Pain Relief Chiropractic

Utilizing dietary approaches to help with fibromyalgia (FM) management has been our main topic these past two issues and serves as GREAT background information for this month’s topic: Vitamin D and its role in the management of pain associated with FM. Let’s take a look!

Vitamin D is found in foods such as fish, eggs, fortified milk, cod liver oil, and more. The sun also helps the body produce vitamin D with as little as 10 minutes of exposure reported to be enough to prevent deficiency. There are several different forms of vitamin D, of which two are important in humans: vitamin D2 (made by plants), and D3 (made by human skin exposed to sunlight). Foods may be fortified with either type, and supplements are available in both forms (D3 is preferred). The main role of vitamin D is to maintain normal blood levels of calcium and phosphorus. Calcium and vitamin D are often taken together to improve bone health and reduce fractures. Research has also shown that vitamin D may protect against osteoporosis, high blood pressure, cancer, and other diseases. “Classic” vitamin D deficiency diseases include bone softening conditions such as rickets (in children) and osteomalacia (in adults). People at high risk include the elderly, individuals who are obese, and those with limited sun exposure. Individuals with conditions such as cystic fibrosis (mucous build-up in the lungs) or inflammatory bowel disease are also at risk for vitamin D deficiency. With that background information, can vitamin D help FM patients with chronic pain?

In a February 2014 study (journal: Pain 2014, Feb 01;155(2)261-268), the first known randomized, placebo-controlled trial was conducted on 30 FM women with serum D3 levels below 32ng/mol/L (80nmol/L). Half were assigned to either vitamin D replacement or a control group that received a placebo (NOT vitamin D). The two groups were re-evaluated again after 24 weeks. The main hypothesis was that those treated with vitamin D3 would have less pain (as measured on a 0-100 pain scale and several additional questionnaires). The study found that there was a marked reduction in pain perception in the FM women treated with D3. Though a larger scale study was recommended to solidify these findings, the authors conclude, “This economical therapy with a low side effect profile may well be considered in patients with FMS.” This study is important, as dosing of vitamin D3 (preferred over D2 commonly prescribed) was based on deficiency levels and provided at 1200 to 2400 IU/day. By the end of three months, those receiving D3 improved from an average of 20 ng/ml to almost 50 ng/ml and reported a 20 point decrease in pain on a 0-100 scale. Further, about 20-25 weeks after discontinuing D3, their levels dropped back to ~26 ng/ml with a corresponding increase in pain levels (by 30%).

WebMD reports similar chronic pain benefits with D3 replacement. In 2003, they reported that D3 deficiency is high “among all U.S. ages, races, and ethnic groups over the past two decades.” They add that a then-recent study found that out of 150 chronic pain patients, 93% of them had “extremely low” D3 levels!

If you, a friend or family member requires care for Fibromyalgia, we sincerely appreciate the trust and confidence shown by choosing our services!

For many sufferers, Fibromyalgia (FM) is equivalent to fatigue and muscle pain. Though there are MANY symptoms associated with FM, these two are standouts! The topic this month centers around diet and its role in the management of FM. Last month, we discussed the importance of exercise (particularly walking), and prior topics have focused on the need for a multi-modal treatment plan that is individualized for YOU. Coordinate your dietary strategies with your chiropractor’s office and they will guide you in your personalized nutritional planning as it pertains to FM.

Because we are all truly chemically unique, there is no one “recipe” for every FM sufferer. This is why we recommend making a list of the various approaches AS YOU TRY THEM in order to sort out those most vs. least effective, and most importantly, foods that should be avoided altogether. Patient histories tell us that certain foods can create reactions such as cramping, diarrhea, constipation, and more and that list often includes MSG, certain preservatives, eggs, gluten, dairy, and other high “allergy-based” foods. In a survey published in the journal Clinical Rheumatology, 42% of FM patients reported that certain foods make their symptoms worse. Hence, keep a daily FOOD JOURNAL and grade how different foods make YOU feel on a 0= ”good”, 5= “no change,” and 10= “bad” scale. In as little as two weeks, you will start to see a pattern and avoidance of the “bad” foods makes a big difference! Write down any and all of your symptoms, pro or con, and include things like headache, indigestion, fatigue, aching, etc.

Once you see a “trend” for vs. against certain foods, ELIMINATE the ones that upset your irritable bowel, headaches, fatigue, etc., and avoid these foods for six to eight weeks. Then, to “challenge” your list of foods, you can then ADD ONE food back into your diet at a time to determine consistency and if it TRULY is a culprit FOR YOU! From experience, Dr. Ginevra Liptan, MD, medical director of the Frida Center for Fibromyalgia, in Portland, Oregon and author of Figuring Out Fibromyalgia: Current Science and the Most Effectve Treatements, dairy and gluten appear to be consistent culprits with fatigue, irritable bowel, and leaky gut symptoms like bloating and constipation. We will guide you in this process and/or help coordinate these services with an allergist and/or dietitian when it’s appropriate.

