Growing evidence shows Fibromyalgia is often a misunderstood functional medicine problem; another reason to see a chiropractor first.
In 1990, a group of Rheumatologist’s published their criteria for patients with chronic pain we now refer to as Fibromyalgia. They found a number of common traits in these patients who seemed to defy medical classification with their complaints of body and joint pain. Since there was no agreed way to describe people with these symptoms, the classification of Fibromyalgia was born.
The book, Cheating Mother Nature, what you need to know to beat chronic pain looked at their criteria which included tender points, sleep problems, and unexplainable diffuse chronic pain and found that there was a similarity that had to do with body compensation patterns and chronic strain. The mechanism behind what the rheumatologists classified was explained by Dr. Brian Rothbart DPM in the 1990’s, and revisited by Dr. William Charschan who explained mechanically what happened when Rothbart’s findings existed in the asymmetrically built patient. Cheating Mother Nature’s section on Fibromyalgia shows the reason that tender points exist which is important to understand because they are points of stress or strain which result in chronic joint pain and abnormal function of the myofascial system. Charschan’s correlation of the location of the tender points to the locations in the original rheumatologist’s description of the phenomenon finally explains what a tender point is and likely results from.
A short while ago, a medical physician I know well had used the term polymodal polymyalgia which was a sophisticated way of saying someone has chronic pain and is seeing multiple providers to help them. While it is true that growing evidence suggests most of those patients that are diagnosed with Fibromyalgia are actually having a functional medical problem, due to the lack of musculoskeletal training most medical providers have, they are often classified with Fibromyalgia and then referred from provider to provider and often are taking Lyrica. Lyrica seems to help those who are having chronic pain by improving sleep and is used off-label as a sleep aid in Europe as per Dr, Alan Lichtbraun, one of the doctors who was on the panel for Fibromyalgia and someone who is a personal friend.
The reason that people require multiple modes of intervention is that the condition can be consuming, affecting those patients in a physical, mental, emotional, and behavioral way, which required from the medical perspective multiple modes of care including rehabilitation, psychology as well as other specialty providers. The question that few ask is that if we improve the pain and function, will sleep improve as well as a patient’s mental state since chronic pain affects concentration, and many of these patients become consumed with their condition.
There are studies that show that improved sleep results in less pain during the day, which is the basis for a new mattress I helped design for Eclipse international, a local mattress manufacturer that sells internationally and produces a number of brands. According to one of my colleagues, Stephen Pearle DC, with true Fibromyalgia (patients who are having a pain regulation problem), there is no fibro and no algia meaning that the pain has no relationship to clinical findings. Unfortunately, this is a very small minority of those who are actually diagnosed with the condition and is a small subgroup of those who have been diagnosed with the condition.
What should you do if you were diagnosed with Fibromyalgia to get the best long-term care?
According to a recent study in the Journal Spine this past August, “41% of patients with an initial fibromyalgia diagnosis no longer met diagnostic criteria for fibromyalgia at discharge and were indistinguishable from LO patients on pain, disability, and depression symptoms” which means that 41 percent after physical medicine type interventions improved enough to no longer need to be classified as having Fibromyalgia”(1).
While many of these patients are under the care of a rheumatologist, many rheumatologists are frustrated by these cases, probably because they just do not understand or have the musculoskeletal background to evaluate mechanical malfunctions.
Chiropractors are best suited to fill this role because of their work with the spine and extremities. Combining the use of methods such as myofascial release treatment, Graston Technique, corrective exercises with core stability training and foot orthotics which help level any asymmetries, they are best suited to help patients such as this and eliminate the need to multiple providers once the pain level has reduced.
When the pain improves, drugs such as lyrica may help to normalize sleep patterns and improve the way the patient feels about themselves during the transition from functional impairment to more normal mechanical function.
Often, a rheumatologist working together with a chiropractor can be a great team for helping fibromyalgia patients, since their unique skills are complementary. You may need to evaluate the type of mattress you use, since the right mattress will enhance your sleep and improve the way you feel during the day, which is the basic concept of how Lyrica seems to work.
1. Spine, August 1, 2014. By Hartzell, Meredith M. MS; Neblett, Randy MA, LPC, BCB; Perez, Yoheli PT, DPT; Brede, Emily PhD, RN; Mayer, Tom G. MD; Gatchel, Robert J. PhD, ABPP.
Read Cheating Mother Nature, what you need to know to beat chronic pain available through Amazon.com