Tag Archives: fibromyalgia

Fibromyalgia and Foot Orthotics.

4 Jan

Fibromyalgia (FM) is a condition that (typically)  evolves slowly over time and often occurs for no apparent reason. The diagnosis is usually made by excluding other conditions leaving you with a diagnosis that in the absence of anything else, “….must be fibromyalgia.” Of course, the problem with that approach is that we all want to know, “…what caused this problem to start with?” In the end, we typically have to accept the fact that, “…it just did,” and move on to, “…now what are we going to do about it?”

A multi-disciplinary (involving several different types of doctors and approaches) treatment approach has been found to work well with Fibromyalgia patients. This approach may include medications from a primary care doctor who is aware and sensitive to this potentially disabling condition, massage therapy from a muscle relaxation point of view, clinical psychology when the stresses associated with FM become overwhelming and out of control, and chiropractic to quarterback joint mobility, diet management, exercise training, modality use, as well as offering foot orthotics. Coordinated care effort utilizing several disciplines is what is reported to be the most successful approach.

Because chiropractic embraces the concept of treating the whole person, this premise fits perfectly in the treatment plan for the FM patient since the entire body is considered, not just a specific area or system. In this approach, we assess posture, movement, alignment, and function and implement treatments to improve each of those areas.

During the postural assessment, because we are a 2-legged species, the feet must be carefully assessed for function and alignment. If you watch people walk, you will often see their ankles roll in with each step and for some, this can be quite dramatic where the ankle rolls in almost hitting the floor. What’s interesting is that most people don’t even know they are doing it! The truth is, most people with flat feet (technically called pes planus) and rolling-in ankles (or, ankle pronation) don’t have any foot pain or symptoms associated with the altered function. In fact, people with very high arches (pes cavus) usually have more foot pain than the flat footed person. If you look at shoes of those of us who pronate (which is about 80% of us), the wear pattern is usually quite excessive on the outer corner of the heel. Sound familiar? It is very common! So, why bother “fixing” ankle pronation if it doesn’t hurt? The answer is that biomechanical function is altered and it negatively affects the rest of the body quite significantly. Here’s what happens. When the ankle rolls in, the knee has to “knock” inwards, the hip has to impinge inwards, the pelvis on that side drops and the spine has to compensate for the pelvic drop and bend away from that side. Watch the shoulders and head sway back and forth as the pronated/flat footed person walks the next time you’re walking at the grocery store, mall, or airport.

So, how does the use of foot orthotics help the FM patient? It has been reported that it takes up to seven times more energy to walk when the ankles pronate excessively. Chronic fatigue is a frequent complaint in the FM patient, and the less energy expended from walking, the more energy will be left over for other daily tasks. Also, the biomechanical stresses on the ankle, knee, hip, and spine will be smaller from wearing foot orthotics, correcting the excessive side-to-side strain on the various joints. The journal Clinical Rheumatology recently reported a significant benefit when foot orthotics were used in the treatment of FM. The bottom line is that this is a VERY SIMPLE FIX and when so much of FM is so difficult to treat, this a no brainer!

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


Fibromyalgia and “SHINE.”

30 Dec

Fibromyalgia (FM) management can be as difficult as making a definitive diagnosis.  FM is characterized by generalized body aches and feeling exhausted, and yet, in spite of the exhaustion, the inability to sleep is a “classic” FM complaint. Some have referred to FM as “blowing a fuse” or as an “energy crisis,” as more energy is expended than what’s being made. FM sufferers, as well as the caregivers, know how physically and mentally difficult it is to manage this controversial condition. Many management strategies that have been published; SHINE is one approach. SHINE stands for Sleep, Hormones, Infections, Nutritional supplements, and Exercise. By focusing treatment strategies on these 5 areas, significant benefits can be achieved.

SLEEP: Some feel this is the most important problem to manage in order to gain control of FM. If we cannot reach “deep sleep,” (which is the sleep stage that is usually reached after about the 4th hour into sleep) then the body cannot fully rest. When discussing sleep problems with the FM patient, it is common to hear them say, “…I wake up every 1-2 hours and can’t get back to sleep for at least 15-30 minutes.” This results in NEVER getting to the deep sleep stage and eventually, because the body hasn’t fully relaxed often for years, everything starts hurting. This is the hallmark of FM. Some “tips” to help us get to sleep and stay sleeping include: keeping the bedroom cool (such as 65°), taking a hot bath before sleep to relax your tight muscles, spraying the pillow with lavender oil (helps promote sleep), taking 75-150mg of magnesium, avoiding caffeine (especially later in the day), the use of Valarian Root (a muscle relaxing herb) and/or melatonin (an amino acid that promotes sleep) can also help. The goal is to try to get 8-9 hours of sleep a night. Establish a routine in the evenings and go to bed at the same time or close to it.

