What is Fibromyalgia?
Fibromyalgia is a condition characterised by chronic widespread pain & increased sensitisation to touch. It is surprisingly common and affects about 2-3% of the European population. 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. Fibromyalgia is linked with fatigue, poor sleep, and cognitive dyfunction.
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.
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. Because women have more active immune systems than men, this may be one reason why 80-90% of cases are in females. The peak age range for fibromyalgia is 55-65 years of age
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.
Is Sleep Liked to 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).
What is the Best 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. Moderate to high intensity exercise acts to inhibit the pain processing pathways in the central nervous system
Belgian Beer & Coffee could help keep you slim. Implications for Fibromyalgia!
According to research performed in King’s College, London, gut bacteria that helps keep you thin may be boosted by foods such as Belgian beer & coffee. Professor Tim Spector, reports that microbes make up 90 percent of living cells in the body. Research suggests that changes in the bacterial population can impact on all aspects of health, including metabolism & weight gain.
Of course the Belgian beer & coffee is a headline grabber; however, the key take-home from this is that foods that improve your gut bacteria may have a positive impact on your nervous system & therefore on your fibromyalgia symptoms which are driven through your nervous system. Foods that have been shown to impart a beneficial effect in terms of improving gut bacteria are vegetables such as leeks, celery & garlic.
Not only does gut bacteria affect your propensity to put on weight but also impacts on your hormone levels & nervous system activity. Fibromyalgia is associated with significant changes in hormonal profile including cortisol (stress hormone) & growth hormone. There is also a significant increase in sympathetic nervous system activation.
Pain is a neurological phenomenon. In other words, pain occurs due to stimulation of the nervous system. We know that a huge proportion of the nervous system is based in the gut, thus the bacterial content of the gut will impact on the level of pain sensitisation.
Interestingly, research published in the Annals of Rheumatic Disease found that Fibromyalgia patients had higher levels of harmful gut bacteria & that the worse the individual’s bacterial imbalance the more severe their pain.
Participants completed a questionnaire, and a lactulose hydrogen breath test was used to determine the presence of small intestinal bacterial overgrowth (SIBO). 20% of controls (normal healthy subjects) had an abnormal breath test. This compared with 84% of those with irritable bowel syndrome & 100% with fibromyalgia producing abnormal test results.
Does Chiropractic Treatment Help 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.
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.
6) Anderberg et al. 1999. Elevated plasma levels of neuropeptide Y in female fibromyalgia patients. European Journal of Pain 3 (1): 19–30.
7) Pimentel et al. (2004). A link between irritable bowel syndrome and fibromyalgia may be related to findings on lactulose breath testing. Annals of Rheumatic Disease; 63:450–452.
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