The American College of Rheumatology established a criteria for the diagnosis of fibromyalgia as follows:
- Widespread pain which lasts for more than three months.
- 11 active trigger points out of 18.
Fibromyalgia sufferers typically experience pain all over their bodies and non-rejuvenating sleep, which means they wake up more tired than when they went to sleep. 2% or 5 million adults are afflicted with FM which leads to 5.5 ambulatory care visits per year in this country from the second most common disorder seen by rheumatologists (more than twice as common as rheumatoid arthritis). Fatigue may cause more alteration in lifestyle than pain. Fibromyalgia shares several clinical features with Chronic Fatigue Syndrome and Irritable Bowel Syndrome. Other prominent features include:
- headaches, backache, neck pain
- sleep disorders, fatigue, exhaustion
- depression, anxiety, stress
- memory and cognitive difficulties
- confusion or brain fog
- vasovagal syncope (fainting)
- loss of strength, stiffness
Pharmacologic therapies include gabapentin (Neurontin), pregabalin (Lyrica), serotonin-norepinephrine reuptake inhibitors (SNRIs), serotonin specific reuptakeinhibitors (SSRIs), and tricyclic antidepressants. Narcotic pain killers are not a good option for fibromyalgia treatment due to addiction and dependency issues; however all drugs have undesired side effects.
Overmedicating fibromyalgia patients is a common problem. A recent cross-sectional survey published in the Journal of Clinical and Experimental Rheumatology revealed non-drug therapies were often more effective and have no risks. In fact, when patients were asked to list the top 10 most beneficial treatments for fibromyalgia, NO DRUGS WERE MENTIONED. Conversely, when they were asked to list the 10 most harmful therapies, THEY NAMED ONLY APPROVED DRUGS!
Although it is most common in middle aged women (women are ten times more likely than men to suffer with FM), fibromyalgia in children has become increasingly common. Musculoskeletal pain is the most common problem seen by pediatric rheumatologists, and 30 – 40% of these kids with chronic pain fit the criteria for Juvenile Fibromyalgia Syndrome. 28% of adults with FM reported the onset of symptoms during childhood.
Because fibromyalgia and chronic fatigue are a group of signs and symptoms, it is considered a syndrome and should be treated differently for effective relief. Fibromyalgia and Chronic Fatigue are complicated conditions and each patient has a unique set of symptoms that need to be addressed in an individual way. Many chronic pain disorders and musculoskeletal complaints from other causes frequently overlap classic areas of fibromyalgia, which include central sensitivity syndrome, CFS, irritable bowel syndrome and post-traumatic stress disorder. Many also suffer concomitant systemic inflammatory illnesses such as rheumatoid arthritis, hepatitis C, systemic lupus erythematosus (SLE or lupus). A careful examination and differentiation of the various possible co-conditions that are commonly found in fibromyalgia patients is critical. Most clinicians now recommend multidisciplinary rehabilitation, pain reduction modalities, exercise and sometimes cognitive behavioral therapy. At Infinite Wellness Center we take this type of multi-faceted approach to care of fibromyalgia and associated disorders. Treatment should be individualized and include nonpharmacologic approaches, which are often more effective than drugs. Aerobic exercise is also one of the most effective weapons against fibro, so it should not be avoided yet patients should also not overdo exercise.
Several of the tools we have successfully treated fibromyalgia with include advanced chiropractic care, therapeutic activities, guided exercises, applied kinesiology, nutritional supplements and prescription medical foods. Dr. Comanor has spent years developing a solution that empirically works better than everything we’ve seen tried for this elusive syndrome, a patented “formula for the relief of the neuropathic pain of fibromyalgia”. He is one of the leading fibromyalgia physicians in the country and recently approved patent on his amazingly effective analgesic for the treatment of this disorder. The Comanor’s Solution does not work for everyone, but for those it helps it is life changing. Fortunately we have developed a testing procedure to see if it can help before you purchase the supplement. This involves a consultation with one of our physicians to verify that you have been diagnosed correctly, then testing and titrating the solution to see if it provides instantaneous relief of symptoms while still in the office. If you respond with a dramatic reduction of symptoms, you are a candidate for continued use that often results in complete remission of symptoms.