HORMONES: These chemicals are produced by our endocrine glands (pituitary, thyroid, parathyroid, adrenals, ovaries/testes, and part of our pancreas. They are in balance with each other, and somehow, in FM they often fall out of balance. Have your health care provider perform tests (usually blood and/or urine) to determine your hormone levels and get them balanced!

INFECTION: The lack of sleep lowers our immune function, and infections can occur more readily. In addition to treatments, there are nutritionally based approaches to improve immune function, and if recurrent illnesses are part of your FM profile PLEASE consult with us regarding ways to boost your immune system!

NUTRITIONAL SUPPLEMENTS: This topic is related to the last as there are MANY supplement recommendations that have been found to boost immune function, increase energy, enhance sleep quality, and more. This is an area of FM management that is largely overlooked by traditional medical management approaches. Remember, a “team” of providers offers the FM sufferer the best way to manage this challenging to treat condition. Look for health care providers who are willing to work together as a team on your behalf.

EXERCISE: This is a MUST! For example, in a 2010 Oregon Health & Sciences University study, women with FM who practiced yoga for 8 weeks had a 24% pain reduction, 30% fatigue reduction, and 42% depression reduction.

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


Fibromyalgia and the Importance of Diet.

16 Dec

Fibromyalgia (FM) management involves many treatment approaches. As was pointed out last month, the importance of sleep quality, hormonal balance, infection management, nutritional supplementation, exercise and more was discussed as the “SHINE” approach. This month, we are going to explore how important diet is in the management of FM.

It’s been said that one of the most powerful tools the FM patient has in their possession is their FORK because, “…food becomes cells.” That is to say, the food we eat is used to build cells, tissues, and support our organ systems. The National Fibromyalgia Association (NFA) has reported that all FM patients have some common physiological abnormalities that include:

Too much Substance P (a pain producing neurotransmitter).

Too little tryptophan (an essential amino acid that helps make serotonin which helps mood and many other things).

Not enough serotonin (a brain neurotransmitter that fights depression)..

Abnormalities in muscle cells, especially the mitochondria that provides energy (ATP) to the cell.

With the exception of substance P, we can control ALL of the above, at least in part, with diet and eating the right food. The following 7 nutritional recommendations can make a significant improvement for the FM sufferer:

ELIMINATE FOOD TRIGGERS: Eliminate foods that irritate the digestive system. The NFA reports that 40% of FM patients have irritable bowel problems and food sensitivities that trigger abdominal pain, diarrhea, and headaches. Common food triggers include: monosodium glutamate (MSG), caffeine, food coloring, chocolate, shrimp, dairy products, eggs, gluten, yeast, milk, soy, corn, citrus, sugar and aspartame. Regarding aspartame and MSG – a 2010 study out of France reported FM symptoms subsided significantly after eliminating both from the diet, as they found that they stimulated certain neurotransmitters.

EAT MORE TURKEY! That’s because turkey contains tryptophan, an essential amino acid that can help combat chronic fatigue and depression, which are common FM symptoms. In a large NFA 2007 survey of 2,596 FM patients, about 40% of the group complained of energy loss. Tryptophan is only acquired through food as our bodies cannot make it or convert it from other substances. Tryptophan is needed by our body to make serotonin (the “happiness hormone”) which improves our mood and makes melatonin, the chemical that helps us sleep deeply. Hence, to fight fatigue, avoid the food triggers mentioned in #1 and increase tryptophan, which can be found in certain protein rich foods such as cold-water fish (salmon, tuna, anchovies, and mackerel), nuts and seeds, soy (soymilk, tofu, and soybeans), turkey, and yogurt. Many of these foods also contain tyrosine, which increases levels of brain neurotransmitters dopamine and norepinephrine. These brain neurotransmitters help with cell messaging, alertness, and reduce cognitive “fog,” often described by FM sufferers. Also consider taking melatonin if sleep is an issue.

EAT MORE SARDINES! Okay, turkey is more “palatable,” but sardines have the ability to reduce muscle pain, of which, according to the NFA survey, 63% of FM sufferers experience. This is thought to be due to coenzyme Q10 (CoQ10) deficiency, essential for muscle function and found in sardines and organ meats. Of course, if these natural food approaches don’t appeal to you, a CoQ10 supplement may be easier. In two studies, FM patients were found to be 40% deficient in CoQ10, and 30% experienced less muscle pain and fatigue after taking 300mg/day for 9 months.

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


Fibromyalgia and the Immune System.

