Fibromyalgia Program

The purpose of this program is to attract and provide a higher level of care to those who have been diagnosed with fibromyalgia. The program is to validate patients with this condition and provide a multi-disciplinary approach to manage their pain and rehabilitate the causes of that pain. Because fibromyalgia is often multifaceted, patients are more likely to achieve success if a coordinated effort using many methods is more likely to produce a favorable outcome.

What is Fibromyalgia?

Fibromyalgia is a chronic widespread musculoskeletal pain and fatigue disorder for which there is no known cause. Fibromyalgia means pain in the muscles, ligaments and tendons, the fibrous tissues of the body. In addition to pain and fatigue, other symptoms include un-refreshed sleep, irritable bowel syndrome, chronic headaches, morning stiffness, cognitive or memory impairment, reduced coordination and decreased endurance.

The American College of Rheumatology published the diagnostic criteria for fibromyalgia in 1990. The selection criteria have shown to be 88% accurate in its ability to identify patients with this illness. In addition to the above symptoms, depression has been noted in a significant percentage of fibromyalgia patients. Statistically 3-6% of the American population has symptoms that point to fibromyalgia. It is estimated that from 6-12 million people suffer from this devastating illness, 75% of which are woman. The predominant age that the illness strikes is between 20-60, commonly striking when a person is in their 20's or 30's. However, it can affect people of all ages.

The most common symptoms of fibromyalgia are muscle pain, fatigue, insomnia, joint pain and headaches. In addition, restless legs, numbness and tingling, impaired memory, leg cramps, impaired concentration and nervousness are accompanying symptoms. Major depression is found in approximately 20% of fibromyalgia patients. While there are no known lab tests that will diagnose this malady, recent research has shown that spinal fluid substance P levels are elevated three-fold in fibromyalgia patients. Spinal levels of nerve growth factor are elevated four-fold in fibromyalgia patients.

The diagnosis of fibromyalgia can be difficult because the symptom patterns can mimic many other illnesses and diseases, many of which are very serious. The average person can take as long as five years and spend thousands of dollars in medical bills just to receive a diagnosis because each symptom may be evaluated individually ignoring the whole of the patient's condition. Many patients are frustrated because their doctors are unable to diagnose their problem because most common laboratory tests usually prove negative. Often patients have been given the impression by their doctors that their pain is in their head. This invalidation by medical professionals is very frustrating for fibromyalgia sufferers.

The diagnostic criteria for fibromyalgia include a history of widespread pain that has been present for at least three months. The pain is considered widespread when it is felt in all of the following regions, the left side of the body, the right side of the body, above the waist, below the waist and the axial skeleton, which includes the cervical spine or anterior chest, thoracic spine or lower back. Shoulder and buttock pain is considered pain on the side or sides reported. Low back pain is considered pain below the waist.

Fibromyalgia Trigger Points

When evaluating a patient if pain is found in 11 of the following 18 tender point sites, that is considered a positive diagnostic criteria for fibromyalgia:

These points could be tender on either side or both sides. For a tender point to be considered positive, the person must state that the palpation was painful. Tenderness alone is not considered painful. Although this has been the established diagnostic criteria since 1990, a consensus of many experts established a report in 1996 saying that a person does not need to necessarily be tender in all 11 points. She may still have fibromyalgia with less than 11 of the required tender points as long as they have widespread pain and many of the common symptoms associated with fibromyalgia. These symptoms would include fatigue, irritable bowel, sleep disorders, chronic headaches, jaw pain, cognitive or memory impairment, post exertional malaise and muscle pain, morning stiffness, menstrual cramping, numbness and tingling sensation, dizziness or lightheadedness, skin and chemical sensitivity.

How is fibromyalgia treated?

Once the diagnosis is established, then what? Treatment selection is truly the art of medicine. It is truly the art of chiropractic. After scouring the research and years of personal experience with patients, we believe that the best approach for the fibromyalgia patient is a multi-disciplinary approach. It is generally agreed that there is not a single remedy or treatment that is effective in all cases, yet a combination of treatments can become effective for many patients. Our approach has been to establish a protocol that encompasses many proven methods for managing fibromyalgia. The following is a list of the ingredients of our treatment protocol. We select from this list and tailor a program for each patient individually.