We also offer encapsulated Rx Medical Foods for dietary management of fibromyalgia as well as other syndromes. Theramine® is available through physician prescription only and reimbursed by insurance. Physician Therapeutics is a company offering targeted cellular technology for clinical nutritional management of pain and inflammation. Effectiveness is supported by randomized double-blind clinical trials, it is regulated by the FDA and must be administered under physician supervision. Ingredients inhibit neuronal firing, activate opioid receptors, inhibit production of prostaglandins, and act synergistically with other metabolic pathways. Theramine® has no harmful side effects, no risk of overdose, is not addictive, and has little to no drug interaction risk.
DYSREGULATION OF THE PAIN RECEPTORS IN BRAIN
According to an article published November 5, 2013 in Arthritis & Rheumatism, researchers used functional magnetic resonance imaging to compare neural responses to painful stimuli in 31 patients with fibromyalgia and in 14 healthy control participants, they found that the patients with FM lacked normal activation of the brain and misread pain signals. Dr. Loggia, the lead researcher and Harvard instructor, stated “While I did expect to observe reduced responses to the anticipatory cues in some regions (eg, the regions involved in the descending pain modulatory system, which is known to be altered in these patients), I did not expect to see so many regions exhibit this behavior.” This suggests altered neurotransmission, that FM is a central nervous system disease, and why narcotics are not a good treatment option for FM. Additionally, abnormalities of sleep patterns of electroencephalograms (EEGs) have been found in fibromyalgia sufferers.
ABNORMAL MUSCLE FUNCTION
Fibromyalgia translated from Latin literally means “pain in the muscle fibers”. Fibro – fiber; Myo – muscle; Algia – pain. Although it is not an inflammatory, some data suggest that abnormal muscle function is part of the pathophysiology of fibromyalgia. A 2013 16-week randomized, double-blind, placebo-controlled trial of oral creatine in patients with fibromyalgia showed increased strength measured by bench press and leg press. A 1998 study showed reduced phosphorylcreatine content in patients with fibromyalgia on magnetic resonance spectroscopy.
Addressing cellular bioenergetics that involve mitochondrial function is an important factor in treating fibro. Nutrients such as CoQ-10, magnesium, B vitamins, vit-D, D-ribose, essential fatty acids and other cofactors help restore proper mitochondrial function. Addressing food sensitivities (especially wheat and dairy) as well as accumulated heavy metal toxicity can be important elements to treatment. Small intestine bacterial overgrowth leads to systemic overproduction and absorption of toxins that cause inflammation and impair nerve, muscle and mitochondrial function which leads to increased perception and sensitization of pain. Bacterial overgrowth produces lactic acid and hydrogen sulfide, which are neurotoxins and metabolic poisons; these cause fatigue, muscle pain, and problems with cognition or “brain fog”. These bacteria also deplete tryptophan, which is an essential amino acid in the human diet and a main building block of serotonin and melatonin, which regulate sleep and pain.
Biological variables that have been linked to fibromyalgia include genetics, female sex, age, poor sleep, trauma, stress, deconditioning, autonomic dysregulation, and chronic infections. Psychological contributory factors include depression, anxiety and psychological or physical trauma. Environmental contributors are poor job satisfaction, childhood abuse, lack of family support, and having friends with chronic pain. Although there may be psychosocial contributory factors, fibromyalgia in NOT a mental disorder or “just in your head”. Historically there was a lack of general knowledge about FM and a lack of objective physical findings on examination, however science is finally catching up with the clinical manifestations of this disorder. Distinct cellular and biochemical abnormalities that have been identified include low serotonin levels, low growth hormone, high substance P in spinal fluid, and low ATP levels in blood cells.