suboccipital muscle insertions at occiput
lower cervical paraspinals
trapezius at midpoint of the upper border
supraspinatus at its origin above medial scapular spine
2nd costochondral junction
2 cm distal to lateral epicondyle in forearm
upper outer quadrant of buttock
greater trochanter
knee just proximal to the medial joint line
Some clinicians also specify the degree of palpative pressure applied, varying between two & 10 pounds.
These remedies are taken from just the titles of the messages. Going inside the messages one discovers that most are combined with one or more items on the list, some that are not on the list, and most are recommended by one or more health practitioners [Message board]. For your VITAMIN & HERBAL needs, please visit my website at: http://www.MyNSP.com/coppersnutribytes.
Most of us have an understanding, especially these days, that research in the medical field is occurring at, and coming up with results at a fast and furious pace. Most people also understand that not every doctor can, or even should, be responsible for staying abreast of every new discovery. Without a specific need or interest in a given area, alot of what is learned never gets to the desk of most doctors. This is one explanation, then, as to how such a large number of medical professionals are still unaware of, misinformed about, or in complete denial of the existence of such a common disorder as fibromyalgia [Smith; AT; NBC].
History
Far from being a new discovery, FMS symptoms were first recorded in the 18th century [Kaplan], and recognized as a specific set of symptoms in the 1860’s. It took more than 100 years, in the late 1980’s, before the official name Fibromyalgia Syndrome was designated by the American Arthritis Foundation and the national Center for Disease Control (or CDC) [Rona]. Prior to that time, FMS was known by at least 100 different names including, fibromyositis, fibrositis, and the old-time familiar, rheumatism [Kaplan].
Despite the apparent familiarity with this disorder, many doctors remain reluctant to make a FMS diagnosis. Maria Shriver reported a statement by Dr. Thomas Bohr on the January 4, 2000 airing of NBC Dateline. In this report, a neurologist at Loma Linda Medical Center in California, Dr. Bohr stated, "…. there is a portion of the medical establishment that contends fibromyalgia is not just over-diagnosed, it downright doesn’t exist [NBC]." His opinion does not appear to be echoed by the majority of doctors. Still, there are enough like him that it sometimes makes diagnosis and treatment difficult to find. Even with doctors that are familiar with FMS, the diagnostic process often exceeds five years [Rona; Casura; AT].
Description
Literally defined, fibro refers to fibrous or connective tissues. Myalgia means pain in one or more muscles [Webster]. Therefore, fibromyalgia means pain in the connective tissues and muscles. It is often referred to as a soft tissue musculoskeletal condition [Sahley, et al, pg. 7].
While this may be literal, it is hardly fully descriptive. It is often described as feeling like one has the perpetual flu [Starlanyl]. This is not quite enough, either. Today, it is the second most prevalent rheumatic illness [Goldenburg; Sahley, et al, pg. 5] and ten million people, in the USA alone [Casura], share the plight of this intensely painful disorder. Among the 1.5-6% [Murray, 1998, pg. 459; Roderick; Sahley, et al, pg. 7; Kaiser] of the world’s population with a positive diagnosis for fibromyalgia, there is a broad range of descriptions.
This holds true for the symptoms of FMS, as well. They are as varied and individual, as are humans. The more frequently experienced symptoms are insomnia, extreme exhaustion and/or fatigue, hormonal dysfunction, irritable bowel and bladder, blurred vision, thermal regulation dysfunction, dysmenorrhea, TMJ, food and environmental allergies, unrefreshing sleep, mitral valve prolapse, muscle pain and spasms, (apparent) joint pain, myofascial pain, depression, anxiety, sugar cravings, excessive thirst, confusion, memory loss, chest pain, irritability, acne, diarrhea, gum disease, oral inflammation, and headaches [Starlanyl; Casura; Yue; Roderick]. The list goes on and on, yet, comparing one patient to another will produce two entirely different sets of symptoms [Yue]. This, in itself, can impede the diagnostic process as numerous illnesses and disorders share these symptoms.
Diagnosis
In 1990, the American College of Rheumatology established diagnostic criteria [S of W], which aids in distinguishing FMS from other disorders. This criteria must include, but is not limited to [et al]:
Widespread, generalized, persistent muscle/joint pain, not explained by an inflammatory or degenerative musculoskeletal disorder, for 3 or more months (though many doctors insist on 6 months)
Ongoing fatigue for a similar time period
Tenderness in at least 11 or 12 of 18 tender points, referred to as (TrPs), on digital palpation:
This diagnostic criteria is beneficial, yet FMS continues to be misdiagnosed and confused with illnesses such as Chronic Fatigue Syndrome, Myofacial Pain Syndrome, Lupus, Epstein-Barr, and many, many others. The chronic nature of each of these, demographics, and similar therapies adds to the confusion [Goldenburg].
