What is fibromyalgia?

Fibromyalgia, a disabling disorder that affects 2-4% of the population, is more commonly found in women than in men. Despite its prevalence, the condition is often overlooked, and diagnosis is frequently missed. Individuals with fibromyalgia typically experience widespread pain, poor sleep, stiffness upon waking, and constant fatigue throughout the day. They may also suffer from headaches, memory and concentration problems, dizziness, numbness and tingling, itching, fluid retention, crampy abdominal or pelvic pain, diarrhea, and other symptoms. There are no abnormalities detected in diagnostic lab or x-ray tests, but a physician can confirm the diagnosis by identifying multiple tender points in characteristic locations. Fibromyalgia is often hereditary, indicating an inherited predisposition. It may remain latent until triggered by an injury, stress, or sleep disturbance. Fibromyalgia is closely associated with chronic fatigue and irritable bowel syndromes, leading some to propose that these conditions may represent different aspects of the same underlying disorder.

What causes it?

Fibromyalgia has been previously misdiagnosed as either an inflammatory or psychiatric condition. However, no evidence of inflammation or arthritis has been found in patients with fibromyalgia, and it is now understood that they are no more depressed or anxious than individuals with other chronic, painful, debilitating conditions. It is believed that depression and anxiety, when present, are more likely to be a consequence rather than a cause of fibromyalgia. Evidence suggests that fibromyalgia may be linked to an abnormality of deep sleep, as abnormal brain waveforms have been observed during deep sleep in many patients with fibromyalgia. In fact, fibromyalgia-like symptoms can be induced in healthy volunteers by depriving them of deep sleep for a few days. Additionally, low levels of somatostatin, a hormone that plays a crucial role in maintaining healthy muscles and soft tissue, have been detected in individuals with fibromyalgia. This hormone is predominantly produced during deep sleep and is increased by exercise.

It should be noted that while the theory of deep sleep abnormality is a favored explanation for the cause of fibromyalgia, there are various other theories, and currently, there is no consensus among fibromyalgia researchers regarding any one theory.

How is it treated?

Fibromyalgia is difficult to treat, not because treatment isn’t usually successful (it is), but because it will take a lot of work, education, and involvement on your part for it to be successful. Simply starting the right medication will have little effect. Successful treatment of fibromyalgia requires:

• Regular sleep hours and an adequate amount of sleep.
• Medication to improve deep sleep.
• Daily gentle aerobic exercise.
• Avoidance of physical and emotional stress.
• Treatment of any coexisting sleep disorders.
• Gentle Chiropractic care.

If any of the following is omitted, significant improvement is unlikely.

Regular sleep:

Individuals with fibromyalgia must adhere to a consistent sleep schedule, going to bed at the same time every night and sleeping for as long as necessary. Even staying up an hour later than usual can trigger a flare-up that persists for several days. The switch over to or from Daylight Savings time can also provoke exacerbations in many fibromyalgia patients. To mitigate this, transitioning gradually in fifteen-minute increments every few days, instead of an abrupt one-hour change, may be helpful. It is worth noting that I have not been successful in achieving significant improvement in patients with irregular bedtimes due to working off-shifts.

Exercise:

Engaging in daily low-impact aerobic exercise is crucial for individuals with fibromyalgia. While patients who overexert themselves or engage in the wrong type of exercise may experience temporary worsening of symptoms, those who fail to establish a daily aerobic exercise routine are unlikely to observe significant improvement in their fibromyalgia symptoms. Aerobic exercise is characterized by elevating the heart rate to a target level for the duration of the exercise session. Heart rates are measured in beats per minute. It is accurate enough for our purposes just to take your pulse for 6 seconds and multiply by 10. The aerobic target heart rate is calculated from the following formula:

• (220 – Age – rhr) x .6 + rhr

Where age is your age in years and rhr your resting heart rate, determined by taking your pulse when you wake up but before getting out of bed. A good place to feel your pulse is at the wrist turned palm up, next to the large bone on the thumb side at the end of your forearm. If you are exercising hard enough you should be able to feel your heart beating and can just count that. For most people, the aerobic target heart rate is at about the point where they can no longer sing but can still talk comfortably.