Some preliminary studies are showing that certain medicinal herbs and natural supplements may help manage FM related symptoms – remember to WRITE DOWN your experience with these various options: 1) 5-HTP (5- Hydroxytryptophan): This is a “building block” of serotonin which is a POWERFUL brain chemical associated with sleep and depression. It is thought that serotonin plays a significant role in reducing fibromyalgia suffering, particularly by increasing deep sleep and reducing pain. Studies show improvement in depression, anxiety, and insomnia as well! Though not ALL studies support its benefits, it’s worth a try given its limited side effects and potential for helping! 2) Melatonin: This is a “natural hormone” used to improve sleep patterns, which is a perfect fit for the sleep problems and fatigue associated with FM! Most people tolerate this well but a few may experience drowsiness, and for those, caution is appropriate when driving! 3) Probiotics: This is “…the new kid on the block,” as it’s showing up on labels of everything from yogurt to granola bars! These contain “friendly bacteria” we want in our digestive systems. Certain “strains” or types of “good-guy” bacteria aid in many conditions including irritable bowel, traveler’s diarrhea, reducing inflammation, boosting the immune system, and more! Note, there are MANY strains of probiotics, which we will discuss in PART 2 next month as we continue this “healthy” discussion of dietary approaches in the management of FM!

If you, a friend or family member requires care for Fibromyalgia, we sincerely appreciate the trust and confidence shown by choosing our services!

Fibromyalgia (FM) is now considered a central nervous system (CNS) disorder rather than a musculoskeletal condition. FM is managed best from a balance of different approaches including chiropractic adjustments, soft tissue therapies, modalities, exercise, diet, supplementation, sticking to a schedule, taking naps, stress management, cognitive behavioral therapy, and more. Common symptoms of FM include chronic fatigue and mental fog. The focus this month is on exercise and the benefits of exercise as it relates to improving quality of life!

Recent research has been published about the benefits of walking – not just for the FM sufferer, but for EVERYONE! Dr. Marily Oppezzo, a Stanford University doctoral adjunct professor in educational psychology and Dr. Daniel Schwarz, a professor at Stanford, have published very convincing evidence that walking is not only physically good for the body, but it’s also mentally good for the brain! In fact, they’ve discovered walking actually improves CREATIVITY! The study found that walking either indoors on a treadmill or outdoors BOTH similarly boosted creative thinking in participants! Hence, for those stranded indoors during climactic weather, whether snowbound in Wisconsin or heat bound in Florida, equal benefit can be obtained from indoor walking, even if it’s not as much fun as being outdoors! Though past research has shown that aerobic exercise generally protects long-term cognitive (brain) function, until this study, the benefits of walking when compared to sitting had not been considered as important. These authors point out that TWICE AS MANY creative responses were produced by subjects when they walked (whether on a treadmill facing a blank wall vs. walking outdoors in the fresh air) than when they sat from a prolonged period of time. This surprised the authors who thought thinking outdoors would easily be favored. They also found that these creative juices continued to flow when the person sat back down shortly after a walk! Now that we know that walking not only facilitates our bodies but also our brain, are there other exercises that can help the quality of life for the FM sufferer?

Dr. Lesley Arnold, a psychiatrist and FM expert at the Univesity of Cincinnati, College of Medicine in Ohio, recommends “a slow but steady pace” when starting a program, making sure that pain and fatigue are under control prior to introducing aerobic exercise. She recommends an initial assessment of the person’s current fitness level and then starts patients at one to two levels below that level, gradually building up stamina to a goal of 20-30 minutes of moderate aerobic activity 5-6 days/week. Exercises that emphasize low-impact, high-aerobic output are the best, and water-based exercises really fit that ticket due to the buoyant nature of water. Running in water against or without a resisting current and simply swinging the arms and legs against the resistance of water are extremely effective. A study published in Arthritis Research & Therapy reported improved health-related quality of life in women with FM for those participating in water aerobics. The soothing benefits of warm water is a good starting point, and classes are often group-based, adding social benefits of camaraderie and motivation, which creates a fun experience that participants can look forward to. Since FM is a CNS vs. a muscle condition disorder, another “brain” stimulating exercise includes simply balancing. Depending on the age, agility, and comfort of the person, try adding balance-challenging exercising to the mix. A good program to try can be found here: http://beta.webmd.com/fitness-exercise/ss/slideshow-off-balance-core-moves