14 Dec

Fibromyalgia (FM) is a condition with a polarized audience comprised of those who believe it’s real and those who don’t. This interesting political-like conflict is, in a large part, centered around the topic we discussed last month concerning the causes of FM. This month’s article will focus specifically on the immune system and its relationship to FM.

“EXTRA, EXTRA, READ ALL ABOUT IT! New research published on 12-17-12 in BMC Clinical Pathology describes cytokine abnormalities were found in FM patients when compared to healthy controls.” OK! But what does that mean?

Very simply, this study reports that immune dysfunction is part of the cause of FM. The most exciting part is that this study identified a BLOOD TEST (finally!) that, “…demonstrates value as a FM diagnostic tool.” Looking at this closer, the researchers used multiple methods to examine cytokine (proteins that help regulate our immune response) blood levels in FM patients. They found the FM group had, “…considerably lower cytokine concentration than the control group, which implies that cell-mediated immunity is impaired in fibromyalgia.” This study’s findings of an immune response abnormality strays from previous study findings which largely pointed to the central nervous system (CNS – brain & spinal cord) as the origin of the FM syndrome. This makes some sense as the study of immunology (in this case, “neuroimmunology” – the combination of neurology and immunology) has only been around for about 10 years, and as such, may hold some important answers as more evidence is uncovered to further support this potential “paradigm shift” in considering the primary cause of FM. The authors offer further excitement as this focus could lead to a better understanding of the cause of other neurological conditions such as multiple sclerosis (MS)! They go on by describing how body temperature, behavior, sleep, and mood can all be negatively affected by “pro-inflammatory cytokines” (PIC) which are released by certain types of activated white blood cells during infection. PIC have been found in the CNS in patients with brain injury, during viral and bacterial infections, and in other neurodegenerative processes (like MS)!

To further support this advance in understanding, the National Institutes of Health (NIH) reported, “…Despite the brain’s status as an immune privileged site, an extensive bi-directional communication takes place between the nervous and the immune system in both health and disease.” They describe multiple signaling pathways that exist between the brain and the immune system that function normally throughout our lifetime. When immune, physiological, and psychological “stressors” occur, cytokines and other immune molecules stimulate interactions within the endocrine (our hormone) system, nervous system and immune system. To prove this, brain cytokine levels go up following stress exposure and similarly go down when treatments are applied that alleviate stress. They list other conditions such as stroke, Parkinson’s, Alzheimer’s disease, MS, pain, and AIDS-associated dementia as being similarly affected as well. They also report that cytokines and other neuro-chemicals play a role in our neuro-development throughout our lifespan, help regulate brain development early in life and brain function throughout life, and how this all changes in the aging brain. There are also interactions of these immune chemicals that result in gender differences on brain function and behavior.

Needless to say, it will be very interesting to watch for additional developments along this line of research as it pertains to the FM patient and future treatment recommendations! Also, immune stimulation by chiropractic adjustments has been postulated as a benefit and this too may be better understood using this new research approach!

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


Fibromyalgia – Do We Know The Cause?

14 Dec

Fibromyalgia (FM) is a condition that is characterized by widespread pain, fatigue and an increased pain response. Symptoms can include tingling of the skin, muscle spasms, weakness in the arms and legs, nerve pain, muscle twitching, bowel disturbances, chronic sleep disturbances, and more. So, what can cause such a widespread, whole body condition? Though the “cause” of FM is unknown, several hypotheses have emerged. Here is what we know:

The brains of FM patients: Structural and functional differences have been identified in the brains of FM vs. healthy individuals. What is unclear is whether these identifiable brain changes cause the FM symptoms or are the result of an unknown cause. Some experts have reported that the abnormal brain findings may be the result of childhood stress, or prolonged, severe stress at any time in life. An area commonly affected is called the hippocampus, which plays a crucial role in maintaining cognitive functions, sleep regulation, and pain perception.

Lower pain threshold: Due to an increased reactivity of pain-sensitive nerve cells in the spinal cord and brain (called “central sensitization), FM patients feel pain sooner and worse than non-FM subjects.

Genetic predisposition: It has been reported that FM is often found in multiple family members. This genetic propensity also includes other conditions that often co-exist in FM patients such as chronic fatigue syndrome, irritable bowel syndrome (IBS), and depression.

Stress & lifestyle: Stress by itself may be an important cause of FM. It is not uncommon to develop FM after suffering from post-traumatic stress disorder. An association between physical and sexual abuse both in childhood and adulthood has also been identified. Poor lifestyle issues including smoking, obesity, and lack of physical activity increase the risk of developing FM.

