere with restful
sleep. Insomnia is very common. Although alcohol may help you to
relax, it is not recommended before bed as it has been shown to
interfere with restful sleep. Some of those with fibromyalgia have
found 5-hydroxy tryptophan (5-HTP) very helpful, as well as the
prescription anti-depressant amitriptyline. I have had success using a variety of different Chinese herbal formulas for people whose sleep is interrupted by pain.
• Exercising- Improved fitness through exercise is recommended. Studies have shown that fibromyalgia symptoms can be relieved by aerobic exercise. Though pain and fatigue may make exercise and daily activities difficult, it's crucial to be as physically active as possible. The best way to begin a fitness program is to start with low impact exercises, like walking and swimming. Starting slowly helps stretch and mobilize tight, sore muscles. High-impact aerobics and weight lifting could cause increased discomfort, so pay attention to your body. The more you can exercise properly, the better off you will be.
• Making changes at work-Most people with fibromyalgia are able to continue working, but they may have to make big changes to do so. It may be necessary to reduce the number of hours at work, find a job that will allow you to have a flexible schedule, or switch to a less physically demanding job. Many people with fibromyalgia require specially designed office chairs, adjustable desks or other adaptations in order to continue working. If you face obstacles at work, such as an uncomfortable desk chair that leaves your back aching or difficulty lifting heavy boxes or files, your employer may make adaptations that will enable you to keep your job.
• Eating well-Foods, just like anything else, have the ability to either stress your body or to help your body heal. Foods that may be stressful for you include: dairy, eggs, wheat, corn, as well as anything with monosodium glutamate (MSG), nitrates or nitrites (as are found in processed foods). Several environmental toxins may also contribute to the overall physical stress on your body, therefore fish should be avoided as well. It is important that you eat as much clean, organically grown fresh foods as possible. Base your diet around whole foods such as: brown rice, legumes, oats, spelt, rice milk, soy, hormone-free chicken or turkey, roots, nuts and berries.
• Nutritional supplements-During my years in practice, I have seen dozens of nutritional products that claimed to be 'the answer' for fibromyalgia. To date, none of them have proven to be of much long-term benefit for anyone. However, there are some people who have used magnesium malate with good results, some people who have used ginkgo biloba with good results and others with various herbals. The bottom line with nutritional supplements is that there is nothing that works equally well for everyone. If you come across something that you would like to try, by all means do so, as long as you check it out with your acupuncturist first to ensure that it won't interfere with any of your other treatments.