Fibromyalgia (FM) is one of the most common types of chronic pain disorders with an estimated five million sufferers in the United States alone. A “hallmark” of FM is the difficulty its sufferers have in describing their symptoms. When asked, “…what type of pain do you feel?,” the response is often delivered with uncertainty such as, “…it’s kind of achy but sometimes gripping…it makes me stop what I’m doing sometimes for only a second or two, but othertimes, I have to sit or lay down until it passes.” It’s sometimes referred to as “deep inside” or radiating, shooting, tender, pins and needles, and locating the pain is another big challenge. It’s often a “generalized” deep ache that includes multiple body areas, sometimes all at once. At other times, it’s spotty and moves around. It’s typically NOT restricted to one side of the body but rather on both sides. It is these inconsistencies that makes diagnosing FM so challenging, sometimes to the point where it can literally take YEARS before a patient is diagnosed. One study reported that of the 92% FM sufferers who had discussed their complaints with a primary care doctor, only 24% lead to the diagnosis of FM! It is often asked what makes FM so difficult to diagnose and the answer is simply, “…we can’t see it,” and, there are no definitive diagnostics like a blood test, an x-ray, or even more sophisticated tests that can be relied upon to easily make the diagnosis. Moreover, many FM sufferers have other conditions that overshadow FM signs and symptoms that often become the focus of her (or his) doctor.

Back in the early 1990s, the American College of Rheumatology reported “a system” for diagnosing FM. This consisted of a physical examination approach where a certain amount of pressure applied to at least 11 of 18 “tender points” had to be present. This was initially received with enthusiasm, as previously FM was a diagnosis made almost entirely on “gut instinct.” However, it soon became apparent that it was not so easy to interpret the patient’s response when these tender points were tested. Today, for a diagnosis to be made, there are three specific findings that are considered: 1) Wide spread muscle pain (in all four quadrants); 2) Pain that has been present for at least three months; and, 3) at least 11 of the 18 tender points are found – LESS emphasis is placed on the latter. The Fibromyalgia Pain Assessment Tool is a questionnaire filled out by the patient that can also help lead to the diagnosis of FM. Assessing the FM patient for other complaints or conditions commonly associated with FM include the following (% prevalence is reported by fibrocenter.com): 1) Irritable bowel syndrome (32-80%); 2) Temporomandibular disorder (TMD) (75%); 3) Chronic fatigue syndrome – sometimes to the point where bed rest is mandatory (21-80%); 4) Tension or migraine headaches (10-80%); 5) Multiple chemical toxicities; (35-55%); 6) Interstitial cystitis (21%) which includes  eight months of bladder pain, urinary urgency, and frequency (more eight times a day and two times a night); 7) Restless leg syndrome (32%); and 8) Numbness, especially the hands and/or feet (44%). Other common complaints include sleep interference, which prevents deep sleep to be reached, depression or anxiety, concentration and/or memory problems, and more!

As chiropractors, we are trained to assess the FM patient, establish the diagnosis, and offer management strategies such as spinal manipulation, massage, exercise training, nutritional counciling, modalities, and more, which can significantly improve the quality of life of the FM patient. To achieve the best outcome, you may require the services of other types of healthcare providers, as the importance of co-management cannot be overemphasized!

If you, a friend or family member requires care for Fibromyalgia, we sincerely appreciate the trust and confidence shown by choosing our services!

Fibromyalgia (FM) has been described as being a “myth” as well as “real” (and probably everything in between the two). This is a VERY controversial disorder that some doctors push under the rug by saying, “….there is no such thing,” while others stake their reputation on it. So with this wide variance in attitude and beliefs about FM, what ARE the facts?

Fibromyalgia has been defined as, “…a complex chronic pain disorder that affects an estimated 10 million Americans” (ref: National Fibromyalgia Association). Women are affected the greatest, but it can affect men and children as well. This condition can be subtle, hardly interfering with life and all of its activities to being totally disabling, disallowing participation in work and the most desired aspects of daily living.

DIAGNOSIS: In 1990, the American College of Rheumatology (ACR) introduced the diagnostic criteria for FM. This includes a patients history of “wide spread pain” for at least three months, AND pain in 11 or more of the 18 specifiic tender points using 4 kg of pressure. Due to the significant controversy about the reality of the disease (as stated in the opening paragraph), ONLY a physician knowledgable about FM should make the diagnosis. Along with this diagnostic responsibility, ALL other conditions having similar presenting symptoms as FM, “…must be ruled out” BEFORE making the diagnosis of FM.

SYMPTOMS: Though the hallmark of FM is widespread, generalized pain (in all four body quadrants), a number of other symptoms are common amongst FM sufferers. Some of these include fatigue (moderate to severe), sleep disorders, brain fog, irritable bowel syndrome (IBS), headaches (including migraine), anxiety, depression, and environmental sensitivities. Studies suggest that there is a “neuroendocrine” (nerves and hormones) abnormality that may contribute to the FM symptoms.

