What is Fibromyalgia?
Fibromyalgia is a condition characterised by chronic widespread pain & increased sensitisation to touch. Unlike most painful conditions, the pain of fibromyalgia involves several areas including the back, neck, shoulders & hips. This pain is due to an over activation of the nervous system giving rise to abnormal pain message signalling & interpretation. This contrasts with most musculoskeletal injuries that take place due to a localised traumatic injury.
As well as generalised muscle pain patients also tend to suffer from fatigue, sleep disturbance, early morning stiffness & headaches. Patients may have impaired short & long-term memory & diminished attention span. This constellation of symptoms is a result of nervous system impairment & reflects biochemical impairment at the neuron which gives rise to impaired nerve communication.
The American College of Rheumatology criteria for diagnosis of fibromyalgia involves the presence of tenderness at 11 of 18 sites. Nine of these sites should be bilateral meaning present on both sides of the body. The involved sites include the base of the skull (suboccipital area), the lower cervical spine, upper trapezius, supraspinatus, second rib, lateral epicondyle, gluteals, greater trochanter of femur & knee. The condition is 7-9 times more prevalent in females versus males.
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Causes of Fibromyalgia
The cause is unknown; however, there is an association with lowered pain threshold levels & decreased serotonin levels. Fibromyalgia is associated with psychological, genetic, neurological & environmental factors. Fibromyalgia is found in 10% to 40% of patients with rheumatoid arthritis & systemic lupus erythematosus (SLE). Both rheumatoid arthritis & SLE are autoimmune conditions where the immune system erroneously attacks the tissues own body cells instead of foreign bodies.
Alongside changes in the immune system, there are also alterations in the central nervous system evident with fibromyalgia. The central nervous system consists of the brain & spinal cord. Changes in central nervous system processing are a key component of most chronic pain syndromes. This may be demonstrated by changes in functional brain imaging studies, which demonstrates enhanced pain-related activations of fibromyalgia patients. Studies also show structural differences n the brains of fibromyalgia patients when compared with asymptomatic patients (Schweinhardt et al. 2008).
Hormonal imbalances associated with the condition include decreased dopamine & serotonin. These hormones can play a role in mood, pain, mental focus & sleep patterns. This ties in with many of the symptoms present in patients presenting with fibromyalgia.
The hippocampus of the brain plays a vital role in short & long-term memory, pain perception & sleep. The hippocampus is located in the temporal lobe of the brain (behind the ear). The hippocampus is particularly prone to degeneration in cases of stress due to the presence of a large number of stress hormone (glucocorticoid) receptors in the this area of the brain.
Sleep & Fibromyalgia
Sleep is important for optimal functioning of the hormonal (endocrine) and immune systems. Most human & animal studies have demonstrated increased pain sensitivity associated with sleep deprivation. Research has demonstrated increased pain in those suffering from insomnia (Marcus, D. 2005)
Prior research has demonstrated alterations in brain wave patterns in sufferers. Patterns of muscle tenderness similar to that experienced in fibromyalgia sufferers can be brought about by disrupting stage IV sleep in healthy volunteers (Moldofsky 1975).
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Treatment of Fibromyalgia
Brain imaging has demonstrated that fibromyalgia sufferers demonstrate a heightened sensitivity & activation in brain areas involved in pain sensation when exposed to painful stimuli. One method of desensitising the pain pathways is through movement & exercise. Physiotherapists specialise in the prescription of exercise.
Research by Richards & Scott (2002) compared the effects of exercise versus relaxation techniques in patients with fibromyalgia. At the end of the trial, 35% of those undergoing exercise rehabilitation reported feeling ‘much better’. This compared with 18% of patients in the relaxation group. Cardiovascular exercise in particular is recommended for those suffering pain.
Chiropractic Treatment for Fibromyalgia
A new study from the journal Rheumatology International found that chiropractic care is effective in the management of symptoms of fibromyalgia. The study involved 120 patients who reported severe pain for a minimum of four years. All participants underwent 12 weeks of therapy that incorporated an exercise programme, behavioural therapy (CBT) & an education component.
Half of the participants were randomly assigned to undergo upper cervical chiropractic adjustments three times per week for the first month. This was then reduced to once a week sessions for the remainder of the eight week trial.
The group undergoing chiropractic care showed greater improvement than the control group showed a 15 percent or greater improvement in questionnaire scores monitoring pain & functional outcomes. The authors concluded that chiropractic adjustments may offer additional benefits when combined with standard treatment protocols.
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1) Wolfe, F., et al. (1990). The American College of Rheumatology 1990 criteria for classification of fibromyalgia report of the Multicenter Criteria Committee. Arthritis Rheumatology; 33: 160-172. http://www.ncbi.nlm.nih.gov/pubmed/2306288
2) Richards, S., Scott, D.L. (2002). Prescribed exercise in people with fibromyalgia: parallel group randomized controlled trial. British Medical Journal; 325: 185-188.
3) Schweinhardt, P., Sauro, K.M., Bushnell, M.C. (2008). Fibromyalgia: a disorder of the brain? Neuroscientist; 14(5): 415-21. http://www.ncbi.nlm.nih.gov/pubmed/18270311
4) Marcus, D.A. (2005). A Primary Care Guide to Practice Management. 2nd Edition. Humana Press.
5) Moustafa IM, Diab AA. The addition of upper cervical manipulative therapy in the treatment of patients with fibromyalgia: a randomized controlled trial. Rheumatology International 2015; 35(7): 1163-1174.
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