The stepchild of mysterious conditions is certainly fibromyalgia syndrome (FMS). It may be more common than we know–one estimate compares levels of disability with that of rheumatoid arthritis (Starlanyl & Copeland 2001).
Common symptoms include muscle aches, poor concentration and memory, fatigue, insomnia, and bladder or bowel dysfunction. These symptoms are common to other more easily measurable conditions such as anemia, hypothyroidism, and some autoimmune disorders. When these test negatively, FMS has been used as a diagnosis of exclusion (Litan, 2001).
Researchers have had difficulty developing specific tests for FMS, perpetuating the lack of regard for its validity. There are complicated, expensive diagnostic blood tests and trigger-point diagnosis (Litan, 2001) that aren’t commonly used in your local clinic. Since pain thresholds can change daily, using trigger-point diagnosis is unreliable. Questionnaires can be used, such as the one developed by the American College of Rheumatology and the Medical Scientific Societies in Germany (Marcus & Deodhar, 2012; Dellwo, 2010).
As to the biomechanics of FMS pain, some research indicates fascia as the source of pain (Litan, 2001), and other studies show that people with FMS have smaller than normal type II muscles necessary for movement and lifting (Marcus & Deodhar, 2012).
Research does clearly indicate a grouping of neurological dysfunction: a nervous system stress response stuck between fight or flight (Starlanyl & Copeland 2001), difficulty falling into deep sleep, low levels of human growth hormone that help regulate muscle repair, hyperalgesia or central sensitization where pain is amplified (Litan, 2001), smaller nerve fibers and more nerve receptors than considered normal (Marcus & Deodhar, 2012), and insufficient glucocorticoids (Sapolsky, 2004). These conditions occur in statistically greater instances in people with FMS (Marcus & Deodhar, 2012).
Sapolsky flatly states what other experts hedge around, that “fibromyalgia is more likely to strike people with anxious or neurotic personalities” (2004, p. 200). This tendency doesn’t help the general view that it’s a pyscho-somatic disorder of overly-hyped pain. Sapolsky neatly explains this. “Sufferers have abnormally high levels of activity in parts of the brain that mediate the emotional/contextual assessments of pain” (2004, p. 200). We can conclude then that the musculature of FMS is built to work harder and the nervous system wired to rebuild it more slowly. The FMS nervous system is also built to perceive pain more acutely and under-prepare for stress. Add a lack of ability to fall into deep sleep and a systemic cascade effect begins–fatigue, constipation, cystitis, skin breakouts, imbalance, emotional fragility.
FMS clearly falls into the domain of Psychoneuroimmunology, or PNI, where multiple systems are involved in an individualized, intricate dance of symptoms and treatments. A FMS patient could easily have an array of specialists covering every system of the body along with a bodyworker, acupuncturist, mental health counselor, and spiritual director. It’s a perfect candidate for a whole health approach.
Whole Health Treatments
Marcus & Deodhar (2012) note that “people with fibromyalgia who have a strong sense of self-efficacy have less pain and disability” (p. 41). In other words, people need tools and a sense of control to manage their pain.
After ruling out possible easily measurable conditions, refining the diet comes first. The enzyme-linked immunosorbent assay/advanced cell test (ELISA/ACT) provides more comprehensive panels than the conventionally used IgA and IgG panels. The ELISA/ACT measures lymphocyte response to a range of allergens from food to chemicals (Litan, 2001). After identifying and limiting or eliminating allergens and sensitivities, practice mindful eating–chewing food well, limiting meals to a few ingredients for easier digestion, and following whole health dietary guidelines (WHeDiGid).
Commonly recommended supplements include vitamin D for immune and nervous systems, the anti-inflammatory EFA, the all-purpose anti-stress B-complex (Litan, 2001), Vitamin C, SAMe, and Melatonin (Marcus & Deodhar, 2012). This is highly individualized and ideally requires the expertise of a metabolic nutritionist, naturopath, or functional medical practitioner.
Bladder issues should be handled specifically with a urologist. Bowel issues can usually be handled with a change in diet and probiotics (Litan, 2001). Herbs that support each system like mullein root for the bladder and cascara sacrada for the bowels are easily available.
Finding comfortable exercise for the sleepless and achy is difficult. It’s important to try a range of possibilities and respect the learning curve–gentle yoga or stretching, easy cycling on a recumbent bike if necessary, walking on dirt with good shoes, swimming, easy gardening. It is very important to build into aerobic exercising and strength-training, understanding that the body may have initial increases in pain and fatigue (Marcus & Deodhar, 2012).