CAUSES: Research has found a genetic link, as FM is OFTEN seen in several family members (among siblings and/or mothers and their children). “Secondary fibromyalgia” arises AFTER other health-related issues occur such as physical trauma (like an acute injury or illness), which can act as a “trigger” for initiating FM. Recently, more attention has been directed to the central nervous system as the “underlying mechanism” for developing FM. Here, the threshold or level of a stimulus that triggers a painful response is found to be much lower in FM patients compared to a healthy group of people (this is called “central sensitization”). Thus, a pain response is amplified in the FM patient due to this lowered threshold of pain tolerance.

TREATMENT: As there is NO KNOWN cure for FM, symptomatic support and functional improvement are two important primary goals when treating patients with FM. In the medical world, there are MANY drugs that have been utilized for FM (such as sleep aids, muscle relaxers, anti-inflammatory, analgesics, and anti-depressants / -anxiety meds). ALTERNATIVE therapies include massage therapy, chiropractic, myofascial release, acupuncture, herbal supplements, yoga, and other exercise approaches such as swimming and/or simply walking are popular care options for many FM patients. Increasing rest, pacing daily activities (to avoid “over-use”), stress management (relaxation tapes, exercise, and nutritional support can ALL HELP reduce FM symptoms and improve quality of life!

If you, a friend or family member requires care for Fibromyalgia, we sincerely appreciate the trust and confidence shown by choosing our services!

Fibromyalgia (FM) can’t occur in men because it’s a woman’s disease, right? In fact, if a man claims to have FM, then he is simply lying (probably just trying to get out of working and/or on disability), right? Unfortunately, that’s what MANY people (and even some doctors) believe!

Though it is true that FM is primarily a woman’s disease, actually nine times more likely, it does INDEED affect men. FM affects 2-4% of the population (an estimated 5 million adults) in the United States (US) with as few as 10% of victims being men. But, that’s still 500,000 men in the US alone, and that doesn’t include an estimated 20% that go undiagnosed (mostly because “men are men”)! The onset, like that for women, can occur, “….out of the blue.” Case studies show a man (or woman), can be highly engaged in an active lifestyle that may include golfing, bowling, or working on a hobby car, when suddenly and for no apparent reason, intense chronic pain can arise and, “…take over the life” of this previously very healthy, vibrant, active man.

We’ve all learned that FM is diagnosed primarily by excluding other disorders after running many tests including x-rays, various scans, lab tests, and more. When all the tests come back negative, the diagnosis of FM is even then only sometimes entertained. The word, “SOMETIMES” should be strongly emphasized as MANY doctors, as well as the general public, STILL have a hard time wrapping their heads around the diagnosis of fibromyalgia. This happens even more when a male patient presents with the FM cluster of symptoms. A male patient may attend a FM support group and be the only man in the room. The National Fibromyalgia Association has only one male board member who reportedly was not initially welcomed! This particular male reported that a neurologist refused to see him, as he did not support the diagnosis and openingly accused him of trying to get disability payments. He stated that it was particularly challenging to find professional care as well as community support. Even his best friend, a doctor, told him that men couldn’t get FM!

The cause of FM remains elusive. Why do so few men compared to women suffer from FM? Though certain types of viral infections, trauma after car accidents, and emotional stress have all been reported to trigger FM, it can also strike without warning. According to Dr. Muhammad B. Yunus, MD (professor of medicine at U. of Illinois, College of Medicine), FM is characterized by an imbalance of brain chemicals described as, “…a neurochemical disease.” He found that FM patients have higher than average levels of substance P (a neurotransmitter that signals pain), and lower levels of serotonin (a neurotransmitter that inhibits pain). Genetics and hormones (particularly estrogen, which is higher in women) also play a role both with causing the disease and with the gender discrepancy found in FM. Estrogen has also been found to reduce pain thresholds, a problem associated with FM, thus making women more susceptible to the disease. Like in women, men can have similar complications including (but not limited to) chronic fatigue, difficulty sleeping, headaches, irritable bowel syndrome, restless leg syndrome, and memory and concentration problems. But, it has been reported that men with FM usually have less wide-spread or, “…hurt all over” pain and may not suffer from as much fatigue, but in some cases, can still be more disabled from FM than women. Depression and suicidal thoughts are reportedly common in men with FM. Prompt diagnosis and treatment continues to be the recommended course in order to obtain ideal management results!

As chiropractors we can offer management, treatment, exercise training, dietary consultation, and coordinate care.

If you, a friend or family member requires care for Fibromyalgia, we sincerely appreciate the trust and confidence shown by choosing our services!