Fibromyalgia is a common cause of chronic pain. A person diagnosed will have fatigue, muscle pain, and stiffness.
Fibromyalgia has a gradual onset. It is usually related to a history of trauma. Approximately 2-3% of the population have fibromyalgia, affecting mainly women ages 20-55 years old. It is diagnosed clinically which means diagnosis is based on the patient’s story, symptoms, and physical exam, not on positive lab findings. In fact, testing for inflammation will be negative. Fibromyalgia is considered a syndrome, not a disease. A syndrome is a pattern of signs and symptoms, whereas a disease is more specific with pathological changes in tissue. The cause of fibromyalgia is unknown. Some diseases can appear to be fibromyalgia and must be ruled out with additional workup, like rheumatoid arthritis and inflammatory myopathy.
Other potential causes of chronic widespread pain:
• Inflammatory rheumatological disease (RA, lupus)
• Systemic autoimmune disorders
• Polymyalgia rheumatica
• Inflammatory myopathy
• Osteoarthritis
• Localized pain syndromes
• Thyroid disorder
How to diagnose fibromyalgia?
A doctor will “palpate” the body of the patient, a fancy term for investigative touch. If a patient is tender to light palpation, we think this is abnormal and investigate further. If a person is tender in many different areas of the body, fibromyalgia is on the list of possible diagnoses.
A person with fibromyalgia will be tender to light or moderate palpation. For example, pressing lightly on a patient’s shoulder will elicit an “ow!” and will likely be surprising to the person pressing. Fibromyalgia symptoms also include sleep disturbances, fatigue, and sometimes brain fog. They will sleep light, wake unrefreshed and stiff. 30-50% of patients diagnosed with fibromyalgia will have either depression or anxiety. About 50% will have headaches, either tension-type or migraine. Some may experience paresthesias; tingling, burning, numbness, creepy crawly feelings on the skin. Other symptoms include irritable bowel, pelvic pain, and temporomandibular joint dysfunction.
In order to diagnose fibromyalgia, a person will have chronic widespread pain of at least 6 different body areas out of 9. "Body areas" include: left arm, right arm, left leg, right leg, head, and upper back. These areas are without joint swelling or inflammatory physical changes. Symptoms must be going on for at least 3 months (aka "chronic.") Blood work is normal: Complete blood count is normal. Inflammatory markers like CRP and ESR are normal. Other possible causes of widespread body pain are ruled out.
Coexisting problems:
• Irritable bowel syndrome
• Chronic fatigue syndrome
• TMJ
• Migraine
• Interstitial cystitis/ chronic pelvic pain syndrome
• Sleep apnea
• Restless leg syndrome
• Raynaud's syndrome
• Autonomic nervous system dysfunction (orthostatic hypotension, tachycardia, palpitations)
Above is a list of other conditions people diagnosed with fibromyalgia may have.
Fibromyalgia Tender Points & Acupuncture
The common tender points are surprisingly similar to acupuncture points. Some of these areas we call the “sea,” located at the knees and elbows, because there is an abundance of Qi. Qi flows through acupuncture "channels" like water. These areas are also where large amounts of Qi can get stuck, resulting in stagnation and thus pain.
Spiritually, these points may express:
A movement in the direction of ease on the earthly plane; Navigating through life’s obstacles with wonder.
Treatment
Without getting too much into the knitty gritty and speculation of fibromyalgia since its cause is unknown, I’ll tell you what works very well for patients.
Stress & Adrenal Fatigue
Chronically stressed people either physically and/or emotionally tax their adrenals. If you are skeptical of "adrenal fatigue", then consider whether "burnout" is real. Our energy reserves don’t last forever. So how does one support adrenal function and reduce stress?
Sleep & Adrenal Support
Sleep is so important. This is how we recharge and heal. At the heart of Chinese medicine is the heart and directly opposite, the kidneys. Elementally, the heart and kidney represent fire and water, respectively. Like water, kidneys are the source of our prenatal essence, a dense fertile fluid, supplying life-force. Essence further differentiates into kidney Yin and kidney Yang, then, kidney Qi. Similar to how alternative doctors view adrenal fatigue, without enough Yin, Yang, or Qi, there is low energy. With little energy to function, our body is more stressed.
Sleep decreases stress, and decreases pain. If your sleep is often disturbed by chronic pain, I recommend talking to your doctor. This is not something you want to sacrifice and not something you have to live with.
I encourage you to take a closer look at your sleep quality.
Fun Sleep Facts:
On average it takes a person 30 minutes to fall asleep.
You should not be waking up more than two times a night to urinate.
If you drink alcohol in the evening, this may be what's causing you to wake up to pee.
Alcohol and cannabis can affect your REM sleep or deep sleep and dreams.
If you are grinding your teeth at night, this can be due to stress or alcohol intake.
If you can't sleep well due to pain, talk to your naturopathic doctor.
If you have restless sleep, talk to your naturopathic doctor.
Too much or too little sleep can cause problems. On average 7-9 hours a night will be optimal for most people.
Sleep Apnea? Try a hepa filter for your bedroom to improve air quality,
Itchy? Rule out food triggers.
Waking up at 1am for no reason? Balance blood sugar.
The Oura ring and other apps can tell you about your sleep quality.
Stress reduction can look like a variety of approaches from conscious breathing, leisurely strolls, cranial sacral therapy, counseling/talk therapy, to supplementation.
Knitty Gritty Tid-bit
There are many theories about what causes fibromyalgia. One theory is central sensitization. Central sensitization is defined as follows: when stimuli that was previously benign becomes noxious or painful.
Another theory is: an underlying infection or toxicity, like mold or lyme disease. Ruling out other possible causes of chronic widespread pain is important because treatment strategy can change. Fortunately, the basics always apply. As naturopathic doctors, we believe removing obstacles and addressing deficiencies will improve the quality of our terrain. We regularly nudge our patients' bodies in the right direction towards health and wellness.
Movement and Health
Novel movements, exercise, or weight training not only support better sleep quality, but help decrease body pain. Moving the body will move Qi and blood, decreasing stagnation, therefore decreasing pain and tension. We may be familiar with the fact that exercise releases endorphins, the feel-good chemicals. We may have noticed movement increases energy, as long as we don't overdo it. Something we may not know is that movement increases lymphatic circulation, our body’s immune system filtration system.
A person with chronic pain or fibromyalgia will have to approach exercise strategically.
Exercise Strategy:
Warm up
Start slow
Low impact
48 hr Recovery
Myofascial Release For Fibromyalgia
Myofascial release, MFR, reduces pain levels. It is NOT deep tissue massage. It is very light, aimed at the fascia, releasing patterns and restrictions. Just because it is not deep
tissue, doesn’t mean it’s not deep acting. Much like cranial sacral therapy, CST, the use of light touch can result in profound change. MFR and CST are soothing to the nervous system, allowing the patient to decompress and unwind in ways that are nearly impossible to do alone.
While this picture looks a bit funny, we are working to release the temporomandibular joint and the associated jaw muscles.
If you feel like you're not getting anywhere with your conventional doctor, I suggest looking elsewhere for help. A holistic approach will offer strategies to improve your quality of life. Pain is often a result of many factors, not only physical trauma, and therefore can be approached and reduced by unconventional methods, without the use pain relievers and anti-depressants.
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