Since the nervous system of FMS patients is usually stuck between fight and flight modes, falling into deep sleep is a challenge, and it is key for improvement. If sleep apnea is suspected, a sleep study is recommended. Sleep medications are generally ineffective or have dangerous side effects (Litan, 2001). Follow general sleep guidelines such as avoiding caffeine, exercise, heavy dinners, and alcohol; practicing quiet evening activities; establishing a circadian rhythm; keeping electronics out of the bedroom; and possibly changing the mattress, pillows, and linens.
Myofacial Release (MFR) can provide immediate relief of pain (Litan, 2001). The restrictive and painful fascia fibers are released and the parasympathetic nervous system activated, a key strategy for the FMS nervous system. Releasing painful scar tissue may require specific cross-fiber techniques such as deep friction therapy (Litan, 2001), Amna therapy, or rolfing. The type of bodywork appropriate for an individual will depend entirely on body chemistry/diet, experience with bodywork, and pranayama capacity. If a patient has never experienced bodywork, it’s best to initially avoid strenuous modalities such as rolfing.
Finally, recalibrating the nervous system is essential. Cognitive-behavioral therapies and relaxation techniques won’t relieve the pain, but they can help how people perceive and handle their pain (Marcus & Deodhar, 2012). This seems to be the hardest area for most people to cultivate. We all need to eat, sleep, and eliminate, so those areas get the most attention first. “I don’t have time for yoga or meditation!” is our common lament. Here is where a coach or buddy comes in. Make the commitment and do it together. Then, one day, the practice is habituated and necessary. The underappreciated Best Practice is breathwork. Whether a few moments in yoga class or a breath-pumping walk, deep breathing activates the parasympathetic nervous system, floods the body with oxygen, and accelerates carbon dioxide removal. New neurons can be generated with bi-lateral stimulation–limb movement across the axis of the body. Adding affirmations, chants, or visualizations increases the efficacy.
If the notion of breathwork, yoga, chi gong, or tai chi are simply too foreign, simple activities like a crossword puzzle or soduku help activate and balance the mind. Watching a quiet movie, reading, crafting–any activity to rest and recharge is supportive. Learning simple stress-reduction techniques is helpful such as time management skills, how to mitigate stressful buttons, prioritizing tasks, learning to say no (Marcus & Deodhar, 2012), asking for help, breaking up tasks. Giving permission to relax and play, wear comfortable clothes, and engage in nurturing self-care (Starlanyl & Copeland 2001).
Avoiding excesses is important, such as extended travel, temperatures, remaining in one position for too long, repetitive motions, rich food, even loud noises and bright lights (Starlanyl & Copeland 2001). Honoring a compromised nervous system requires vigilance in daily maintenance and special circumstances.
Other therapies that may help include cranial electrotherapy stimulation where minute amounts of electricity are given to the brain, cranial-sacral therapy where a therapist gently pulses cerebrospinal fluid, eye movement desensitization and reprocessing (EMDR)– specifically for trauma (Litan, 2001), Ayurvedic practices, chiropractics, homeopathy, TCM and acupuncture, Osteopathic Medicine (Starlanyl & Copeland 2001), and transdermal magnesium therapy.
Treatments that generally have not shown adequate support for FMS include magnets, swedish massage, Guaifenesin, IV Therapy, and DHEA (Litan, 2001).
It may sound like a lot of work, and ideally FMS can be managed by following Integrated Best Practices. Treating FMS is a perfect example of how a condition or illness can be our teacher. Some people may never learn how to fully relax, or that they love cranial-sacral work, or how to prepare delicious vegetables unless they have enough motivating pain.
References
Dellwo, A. (2010, May 22). New diagnostic criteria for fibromyalgia. Retrieved from http://chronicfatigue.about.com/b/2010/05/22/new-diagnostic-criteria-for-fibromyalgia.htm
Liptan, G. (2001). Figuring out fibromyalgia. Portland: Visceral Books.
Marcus, D. & Deodhar, A. (2012). The woman’s fibromyalgia toolkit. New York: DiaMedica Publishing.
Sapolsky, R. (2004). Why zebras don’t get ulcers. Third Ed. New York: St. Martin’s Griffin.
Starlanyl, D. & Copeland, M. (2001) Fibromyalgia & chronic mayofascial pain. 2nd Ed. Oakland: New Harbinger Publications.