Comparative tests by researchers to distinguish between multiple chemical sensitivities (MCS), fibromyalgia (FMS), and chronic fatigue (CFS) were conducted in the early 1990’s, using patient questionnaires to evaluate symptoms. The results showed that 70% of those previously diagnosed with FMS, and 30% of those diagnosed with MCS, met criteria for CFS established by the Center for Disease Control (CDC) [Rona; Murray, et al, pg. 363].
Many of the symptoms mimic such illnesses and initial diagnosis is usually something other than FMS until ruled out by imaging studies, blood tests, or other clinical tests. To date no such tests for positively identifying FMS exist, though a February 1999 news release has named the Anti-polymer Antibody Assay (APA assay, a patented blood test) as appropriate for FMS testing on the basis that researchers have discovered anti-polymer antibodies in the blood of FMS patients [AT].
Recent reports of completed tests are beginning to identify specific clinical factors. Still, these have yet to be grouped together into a cohesive package of identifying factors. Reaching the desks of doctors with this information, once established, is another concern. A diagnosis by process of elimination coupled with established criteria remains the general course of events.
To complicate matters even more, there often exists a co-morbid diagnosis of one or more of the illnesses FMS mimics. Frequent co-morbidity exists with Irritable Bowel Syndrome, migraine headaches, osteoarthritis, and rheumatoid arthritis, as well as others. In his April 1999 FMS review, Dr. Don L. Goldenberg of the Department of Rheumatology, Newton-Wellesley Hospital in Massachusetts, claims FMS is present in 10% to 40% of patients with systemic lupus erythematosus (SLE) and in 10% to 30% of patients with rheumatoid arthritis. He further claims that 25-50% of all patients referred for treatment of Systemic Lyme Disease never had Lyme at all, but rather FMS. With other than the systemic illnesses, Dr. Goldenberg feels there is little value in attempting to differentiate between FMS or the other syndromes as the overlap of symptoms is so extensive.
Cause
Many skeptics like Dr. Bohr appear as though they would like us to believe that FMS is entirely a psychiatric illness. Anti-depressant medications are often prescribed for FMS patients, and frequently prove helpful in alleviating some of the symptoms. There is, undoubtedly, an association between FMS and major depression. However, it is the old, "which came first, the chicken or the egg?" argument. The unrelenting, often disabling pain of FMS might certainly lead to depression. On the flip side of things, the classic psychosomatic theory claims depression as the cause, not the result.
Patients with a concurrent diagnosis of Irritable Bowel Syndrome (IBS) are shown to have a more frequent past and present diagnosis of depression. There is a higher frequency of comorbidity with depression and IBS in women who experienced physical and/or sexual abuse as children.
Stress plays a major role in stimulating and/or exacerbating the core symptoms of many of these crossover disorders. However, the majority of those with FMS are not depressed. Only one-third of FMS patients shares a concurrent diagnosis of major depression, eliminating the probability of it being the cause of FMS [Goldenburg].
Fibromyalgia Syndrome crosses all borders, be they socioeconomic, age, racial or gender. It affects populations worldwide. Women are diagnosed between five and twenty times [AAFP; Yue; Casura; Sahley, et al, pg. 7] more frequently than are men. Women have been shown to have a lower pain tolerance and threshold, and generally exhibit more health-seeking behavior than do men. The diagnostic percentages for both sexes increase as age at the time of diagnosis rises above fifty [Goldenburg].
No single identifying cause of fibromyalgia has yet been discovered. More than 100 years of research has only recently begun to find any consistent soft tissue or muscle abnormalities. Electric stimulation produced greatly increased pain levels of the upper extremities in FMS patients as opposed to normal controls. FMS patients tend to be hypersensitive to pain and auditory stimuli, and there is some evidence to suggest these people have an actual altered perception and response to these stimuli [Goldenburg]. It is hypothesized that one of the main reasons for the presentation of extreme physical symptoms is the high level of breakdown in muscle tissues [Sahley, et al, pg. 8].
Research completed in 1999 and, so far, in 2000, has discovered reduced levels of serotonin, elevated levels of Substance P (a neuropeptide), and abnormal anti-nociceptive (pain stimulus) peptides in the cerebral spinal fluid [Goldenburg; White; Smith; Roderick]. Nearly a quarter of patients studied with cervical spine injuries developed FMS, while a much smaller number developed this following a leg injury [White]. With FMS, many believe they can trace onset back to a specific emotionally or physically traumatic event in their lives [Buskila, et al; Goldenburg]. Brain imaging studies of women with FMS have revealed a reduction in the cerebral blood flow to the thalamus and caudate nucleus (1 of 4 basal ganglia). The caudate nucleus and thalamus are responsible for sending the signal of noxious stimuli to the brain. Reduced blood flow to these areas has been identified in other chronic pain disorders as well [Goldenburg; Smith].
