Nicole Trboyevich

Fibromyalgia. What is this common condition that society has so slowly come to recognize as a real medical condition? How is Fibromyalgia treated and how effective is western medicine verses eastern medicine? Although there is no cure for Fibromyalgia, it is a treatable condition. There are many options for a Fibromyalgia sufferer to help treat and manage their pain. Some of these treatments include traditional medicines such as pain medications, injections or depression medication. Non-traditional medicines include vitamin supplements/herbs, exercise programs such as yoga, massage, acupuncture and a healthy diet. The most important element in the treatment and pain management of Fibromyalgia is patient education. You must rely on yourself to educate, so you can fully understand the condition you have in order to begin the healing process.
Lets start by breaking down the word “Fibromyalgia”. “Fibro” means fibrous tissue. This can include the tendons, ligaments, and bursa. “My/o” pertains to the muscles, and “algia” denotes pain. So there you have it, pain that relates to the muscles, ligaments, tendons, and bursa. Fibromyalgia has been described as far back as biblical times which would be described as a chronic musculoskeletal pain with an association to chronic fatigue and depression. Over time Fibromyalgia has had many alter egos such as fibrositis, rheumatism, tension myalgia, and myofibrositis. Some physicians would describe the condition as “psycho-generic rheumatism”. This particular term, states that patients with these symptoms were simply creating them or imagining them in their own mind. There are two types of Fibromyalgia recognized: Primary and Secondary. Primary Fibromyalgia has no known cause but is thought to be brought on by trauma, infection, stress, and inflammation. Secondary Fibromyalgia is different because it is caused by primary condition such as hypothyroidism. Treatment for the primary condition causing Secondary Fibromyalgia can often resolve this type of Fibromyagia. So how can this condition be described? With many, its a wide spread pain, a person with Fibromyalgia will often complain of chronic pain all over the body. Certain parts of the body can hurt more then others on any given day. The pain can fluctuate one day, and the next it can be mild or even non existent. Fibromyalgia is NOT a gender related condition, but many more women suffer then men. One idea behind this is that there is a difference in gender perception of pain. Because women have high estrogen levels and low testosterone, women tend to be more sensitive to pain then men. But on the contrary because of over sensitivity, women can tolerate pain better. Besides having a general feeling of pain all over there are many other symptoms associated with Fibromyalgia.
Stiffness
Numbness
Headaches
Poor sleep
Decreased memory/concentration
Irritable bowl syndrome (IBS)
Temporal Mandibular Joint Disease (TMJD)

So lets take a look at how pain perception is recorded in the body. In order to do this, we need to look at the Central Nervous System (CNS). The CNS consists of the brain and the spinal cord. It is responsible for communication from the brain to the rest of the body, a central highway with nerve impulses running to and from the brain via the spinal cord which
are relayed back to the brain which in turn creates a response. When a person stubs their toe, the body sends nociceptors (negative biological sensor) to the brain, this relays the perception of pain. The body in turn sends mechanoreceptors (positive biological sensor) that will alleviate the perception of pain. A Fibromyalgia patients “body becomes “cross-circuited”. Not only does the body not send the chemical message to alleviate pain, but instead, pain is amplified.”(Wallace, Daniel J. M.D. And Janice Brock Wallace. Making Sense of Fibromyalgia, a guide for patients and their families) Pain can then radiate from the toe to other parts of the body that were not directly affected by an injury.
There are no diagnostic tests such as x-ray, MRI or blood tests that can identify Fibromyalgia at this time. Instead, Fibromyalgia is diagnosed by a series of common characteristics. The most important factor in diagnoses is a tender point or a trigger point test. There is a difference between the two and it is that a tender point is an area that is tender when pressure is put on it. It can be tender in the muscles, tendons or bony landmarks. Many of these tender points are at muscle attachment sites which are generally tender on all people. This can makes a positive tender point hard to declare, this is where a trigger point comes into play. When baring weight on a tender point, a trigger will radiate pain numbness or tingling to another point in the body, creating what is called the “trigger point”. A positive trigger point test will show a patient has at least 11 of the 18 known trigger points. Although there are only 18 trigger points, it is important to know that a trigger point can be anywhere in the body and is not limited to these specific areas. Pain also has to be through out the body, this means that pain has to be above the waist, below the waist and on the right and left sides of the body. In addition to this criteria, the pain needs to be present for more then 3 months to rule out any pain caused from viruses, or trauma. Tissue findings are an important part in the diagnosis of Fibromyalgia. A patient with Fibromyalgia has muscles that feel very ropy and tight with fibrosis within the muscle tissue.