The kind of exercise is unimportant. Just make sure to pick something that doesn’t make you hurt worse. It may take trying several different kinds before finding one or more types that agree with you. Popular kinds include walking, regular or exercise bicycles, ski simulators, rowing machines, elliptical machines, swimming, and *gentle* aerobic dance. Jogging, vigorous aerobic dance, and weight lifting tend not to very good choices. If your pain is mainly in your legs or back, consider exercising just your arms with a Thigh master or similar equipment. While many patients insist that they get plenty of exercise at work, doing housework, or in their yard, this is rarely the case. These types of exercise are rarely helpful, as they don’t result in a sustained elevation of the heart rate, and often increase pain and make patients feel worse. You need to set aside a time specifically for daily exercise. Particularly if you are out of shape, start out with just 3-5 minutes of exercise and gradually increase as tolerated, shooting for twenty to thirty minutes. Take a few minutes to stretch your muscles, then start out slowly, increasing to full speed after a minute or two. Slow down again for the last minute or two and repeat the stretches. There are five recommended stretches, each done for 20 seconds a side. They should be gentle and painless. Hold onto a tree or post for support for #s 3-5:

• Shrug your shoulders in a circular motion.
• Reach your arm over your head and bend to the opposite side.
• Bend forward with your legs straight.
• Pull your foot towards your buttock while standing on the other leg.
• With your feet flat on the ground and one foot ahead of the other, lean forward, bending just the front knee.

Exercise is more effective if done in the late afternoon or evening. If you absolutely can’t do it then, exercising earlier in the day is better than not exercising at all, but you will probably need to exercise longer for the same effect. Some patients find that exercise provides an immediate benefit, making them feel more alert and comfortable for several hours. If you experience this effect, you may want to try exercising three times a day instead of just once. Patients who can do this are the ones most likely to eventually be able to get off medication. Exercise seems not to work through conditioning of muscles but rather through a direct, possibly hormonal effect on pain and sleep. Patients who have been exercising regularly and then miss a day usually find that their fibromyalgia symptoms are significantly worse the next day.

Avoid physical and emotional stress:

Adequate exercise is a crucial element in the effective management of fibromyalgia. However, it’s important to avoid excessive physical activity or the wrong type of exercise that can trigger a relapse. Instead of attempting to complete all physical tasks, such as housecleaning or yard work, in a single day, break them up into smaller portions and spread them out over several days. It’s crucial to be mindful of your limits and stop when necessary. It’s essential to learn to decline invitations or activities when you’re not feeling up to it. Avoid taking on additional stressful responsibilities if possible. If you’re experiencing ongoing depression or anxiety, consider seeking professional help from your family doctor or psychiatrist to reduce your overall stress level. Relaxation techniques or chronic pain programs may also be beneficial in reducing stress. Individuals with fibromyalgia must learn how to manage their physical and emotional energy efficiently.

Treat other sleep disorders:

There are several sleep disorders that can worsen fibromyalgia symptoms, besides insomnia. Obstructive sleep apnea is common in men with fibromyalgia and some women, characterized by loud snoring and pauses in breathing during sleep. Periodic limb movements of sleep is another condition in which patients twitch every few seconds for long periods during the night. These conditions may go unnoticed until the patient’s spouse complains. It is crucial to treat these disorders as they may lead to accidental death, injury, strokes, or heart attacks.

Other sources of sleep disturbance include a spouse’s snoring and young children. Avoidance of alcohol after supper or weight loss may eliminate snoring, and sleeping on the side may help. Earplugs can also be used. Tranquilizers and sleeping medications of the benzodiazepine group should be avoided as they suppress deep sleep and worsen fibromyalgia symptoms. Alcohol and narcotic pain medications have the same effect and should be avoided in the evenings. Exercising before bedtime should also be avoided. Patients with fibromyalgia should eliminate caffeine from their diet completely as it may disrupt sleep and increase muscle pain and headaches. Protein consumption should also be avoided in the evening.

Gentle Chiropractic care:

Several patients have reported that gentle muscle work, heat, and chiropractic adjustments help alleviate their fibromyalgia symptoms. Some individuals have also identified certain foods that trigger their symptoms similar to migraines. Specific chiropractic adjustments can provide significant relief by enhancing the nerve-muscle-joint interaction and promoting the elimination of waste products, which may reduce pain sensitivity and tender nodules. However, it may take more than two weeks to observe the beneficial effects of chiropractic treatment. It is important to note that although patients may experience good initial results with optimal treatment, brief relapses are not uncommon.

Support and Education:

To achieve optimal outcomes, it is essential to actively participate in your treatment and have a thorough understanding of this complex disorder. Patients with fibromyalgia frequently receive less compassion and assistance from their loved ones and employers due to the absence of observable signs of illness. Several patients have been informed by other doctors that their condition is imaginary, which can be discouraging. Consequently, I highly recommend attending support group gatherings, not only to avoid feeling isolated but also to acknowledge that you are not the only one experiencing this. There are local chapters in most areas now of the Fibromyalgia Network.

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