1. Chiropractic adjustments - Manipulation of the spine has many benefits, these include enhancing and improving joint mobility, normalizing functioning of the nervous system, enhancing endorphin release, relieving pain generated by joint nerve receptors.

2. Physiotherapy modalities - Modalities including electrical stimulation, ultrasound, ice and heat along with vapo-coolants used in spray and stretch techniques will rid the muscles of waste products, sedate pain receptors, reduce muscle spasm, decrease inflammation, swelling and pain.

3. Massage - Skillful deep muscle therapy rendered at the hands of a certified massage therapist can reduce muscle spasm, increase circulation, break up fibrous adhesions and effectively relieve emotional stress that builds up in skeletal muscles.

4. Flexibility exercise - Stretching and yoga are used to enhance blood flow to the muscles, relieve morning stiffness, and rid the muscles of waist products that accumulate as the muscle fatigues. This type of exercise also increases joint flexibility, and can produce endorphin release.

5. Water therapy, which includes flexibility and cardiovascular exercise as well as motion therapy performed in a pool, disengages gravity and could accomplish goals and therapeutic ends that might be otherwise impossible. The patient who has had fibromyalgia any length of time can experience debilitating weakness in the muscles. Strengthening strategies can be implemented first in the pool where the patient can regain some of their strength without worsening their condition.

6. Strengthening exercise - Isometric and isotonic exercise will bring back lean muscle mass to the body, increase strength of inflamed muscles and increase their resistance to fatigue. Resistance exercise must be implemented incrementally and slowly to achieve these goals.

7. Cardiovascular exercise - paced aerobic exercise on a regular basis will bring oxygen to not only skeletal muscles, but the organs of the body. It can help with irritable bowel syndrome. It can oxidize the chemistry produced by stress. It will free the muscles of lactic acid and other waste products. It promotes a healthy heart and lungs. It contributes to emotional alertness and causes endorphin release, which enhances a patient's sense of well-being. This type of exercise must also be implemented slowly and incrementally.

8. Dietary management - This is what we call macro nutrition. It is the sum total of what you eat. Eating habits are crucial in management of a fibromyalgia patient. Often the pain and disability of this condition can lead to obesity. Proper diet will not only enhance and optimize a patient's metabolism, but can aid in goals of weight loss and stabilization of blood sugar levels. This can be beneficial and positively mood altering. In addition, healthy dietetics can have a profound effect on irritable bowel syndrome and other symptoms related to fibromyalgia.

9. Nutritional supplementation - The use of vitamins and herbs is a complimentary alternative medical care that has shown great promise in the management of fibromyalgia. The use of specific nutrients and herbs can promote utilization of foods, enhance energy and assist the patient in achieving normal sleeping patterns. They can affect blood sugar and hormones levels to relieve pain and stabilize mood.

10. Medical management - Some components of fibromyalgia can have life-threatening consequences. These include clinical depression, suppression of the immune system, sleep disorders, and digestive disorders. The appropriate use of prescription pharmaceuticals can be important and useful in this condition. There is no substitute for a thorough medical evaluation to rule out other conditions.

11. Psychological counseling - Nervousness and depression can be a profound consequence of fibromyalgia. There is a strong relationship between our mental/emotional selves and our physical selves. A trained psychologist can make a big difference in sorting out and helping the patient with the emotional side of this condition.

12. Support group - Mutually sharing experiences with other patients with the same condition is an important tool in the management process of fibromyalgia. The patient will not only have the opportunity to be helped, but will have the opportunity to help others.

The first step in the process is an evaluation. We provide an evaluation that encompasses more than 70 tests and measurements to ascertain if a patient has fibromyalgia. It is important in the process of establishing a diagnosis that other conditions including arthritis, neuritis, sprains and strains are either identified or ruled out.

Once a diagnosis has been made, an individual treatment protocol and lifestyle management program is outlined and implemented including some or all of the above ingredients. Again, there is no cure for fibromyalgia, it is managed. Improvement of this condition is measured in months not days, but we are confident that with the appropriate mix of complimentary and traditional medicine we will achieve an excellent outcome in most of the patients that follow our recommendations. For a free consultation, call us today at (714) 527-3332.