Western Medicine and Treatment
There are two kinds of treatment we can turn to when suffering from Fibromyalgia and they are Western Medicine or Eastern Medicine. The Definition of Western Medicine as stated by the National Cancer Institute, US National Institutes of Health (http://www.cancer.gov/dictionary/?CdrID=454743) is a system in which medical doctors and other healthcare professionals (such as nurses, pharmacists, and therapists) treat symptoms and diseases using drugs, radiation, or surgery. Also called allopathic medicine, biomedicine, conventional medicine, mainstream medicine, and orthodox medicine. Western Medicine for fibromyalgia consists of the use of drugs to reduce the pain a patient is suffering from. The main kinds of drugs used for this are analgesics and non-steroidal anti-inflammatory drugs (NSAIDs). Common analgesic medications that you may know are Tylenol (Over the Counter) or Tramadol (Rx). NSAIDs are Aspirin and Ibuprofens, common forms of these are Advil and Motrin. These Medications can be effective in the reduction of pain for the Fibromyalgia sufferer but have many side effects that can be serious. Some of the most common side effects are nausea, vomiting, diarrhea, constipation, rash, dizziness, headache and drowsiness. The most serious side effects from using these drugs are kidney failure, liver failure, ulcers and excessive bleeding after injury or surgery. Many of these drugs are readily available over the counter. This can allow the consumer to feel that these drugs are safe to use daily and are often consumed at the maximum daily dosage and patients are unaware of the potential damage they can cause. Another drug that is commonly prescribed are antidepressants. There are many different kinds of antidepressant medications that are commonly used for Fibromyalgia. Although they are an antidepressant, in these cases they are not used for depression but for the effects they have on sleep and pain. The downside to using these drugs are the potential side effects that can be as simple as dry mouth or dry nose, to having more severe effects such as anxiety, confusion, and even muscle break down. These effects can add excessive stress on an already hard to manage condition. Although many fibromyalgia suffers do use these drugs for pain management, they often combine them with Eastern Medicine.
Eastern Medicine and Treatment
Eastern Medicine is also known as Alternative Medicine or Traditional Chinese Medicine (TCM). The definition of TCM is an ancient holistic system of health and healing, based on the notion of harmony and balance, and employing the ideas of moderation and prevention. Techniques of TCM include acupuncture, massage, acupressure, therapeutic exercises and diet.
Acupuncture
Acupuncture is the use of very fine needles in the skin at various points on the body. This is thought to cause a change in blood flow, neurotransmitters and the release of natural endorphins in the brain that can block pain. Some side effects of acupuncture are bleeding, bruising, dizziness, fainting, nausea, and increased pain.
Massage Therapy (MT)
Massage Therapy is one of the oldest methods of healthcare. Massage increases blood flow to the muscles, tendons and ligaments. It also helps flush out waste product that has settled in the muscles and joints. Massage can help a patient relax, reduce stress, lower heart rate and improve the range of motion in the joints. In Fibromyalgia patients, gentle massage is appropriate verses deep tissue as the patient may have many painful trigger points. Although Fibromyalgia patients can be more sensitive to deep tissue MT, a massage therapist can use these techniques with in the patients pain tolerance to affect the tissue. A massage therapist must also keep in mind that many Fibromyalgia patients may be on medication for pain, and this means their pain tolerance may be higher then normal. A complete history form and extra caution should be taken while treating for Fibromyalgia.

