Fibromyalgia: Understanding Its Causes and Resolution; Part II of II

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Fibromyalgia: Understanding Its Causes and Resolution; Part II of II

SINCE I BEGAN WRITING articles for Today's Chiropractic and other publications in 1979, I have tried to find commonalties among disease states, rather than the differences between them.

Nowhere is this perhaps more true than with the syndromes of fibromyalgia and chronic fatigue and their relationship to overall poor health.

In the first part of this series, the similarities between fibromyalgia and chronic fatigue were illustrated. In clinical practice, it is almost uniformly observed that the patient with fibromyalgia is the patient with accompanying chronic fatigue. The clinical features of fibromyalgia and CFS are strikingly similar.(1)

Fibromyalgia is considered a chronic ailment and people with chronic illness share a number of characteristics, muscular aches and pains being extremely common.

Attempts have failed to differentiate criteria for fibromyalgia from chronic fatigue syndrome, psychosomatic disorders and a variety of rheumatic disease conditions, muscular disorders, etc. Magnetic resonance imaging has not revealed any primary skeletal muscle abnormality.(2)

There is no evidence that fibromyalgia is a disease of the muscles per se.(3)

Over the past 23 years of practice as a natural hygiene practioner and clinical epidemiologist, the last 15 years as a doctor of chiropractic, I have observed numerous patients with fibromyalgia who share these symptoms. The vast numbers of people in our population with fibromyalgia are run-down, ill people whose batteries are generally functioning on low.

In taking the history, it is common to find the patient experienced a multitude of other health problems prior to the onset of fibromyalgia, with fatigue and functional gastrointestinal problems being particularly common.

Reported remedies for fibromyalgia are as common as fleas on a dog. Everybody and their mother has the "cure," such as:

- You need to drink aloe vera juice;

- You need magnesium;

- Take glucosamine sulfate, I did it and that worked for me;

- Six grams of buffered vitamin C per day, that's what you need;

- Don't you know that fibromyalgia comes from hidden anger?;

- Fibromyalgia is the result of not having juice plus tablets;

- It comes from not getting enough exercise;

- Everyone knows it stems from a T4 subluxation;

- You need massage work;

- It comes from having undigested meat in your intestines;

- It's a sign of a sexual malfunction;

- It's unresolved frustration;

- You need a homeopathic evaluation;

- The regular smelling of these flower extracts takes care of fibromyalgia; and/or

- It is indicative of repressed sexual urges, etc.

How often have we seen patients who have gone through so many "cures" that have been touted to them by practitioners, their neighbors, ads they receive in the mail or an article that they "read somewhere?"

With such a myriad of misinformation out there and with so many people touting so many different "remedies," what can we say about the condition in general terms?

The frequency of the triad of fatigue, depression and digestive problems which accompany fibromyalgia leads to several conclusions:

The condition is one representative of overall poor health, not simply an isolated problem with muscle tissues.
The patient has undergone stress(ors) of some type beyond their body's capacity to cope in a healthy fashion.
In light of the above, the patient's overall health must be addressed, not simply the symptoms of muscular discomfort. When the patient has obtained good digestion and good energy levels, he/she will also find that muscular pains dissipate. As long as the focus remains on the muscular discomforts alone, the patient's problems will likely continue. This is a difficult point for patients to understand, and even more difficult to convince many doctors, who would like to have a "remedy" of some type available that is quick and convenient.

Life in modern society has become increasingly stressful in ways that challenge the adaptive abilities of much of our population. The late Dr. Hans Selye revolutionized scientific thought with his theory, years ago (confirmed by a multitude of scientific studies), that the body reacts to every variety of stress in the same ways.(4)

As perhaps you are aware, Selye discussed three phases of stress, including the alarm reaction, a stage of resistance and a stage of exhaustion, when the body can no longer meet the demands of stress placed upon it and adaptation fails.

Intense stressors, such as surgery, a serious accident or severe burns, can cause a person to pass through all three stages (alarm, resistance and exhaustion) in a single day.

