Fibromyalgia

FIBROMYALGIA SYNDROME – (CHRONIC FATIGUE SYNDROME)

What is FMS according to medical science? FMS is a chronic (i.e. long standing) condition. The patient has muscular pain and tenderness throughout the body and frequently other symptoms like sleep disturbances, fatigue, hearing disturbances, muscle twitches, cold extremities, headaches & migraines, TMJ syndrome and blurred vision. For a diagnosis of fibromyalgia to be concluded, although fibromyalgia can be over diagnosed [1], the patient must exhibit tenderness in a minimum of 11 of 18 pre-defined points on the body (see figures). Have a good look at the location of these points, as I think that along with other evidence they provide a pointer to a possible cause of FMS.

Although the exact cause of FMS has apparently not been discovered and there are various research theories including poor nutrition, stress factors, alterations in the pattern of sleep and changes in neuroendocrine transmitters (serotonin, substance P, growth hormone and cortisol) a common theme which appears to emerge throughout the research is that of poor posture, cervical spine dysfunction and degeneration in the spinal joints.

Hiemeyer et al[2] for example, examined 40 patients with FMS and noted the relationship between posture and tender points. They discuss disappearance of tenderness at a number of the tender point sites following correction of posture and conclude; “flexed posture could be an important factor in generalized muscular pain, and posture therefore should be an essential part of the clinical examination of patients with FMS.”

Muller et al[3] state “In fibromyalgia as well as in low back pain we frequently find disturbances of the posture of vertebral column clinically and radiologically.” Further Buskila et al[4] examined two groups of patients, a control group (59) consisting of patients with leg fractures and a study group (102) with a neck injuries. “FMS was diagnosed in 21.6% of people with neck injuries versus 1.7% of those in the control group” and further “FMS was 13 times more frequent following a neck injury than following a lower extremity injury” and “almost all symptoms were more common and severe in the group with the neck injury”.

Schnur[5] conducted a review of the record of 61 patients with primary fibromaylgia syndrome (PFS) and found “in over 50% of examined patients diagnostic details referred to chronic lumbar and cervical spine syndromes” and chronic lumbar and cervical spine syndromes pre-dispose the person to development of PFS.

A study by Ambrogio et al[6] is interesting if only for the finding that “from a patient’s perspective, neck support is an important part of a comprehensive physiotherapy program.” Thus FMS patients, in a small study, indicate that to have some support for their necks was important to them. This is another pointer, I assert, to the cervical spine being heavily involved in the origin of FMS. In fact, I believe, like others before me, that it is highly likely that a subluxation at the level of the atlas is the causal factor in the generation of FMS, and patients should be checked by professional precision upper cervical chiropractors. Such subluxations not only initiate pain in the neck, head, and shoulders, but also have been shown to directly cause postural distortions[7].

A study by Larsson R, Oberg PA, Larsson SE[8] is interesting because the authors propose “chronic neck pain may increase the transmitter activity of neuropeptides in the upper cervical medulla causing impairment of blood flow in the local muscle” and conclude “an impaired regulation of the microcirculation in the local muscle is of central importance in chronic trapezius myalgia, causing nioceptive pain.” This study, these two studies[9],[10] and many other studies by Larsson et al, show patients with neck and shoulder pain as having reduced blood flow through these painful muscles, further exacerbating the pain. I assert that if your “head is not on straight”, your cervical and shoulder muscles fight to maintain your head erect. These spasms I believe cause the neck, back and shoulder pain associated with FMS. Further atrophy (wasting) of these muscles due most probably to reduced blood flow just compounds the painful problem.

Could it be that an upper cervical subluxation uncorrected over a long period directly causes FMS? Let’s look at Dr Daniel Clark’s (www.uppercervicalillustrations.com) graphic opposite. (Reprinted with permission from Daniel O. Clark, D.C.)

This is what is known in upper cervical chiropractic circles to occur to the body/skeleton when one sustains an atlas subluxation. Now look at the location of the tender points in the previous diagrams. I contend that if you overlay those tender points over this diagram, the tender points will correlate highly to muscle tension caused by the misaligned skeleton. The neck, shoulder, pelvis and knees are all affected by the upper cervical subluxation. The 10 tender points to the top of the body (front and rear) could be caused by the muscles straining to hold the head perpendicular. The others may be due to the unlevel pelvis and corresponding functional short leg. Now think about the earlier references to poor posture and cervical spine disorders in those people with FMS. Is there a connection? I think so.

Not many therapies appear to be successful at alleviating FMS symptoms. One study by Freidman and Nelson[11] does discuss some success with some individuals using “ice water circulating through hollow metal tubes” which was delivered “intraorally for 15 minutes in the posterior maxillary area”. According to the authors, 9 out of 12 patients had “reduced cervical pain perception” and electromyography revealed less upper trapezius signal, or lessening of pain in the trapezius muscles. The authors suggest a “strong trigemino-cervical relationship to neck pain and headache.” There’s that reference to neck (cervical) pain again!

If an upper cervical subluxation is responsible for postural changes, neck pain and the development of FMS as I suggest then upper cervical chiropractic may have a role to play in the treatment of FMS patients.

Like conventional treatment studies however, there haven’t been a lot of studies which demonstrate the efficacy of a chiropractic treatment for FMS, but if you read the chiropractic studies the results appear to be quite favorable.

A study by Blunt, Rajwani and Guerriero[12] of 21 patients consisted of a utilizing “chiropractic spinal manipulation, soft tissue therapy and passive stretching” and the results indicated that “chiropractic management improved patients’ cervical and lumbar ranges of motion .. and reported pain levels”. A study by Hains[13] combining spinal manipulation and ischemic compression found results of “statistically significant lessening of pain intensity and corresponding improvement in quality of sleep and fatigue levels.” Hains and Hains conclude that the “study suggests a potential role for chiropractic care in the management of fibromyalgia”.

In a study of 23 patients with fibromyalgia by Amalu[14] he states “The most common medical treatments for FMS and CFS can include one or more of the following: tricyclic antidepressants, nonsteroidal anti-inflammatories, physical therapy, gentle stretching, low impact exercises, stress reduction, counseling, and lidocaine injections with or without hydrocortisone”. It is not uncommon for FMS or CFS patients themselves to try many treatments including but not limited to physical therapy, massage, acupuncture, mainstream chiropractic, osteopathy, medications and exercise with little to no improvement. As a result of pursuit of these multiple therapies it is also a common for patients to doubt the efficacy of yet another treatment like upper cervical chiropractic.

However, you will note that Amalu’s “treatment consisted solely of corrections to aberrant arthrokinematic function of the occipito-atlanto-axial complex.” In other words treatment to correct dysfunction of the upper cervical spine [C0(skull)-C1(atlas)-C2(axis)]. He uses an upper cervical chiropractic method of adjusting known as Applied Upper Cervical Biomechanics (International Upper Cervical Chiropractic Association-IUCCA) in combination with paraspinal infrared scans to measure the stabilization of the upper cervical joint complex and hence effectiveness of the adjustment.

Amalu found “Upon stabilizing the upper cervical spine .. improvement in the symptomatic profile of both FMS and CFS was 92-100% (VAS[15]) for all 23 patients. Chronic fatigue syndrome (CFS) is mentioned because invariably FMS patients are also diagnosed with CFS. Read the entire case for the patient outcomes.

In conclusion Amalu states “The body of literature detailing the upper cervical spine’s role in affecting global physiology is substantial. Further research into this area of the spine, combined with objective monitoring of neurophysiology, may reveal that chiropractic does indeed offer a consistent conservative solution for patients with fibromyalgia and chronic fatigue syndrome.”