Dopamine dysfunction: Dopamine is a chemical needed for neurotransmission and plays a role in pain perception. It is also connected to the development of restless leg syndrome (RLS), which is a frequent complaint of FM patients. Medications found effective for RLS such as pramipexole (also used for the treatment of Parkinson’s disease) can be helpful for some FM patients.

Abnormal serotonin metabolism: Another neurotransmitter, serotonin, regulates sleep patterns, mood, concentration, and pain and can be involved in causing FM. Decreases in other neurotransmitters (especially norepinephrine), when combined with serotonin depletion, can especially cause FM (more so in women than men). Hence, medications like duloxetine (Cympalta) originally used to treat depression and painful diabetic neuropathy, have been found to help FM patients, especially women.

Deficient growth hormone (GH) secretion: Abnormal levels of GH have been found in FM patients, but studies report mixed results when treating FM with GH.

Psychological factors: Strong evidence supports the association of FM and depression. Similarities include neuroendocrine abnormalities, psychological characteristics, physical symptoms and similar treatment benefits using the same approach (medication, counciling, etc.).

Physical Trauma: Trauma can increase the risk of FM. One report found a direct association with neck trauma and increased risk of developing FM.

Small bowel bacterial overgrowth: This can contribute to FM and may explain the association with IBS. The autoimmune response to the presence of bacteria resulting in FM symptoms has been hypothesized in these cases.

CONCLUSION: As previously stated, it is clear that a “team” of providers is needed to effectively treat FM. We’d be honored to be part of your team!

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


Fibromyalgia Diagnosis: A Breakthrough!

12 Dec

Confirming the diagnosis of fibromyalgia (FM) is challenging, as there are no blood tests to verify accuracy of the diagnosis like so many other disorders. However, blood tests are needed when FM is suspected to “rule in/out” something else that may be mimicking FM symptoms. Also, FM is often associated with other disorders that are diagnosed by blood testing, so it is still necessary to have that blood test. So what is the CURRENT recommendation for diagnosing FM?

The American College of Rheumatology (ACR) developed criteria for diagnosing FM in 1990 and has updated it since then. The original 1990 criteria included the following: 1) A history of widespread (whole body) pain for three months or more; and 2) The presence of pain at 11 or more of 18 tender points which are spread out over the body. The main criticism regarding this approach has come from the poor accuracy and/or improper methods of testing the 18 tender points. As a result, this examination portion of the two main criteria has been either skipped, performed wrong, or mis-interpreted. This left the diagnosis of FM to be made based on symptoms alone. Also, since 1990, other KEY symptoms of FM have been identified that had previously been ignored including fatigue, mental fog (“cognitive symptoms”), and the extent of the body pain complaints (“somatic symptoms”).

As a result, it has been reported that the original 1990 approach was too strict and inaccurate because too many patients with FM were missed – 25% to be exact – by using this method. In 2010, the diagnostic approach was modified by using two different questionnaires: 1) The “Widespread Pain Index” or (WPI), which measures the number of painful body regions; and 2) the development of a “Symptom Severity” scale (SS). The MOST IMPORTANT FM diagnostic variables included the WPI score and scores of “cognitive symptoms,” which includes the “brain fog” common with FM, unrefreshed sleep, fatigue, and the  number of “somatic symptoms” (other complaints). The Symptom Severity scale (SS) incorporates these four categories and is scored by adding the totals from each category.  By using both the WPI and the SS, they correctly classified 88.1% of FM cases out of a group of 829 previously diagnosed FM patients and non-FM controls!

What’s important is that this NEW approach does NOT rely on the “old” physical exam requirement of finding at least 11 of 18 tender points. Because FM patients traditionally present with highly variable symptoms, removing the challenge of determining the diagnosis by physical examination is very important! Plus, now we can TRACK the outcomes of the FM patient to determine treatment success both during and after care. Since the 2010 approach has been released, it has been published in multiple languages and is starting to be used in primary care clinics. Recently, in July 2013, a study reported that the Modified ACR 2010 questionnaire is highly sensitive and specific for diagnosing FM, and its future use in primary care was encouraged. What is most exciting about this is that a referral to a rheumatologist may not be needed since this tool can be easily administered by primary care physicians, which include chiropractors!

In past health updates, we have discussed the need for a “team” of health care providers to best manage the FM patient. This multidisciplinary approach offers the FM patient multi-dimensional treatment strategies that encompass manual therapies, physical therapies, nutritional strategies, pharmacology, exercise, and stress management, cognitive management, and behavioral management. Now, with the release of the Modified ACR 2010 criteria, we can diagnose FM more accurately, track progress of the patient, and make timely modifications to the treatment plan when progress is not occurring. This is a “win-win” for the patient, providers/health care team, and the insurer!

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