For modern men and women, the more common scenario is living through repeated alarm reactions and a multitude of stages of resistance one after another, gradually and systematically lowering our body's ability to cope with the situation and leading to a maladaptive response and illness.

These ongoing stressors place demands on the body for increased nutrients, rest and sleep, all three of which are short in supply in many Americans' lives. As the body fails to meet the demands of stress, a variety of symptoms can occur, with indigestion, fatigue and muscular discomforts being particularly common.

As a "stress-related disorder," patients with fibromyalgia must look beyond their muscular pain and consider their overall health and well-being. The patient, along with the doctor, must dissect the lifestyle to evaluate what factors are lowering resistance and producing resulting fatigue and enervation of the body.

This process requires time and reflection by both the doctor and patient, rather then the simple application of some type of "convenient therapy."

Some of the more common areas from which fibromyalgia symptoms may stem include:

Poor diet and poor digestion: Particularly common are diets loaded with refined carbohydrates. Food allergies may play a role. Habits such as overeating, eating under stress, eating too frequently, etc., often contribute to the body's maladaptive response.
Emotional stressors: Marital difficulties, loneliness, job dissatisfaction, boredom, lack of purpose in life and other ongoing frustrations take a heavy toll on bodily efficiency when they are prolonged.
Lack of sleep and rest: The average American obtains 20 percent less sleep now than they did at the beginning of the century.(5) Without adequate sleep and rest, the body does not have the opportunity to eliminate wastes or repair tissues. Symptoms such as fatigue and muscular discomforts are common consequences.
Toxic habits: The ingestion of coffee, soft drinks, tobacco, alcohol and a variety of prescription and non-prescription drags, all contribute to poor overall body efficiency.
Excesses of all kinds: Excesses even of "good" things can lead to a loss of body efficiency. Excess sexual activity, excess exercise, excess work and excess food all fall into this category.
The question I receive from both patients and their doctors of chiropractic is: "What can we do for fibromyalgia?"

My answer is: Determine the causes of the patient's overall poor health and address them thoroughly. When the patient's overall health is improved and their vitality elevated, their symptoms of fibromyalgia will dissipate.

I have yet to see a single patient with complaints of fibromyalgia whose general health was excellent. Likewise, I have yet to have a patient whose overall health was improved whose fibromyalgia did not improve as well.

The following two case studies will help illustrate this relationship between overall poor health and fibromyalgia.

CASE STUDY 1

History: A 33-year-old female was referred to me by a doctor of chiropractic with symptoms of severe fibromyalgia over a period lasting three years. Spinal adjustments and physiotherapy had brought the patient only partial and very temporary relief.

The patient was receiving disability due to her inability to manage her job with the severe discomforts she was having. Her medical physician had prescribed antidepressant medication, which the patient had used for several months but discontinued since she had not found it to be helpful.

She found it difficult to sleep due to the muscular pains, and even mild exercise had proven to cause too much discomfort for the patient to handle.

In addition to chiropractic care, she was taking a number of multi-level marketed nutritional supplements and some homeopathic remedies, none of which had proven of benefit. The patient had additional complaints of ongoing fatigue, depression, low-sex drive, a tendency to become cold easily and constipation alternating with diarrhea.

Examination: The patient was of normal weight for height. Vital signs within normal limits. She was extremely sensitive to touch anywhere on her body, particularly the shoulders, neck and mid and lower back. There were multiple areas of fixation present throughout the spine despite several years of adjusting by her doctor, a competent doctor of chiropractic.

She was very anxious about her overall condition and the way it had affected and limited her life socially and occupationally. The anxiety was evident in her facial expressions and the manner in which she conducted herself. The patient's facial expression was tense, indicating her discomfort and concern.

Laboratory Testing: Laboratory testing included a blood chemistry, blood count and a sedimentation rate. A dietary history was conducted and a food allergy panel and amino acid analysis performed.

The blood chemistry/blood count revealed a modestly lowered hemoglobin and a moderately elevated triglyceride level. The fasting glucose level was elevated at 115. The sedimentation rate was normal despite the severe muscular pains the patient was experiencing.