Effective Techniques of MT
Many techniques of MT will dramatically ease the pain of Fibromyalgia patients. The techniques that have shown the most results in the above study were Deep Pocket Compression with Dynamic Folding and Joint Physics. The technique deep pocket compression with dynamic folding, directly affects the muscles. This technique brings the origin and the insertion of a muscle closer together, putting the muscle at its most relaxed state. This allows for deeper penetration of the muscle without causing pain to the patient. This technique offers a soothing fluid movement while working the tissue which can help relax the patient. This is especially beneficial for a Fibromyalgia patient because they can often be more sensitive to muscle work. The next technique, joint physics, directly affects the joint capsule. Joint physics can be applied to any joint in the body with an array of techniques called shearing, torque, accommodation, traction, wringing, distraction and shake. By using these techniques we stimulate the production of synovial fluid which nourishes the joints. Synovial fluid is produced naturally in the body, but when there is damage to a ligament, production of the fluid slows. When synovial fluid is released into the joint, it fills in any damaged areas of the ligament and tendons. This lubricates them, and in turn helps them heal and increases the range of motion in the joint. This can relieve a Fibromyalgia patient from joint stiffness and loss of range of motion. The overall affects of MT techniques on a Fibromyalgia patient is that they increase range of motion, decrease pain, promotes relaxation and greatly reduces stress.
Diet
Unfortunately many people have a hard time believing that pain can really be a warning sign telling you to do something different within your body. What you put in your body can directly affect how you feel on a day to day basis, as well as how your body can reconstruct itself on a cellular level. If you are not getting adequate vitamins and minerals to help aid in cellular reconstruction, your cells will be replaced by inadequate cells. Diet can help Fibromyalgia patients in many ways. Getting adequate nutrition by eating a well balanced diet combined with additional supplements and monitoring what one eats can reduce inflammation in the muscles and joints. Over 80 nutrients are needed for proper metabolism and energy production (Jane Oelke, N.D. P.H D. Natural Choices for Fibromyalgia, Discover your Personal Method for Pain Relief , pg. 87). If insufficient amounts are not provided the metabolism will be impaired and degenerative diseases will occur more often (Jane Oelke, N.D. P.H D. Natural Choices for Fibromyalgia, Discover your Personal Method for Pain Relief , pg. 87) . Include diets that are high in magnesium. Foods high in this mineral are green leafy vegetables, whole grains, some nuts and seeds. Magnesium, along with malic acid (fruit acid found naturally in apples) are often suggested for people with Fibromyalgia because they are both needed for the generation of energy in cells (Mayo Clinic Staff, “Fibromyalgia”. January 23rd, 2009 www.mayoclinic.com/health/fibromyalgia/DS00079/DSECTION=coping and support). There has been a possible link to low levels of Vitamin D and Fibromyalgia. A study published in the Mayo Clinic Proceedings examined 150 people with persistent, non-specific musculoskeletal pain in Minnesota. The researchers found that 93% of them had a deficient levels of vitamin D. (Mayo Clinic Staff, “Fibromyalgia”. January 23rd, 2009 www.mayoclinic.com/health/fibromyalgia/DS00079/DSECTION=coping and support). In order to get enough vitamin D you can take an oral supplement or get 15 minutes of sunlight a day. Eating foods high in vitamins A, C, and E are also a vital source of nutrients for both Fibromyalgia patients and healthy patients. These vitamins are the most common antioxidants. Vitamin C is essential for the health of connective tissue, and the support of bones, blood vessels, joints, organs, muscles, eyes, teeth and skin (Jane Oelke, N.D. P.H D. Natural Choices for Fibromyalgia, Discover your Personal Method for Pain Relief , pg. 89). Vitamin A is needed for the health of the immune system and also helps with reproduction of the cells in the respiratory and digestive tract. Vitamin A can be found in carrots, sweet potato, red pepper, spinach, kale, mangoes and apricots. Cod liver Oil has one of the highest content of vitamin A of all. If you are taking oral supplements be sure to watch your intake of vitamin A as large doses of vitamin A can be dangerous and cause nausea, vomiting, dizziness, itchy skin and hair loss. Vitamin E is most effective antioxidant for the health of the cell wall. Vitamin E can be found in whole vegetables such as asparagus, avocado, eggs, milk, nuts, spinach, and wholegrain foods. In addition to these vitamins, there are thousands of other antioxidants obtained from foods. Phytochemicals or plant chemicals that have the strongest antioxidant properties are found in fruits and vegetables. (Jane Oelke, N.D. P.H D. Natural Choices for Fibromyalgia, Discover your Personal Method for Pain Relief , pg. 90). A great rule of thumb for the nutritional value of food is that the darker the color, the greater the amount of phytochemicals.
Now that we have had discussion on what we should be eating, we can go over what we should be limiting in our diet. Specifically, we want to limit pro-inflammatory foods. These are foods that can cause inflammation to occur in the muscles, joints and ligaments. High fat foods and refined carbohydrates should be limited. These includes meat, especially red meat, dairy products, some nuts, any bleached flour, rice or sugar. A general rule is that if it contains flour, sugar or any other kind of sweetener, it will be pro-inflammatory. There are many alternative foods that are anti-inflammatory a few of them are bell peppers, broccoli, brussel sprouts, garlic, green beans, olives, spinach, sweet potatoes, apples, avocados, black currants, berries, kiwi, lemons, oranges, tomatoes, almonds, walnuts, halibut, salmon, whitefish, green tea, mint, basil, cinnamon, cloves, rosemary, parsley. For more information on anti-inflammatory foods go to www.metabolismadvice.com.
Exercise
Exercising is one of the single most important things you can do for your body. It reduces stress, burns excess sugars/fat in the body, and promotes regular sleep patterns. For the fibromyalgia patient these four things are essential for the management of such a condition. It is important for the fibromyalgia patient to know that at first exercise may increase your pain but exercising regularly will often decrease these symptoms. Some of the best exercises for this condition are walking, biking, swimming and yoga. Yoga specifically targets stretching, strengthening posture and relaxation breathing. With any exercise program be sure to talk to your doctor to find what regimen is best for you.
Future of Fibromyalgia
Fibromyalgia is a condition that is not yet understood, nor is there a known cause. So why are we treating this disease with drugs that can potentially worsen symptoms and bring on side effects that were not present before drug treatment? Should we be treating a condition that is not understood, with these potentially harmful drugs? Only a Fibromyalgia sufferer can choose how they will treat their symptoms. Weather it be Western or Eastern Medicine is a question that will be asked until we find the true cause of this mystery disease.

Bibliography

Natural Choices for Fibromyalgia, Discover your Personal Method for Pain Relief
Jane Oelke, N.D. P.H.D.

Fibromyalgia, Up Close and Personal
Mark J. Pellegrino, MD

Fibromyalgia, The First Year
Claudia Craig Marek

Making Sense of Fibromyalgia, A guide for Patients and Their Families
Daniel J. Wallace, MD
Janice Brock Wallace

A Massage Therapists Guide to Pathology, Fourth Edition
Ruth Werner

National Cancer Institute, US National Institutes of Health (http://www.cancer.gov/dictionary/?CdrID=454743)

Mayo Clinic Staff, “Fibromyalgia”. January 23rd, 2009 www.mayoclinic.com/health/fibromyalgia/DS00079/DSECTION=coping and support