The dietary history and computerized analysis revealed a significant intake of coffee and refined carbohydrates. As is usually seen with patients with a high-refined carbohydrate intake, the diet was almost entirely devoid of fiber, B complex vitamins and trace mineral elements. While the protein intake was excessive, the amino acid analysis showed low amino acids in 10 of the 20 amino acids tested, indicating impaired digestion of proteins. The food allergy panel showed only some low-level food allergies, and I did not consider it significant in this patient's case.

Plan of Action: A report of findings was given to the patient, in which I emphasized to her the need to rebuild her overall health and to pay less attention to her symptoms.

I explained that I felt strongly that when her energy level and digestion were improved, so too would be the muscular discomforts. Toxic habits had to be given up, in her case coffee. She asked what she would drink if she did not drink coffee. "Water," I replied, the "gift of the gods."

I further instructed her that she should be in bed each night by no later then 10 p.m. and that she could get up any time after 6 a.m. she desired. She complained that she had trouble falling asleep that early, so I changed my directive by stating that she needed to get up by 5:30 a.m. each day, and I assured her that she soon would have little, if any, trouble falling to sleep at night.

The patient was fasted with total bed rest for the initial seven days. She found her pains greatly elevated for the first three days, along with headaches from the caffeine withdrawal. She reported that the second day was very uncomfortable, but on the fifth day she said the discomforts had eased considerably. By the seventh day, she reported a substantial decrease in her muscular pains and a "sense of calmness" that she had "never before experienced."

Outcome: Due to time constraints, the fast was carefully broken on the eighth day with a gradual transition to much healthier eating habits. Her fast left her with a healthy desire to consume natural foods, and she lost her desire to consume coffee and sweets. A modest amount of freeform amino acids were given, according to her blood amino acid study. She was instructed to begin a light exercise program, which she now found tolerable.

After ten days of carefully eating a diet of fresh foods by the patient, another blood chemistry and blood count were performed. The patients triglyceride level had dropped 75 points to normal levels, her fasting glucose had dropped to 88, and her hemoglobin level had risen to normal.

The patient returned home after her three-week stay, estimating that she had improved over 75 percent overall. Her bowels began to function normally, her digestion was vastly improved, her energy level was greatly enhanced and along with that the muscular discomforts of fibromyalgia dissipated.

The patient was carefully counseled on how to maintain her health through her living habits at home so as to maintain and continue her improvement. She and her doctor of chiropractic were well satisfied with her results.

Follow-up: The patient remained well and continued to improve for the next five months, at which time she returned to going to bed late and drinking coffee and her symptoms began to return.

Upon consulting with me again, she explained that she thought returning to some of her old habits would be okay, since she now was eating better and had "been cured."

I made it clear to her that by returning to the same causes of her illness, she could expect to reap the same results. The patient again began living more hygienically, giving up the coffee and returning to an earlier bedtime, and again, her health and vitality returned.

CASE STUDY 2

History: A 45-year-old female, referred to me by a local doctor of chiropractic, presented with complaints of fatigue, fibromyalgia, migraine headaches and depression. She had experienced a gradual decline in her health over the past seven years. She was receiving both weekly chiropractic adjustments and weekly massages.

She had undergone a complete hysterectomy five years previously, and she complained of also having periodic heartburn, for which she ate Tums, an antacid.

Her relationship with her husband was stressful, as was her relationship with her daughter, who had taken advantage of her financially. She felt very unappreciated at her workplace, despite being one of the top salespeople in the company.

Her eating habits were erratic, but her sleep patterns were normal. She took periodic walks, but she had no regular physical activity program. There was a family history of cardiovascular disease.

Examination: Vital signs within normal limits. Weight normal for height. Tender to palpation throughout the cervical and thoracic spine. Extremities cold. A good deal of muscular tightness throughout the spine and shoulders.

Laboratory: Blood chemistry revealed elevated an cholesterol level (245). CBC WNL. Sedimentation rate WNL.

Dietary history revealed an excessive amount of refined carbohydrates, irregular eating habits and periodic periods of heavy consumption of candy. The patient completed a female hormone profile, which showed an excessive amount of estrogen relative to progesterone (patient was taking estrogen prescribed by her medical physician). Multiple allergies to dairy, wheat, rye and tomatoes were noted, and the patient also exhibited an elevated serum candida titer.

Plan of Action: Patient was unable to fast, in light of her work activities, so she was placed on a restricted diet, consisting of mostly raw vegetables, for a period of ten days, and she handled it well. This was followed by a customized diet which eliminated refined carbohydrates, all her allergens, and emphasized whole natural foods with a somewhat lowered total carbohydrate intake, in light of her yeast overgrowth. She was counseled on proper eating habits, including avoiding eating when overly fatigued or stressed.

I further advised the patient to begin a swimming program at a local YWCA, to seek out marriage counseling and to allow her adult daughter to work out her own financial problems in the future, while forgiving her for her past mistakes.

The patient was given some phytoprogesterone cream to apply to her skin to assist in rebalancing the estrogen/progesterone ratio. She was also instructed not to rely on Tums, as this would interfere with normal HCL production and did not address the causes of her heartburn.

I asked her to speak to her supervisor at work to see if some of the problems could be worked out amiably, and if not, consider securing employment elsewhere.

Outcome: The patient's heartburn disappeared during the 10-day vegetable diet. Her energy level improved fairly rapidly over the next 45 days, although she had some temporary exacerbation of her symptoms, likely occurring from withdrawal of the food allergens and sweets, along with yeast dying off.

She enjoyed swimming, and gradually found that her extremities began to warm up as her energy level improved. Her spouse refused to get marriage counseling, but as her own health improved, she found herself better able to tolerate his shortcomings. The problems with her daughter improved, although they have not been totally resolved. The migraine headaches disappeared, which was likely due to correcting the estrogen/progesterone ratio.

A follow-up test 45 days later on her blood chemistry showed her total cholesterol to have dropped from 245 to 167. The symptoms of fibromyalgia improved, according to the patient, approximately 80 percent.

She discussed problems with her job with her supervisor and some positive changes were made, although the patient is still not completely satisfied with the work situation. The need for her chiropractic care has been reduced, and she now gets adjusted once every six weeks, as opposed to once every two weeks.

Discussion: Occupational and familial problems can be potent stressors and initiate or exacerbate many health problems, including fatigue and fibromyalgia. I have found it critical to address these issues when they are present with the patient directly or to refer them to an appropriate counseling source.

It is very true, however, that by improving the patient's biochemical status that they are placed in a much better position to deal with the stressors of life and manage them, without so much distress and discomfort.

SUMMARY

Fibromyalgia is a symptom of imbalanced health, and there is no single approach or cure for it.

Each patient's overall health must be investigated, and each patient's lifestyle and individual biochemical traits considered. Those who tout special herbs or multi-level-marketed wonder formulas or otherwise pursue the "cure train" will be disappointed.

Social factors, such as work and familial relationships, should be considered along with investigation of the patient's lifestyle (hygienic) habits.

Careful investigation and hard work, by both the patient and a caring, analytic practitioner, will usually bring about significant improvement in the patient's condition, as long as causes, rather than symptoms, are addressed.

Part II References

(1.) Dawson, D., and Thomas, S., eds., Chronic Fatigue Syndrome, p. 87.

(2.) Journal of Rheumatology, 20: 344, February 1993.

(3.) Journal of Internal Medicine, 235: 199, March 1994.

(4.) Selye, H., Journal of Clinical Endocrinology, 6, 117, 1946.

(5.) National Council on Sleep Disorders report, The Atlanta Journal and Constitution, March 22, 1995.

Part I References

(1.) Goldberg, P. A., "Arthritis and Rheumatism Sufferers: The Forgotten Patients," Today Chiropractic, November/December 1994, January/February 1995, March April 1995 and May June 1995.

(2.) Goldenberg, D.L. "Fibromyalgia syndrome: An emerging but controversial condition" JAMA. 257: 2782,

(3.) Wolfe, E, Smythe, H.A., Yunus, M.B. et al., "The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia: Report of the Multicenter Criteria Committee," Arthritis Rheum. 33: 160, 1990.

(4.) Squires, "Fibromyaliga -- David's Story" A Resource Catalogue, To Your Health, Inc., Fountain, Hills, Arizona.

(5.) Chaitow, L., Fibromyalgia: What Causes It, How it Feels, and What To Do About It. Thorsons, San Francisco, CA, 1995.

(6.) Journal of Rheumatology, 20: 344, February 1993.

(7.) Journal of Internal Medicine, 235: 199, March 1994.

(8.) Goldberg, P.A., M.P.H., D.C. Exploring Chronic Fatigue Syndrome (three parts) See Today Chiropractic November/December 1995, January/February 1996 and March April 1996

(9.) Koraroff, A.L., and Godenberg, D., "The chronic fatigue syndrome: Definition, current studies and lessons for fibromyalgia research," J Rheumatol. 19 (suppl.) 23, 1989.

(10.) Behan, P.O., Behan, WMH., and Bell E.J., "The postviral fatigue syndrome: An analysis of the findings in 50 cases," J. Infect. 10:211, 1985

(11.) Dawson, D. and Thomas, S., eds. Chronic Fatigue Syndrome, p. 87.

(12.) Goldbenberg, D.L., "Psychologic studies in fibrositis,"Am. J. Med. 81: 67, 1986.

(13.) Simms, R.W., and Goldnberg, D.L., "Symptoms mimicking neurologic disorders in fibromyalgia syndrome," J. Rheumatol. 15: 1271, 1988.

(14.) "About Fibromyalgia Syndrome," Health Points, TyH Publications, Fountain Hills, AZ, 1995.

(15.) Chaitow, L., Fibromyalgia: What Causes It, How it Feels, and what to Do About It, Thorsons, San Francisco, CA, 1995.

(16.) Dawson, D.M., and Thomas, D. S., Chronic Fatigue Syndrome. Little, Brown and Company.

(17.) Vaeroy, H., Helle, R., Forte, O., et al., "Elevated CFS levels of substance P and high incidence of Raynaud phenomenon in patients with firbomyalgia: New feature for diagnosis," Pain 32: 21, 1988. As reported by Dawson and Sabin (editors) in Chronic Fatigue Syndrome, p. 85.

(18.) Bengtsson, A. and Bengstsson, M., "Regional sympathetic blockade in primary fibromyalgia," Pain. 33:161, 1988. As reported in Chronic Fatigue Syndrome edited by Dawson and Sabin p. 85.

(19.) Di Fabio, A., and Jaconelio, P., Soft Tissue Arthritis. Arthritis Trust of Canada, Kanata, Ontario.

(20.) Pressman, A.H., "Metabolic Toxicity and Neuromusscular Pain, Joint Disorders and Fibromyalgia," Townsend Letter for Doctors and Patients, November 1995, p. 80-81.

(21.) Abraham, G.E., and Flechas, J.D., "Management of Fibromyalgia: Rationale for the Use of Magnesium and Malic Acid, "Journal of Nutritional Medicine, 1992, 3, 49-59, p. 49.

(22.) Goldenberg, D.L., Felson, D.T. and Dinerman, H., "A randomized, controlled trial of amitriptyline and naproxen in the treatment of patients with fibromyalgia," Arthritis Rheum. 29: 1371, 1986.

(23.) Russell, I.J., Flecthcer, E.M., Michalek, J.E., et. al., "Treatment of primary fibomyaligai syndrome with ibuprofen and alprazolam: A double blind, placebo controlled study," Arthritis Rheum. 34: 552, 1991.

(24.) Chaitow, L., Fibromyalgia.

Life University.

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By Paul A. Goldberg

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