A study at the University of Washington Medical Center in the early 1990’s attempted to clarify as to whether or not FMS patients are more susceptible to actual muscle damage from activity than are non-FMS persons. The results showed there was no more damage to one group than the other. However, researchers then questioned as to whether pain is an adequate indicator of muscle damage. Magnetic resonance spectroscopy indicated that those with FMS had a consistently higher occurrence of phosphodiester than did healthy subjects, indicating abnormalities in the thin, transparent sheath of striated muscles [Jubrias, et al].
Further studies in this vein have followed, with the conclusion in one from 1998 stating that, "P-31 MRS provides objective evidence for metabolic abnormalities consistent with weakness and fatigue in patients with FM [Park, et al]."
Research reported in March 2000 finds that the basal autonomic state of persons with FMS is "characterized by increased sympathetic and decreased parasympathetic tones." The physical, symptomatic, and psychological health of these patients implies an autonomic dysregulation [Cohen, et al]. Other testing reports in 2000 show that there is a significant difference in the way FMS patients respond to pain compared to controls [Ernberg; Lekander].
Sleep abnormalities are present in the majority, if not all sufferers. Men tend to suffer from sleep apnea. Both men and women may experience abnormalities in slow-wave-sleep and non-rapid-eye movement cycles [Goldenburg].
There is also evidence that the tendency to develop this disorder may run in families, suggesting a genetic causal factor [Young, et al; Sahley, et al, pg. 7]. Abnormalities in various neurohormones, disturbances in microcirculation, low phosphate and magnesium, deficient adenosine triphosphate (ATP) synthesis, exaggerated response to certain hormones, sympathetic and parasympathetic imbalances and interference in the release of growth hormone have all recently been clinically identified in FMS [Leal-Cerro, et al; Sahley, et al, pg. 10-14; AJM].
Viral factors, particularly the Epstein-Barr virus, have been strongly suggested, by patients and researchers, as a causal factor in CFS and FMS. The theory is that a comorbid infectious state has depleted immunological response, creating inflammation, which increases the nitrous oxide levels, raising the homocysteine levels in cerebral spinal fluid [HealthWatch]. One quarter of all Lyme sufferers developed FMS after completion of Lyme treatment, also presenting the possibility of a viral causal agent [Goldenburg]. Still, there is no conclusive evidence to establish this as fact.
In a January 1999 report by Dr. Garth L. Nicolson, Dr. Nicolson claims that as many as 70% of those with a positive FMS diagnosis may be responding to mycoplasmas and other bacteria, and/or exposure to "chemical or other insults" capable of suppressing immune function. He does not believe these to be the actual cause of FMS, but rather that they exacerbate the symptoms and progression of the illness. Studies he sites in his report, and results of his own studies claim the majority of patients tested present evidence of the presence of pathogenic species, such as: M. fermentans, M. penetrans, M. pneumoniae, M. genitalium, M. pirum and M. hominis. The report further claims the use of blood testing specific to identifying mycoplasmal infections, as well as polymerase chain reaction and nucleoprotein gene tracking as effective validation [Nicolson].
Lily G Casura reports in the January 2000 issue of Townsend Newsletter that patients have stated they feel like they were "run over by a Mack truck". There are moments, even full days when it feels as though there is not a single part of one’s body that is not feeling extreme pain. This affects daily activities, mood, ability to digest foods, sleep, and body parts and actions most people cannot even identify. The mental confusion and short-term memory loss are often overwhelming and embarrassing. Even a loving hug can bring on an episode of excruciating pain that may last for days.
Treatment
The treatments for fibromyalgia are as varied as diagnosis and apparent cause. Since there is no singular biophysiological cause, how can there be a cure or a single treatment protocol? While researchers continue to ponder their results, the medical profession and alternative health care providers continue to debate the best course of action to take. Within each of those sects, med-to-med and alternative-to-alternative debates abound. Needs to address that all agree upon are to re-establish appropriate sleep patterns, treat depressive states, and that increased exercise is of major benefit [Sieber].
The medical profession is split on treatment on a number of fronts. Those believing only in the psycho-factor tend to treat with anti-depressants and sleep medications and little else. Others will add narcotic pain relievers. Some believe only non-steroidal painkillers to be effective, while some conclude that neither type works [Kaiser]. Dr. Goldenberg believes, "Medicines that affect pain perception, sleep, and mood have been useful and should be integrated with activity, exercise, and educational programs." Dr. Devin J. Starlanyl believes guifenesin, a common expectorant in cough syrup, given at specific doses to be effective. She also follows with recommendations of exercise and education.
Here, again, another split occurs as to what type of exercise is appropriate. Some recommend intense aerobic, cardio-vascular exercises, while some believe in strength training or slow-stretch types like Tai chi or yoga.
A few enlightened medical professionals, like Dr. Christine Fritsch, MD, of Kaiser-Permanente North, Dr. Bill Sieber of CorText Research in CA, or chiropractors like Dr. Harvey Eckhart of Santa Rosa, CA’s Preventive Health Care Clinic find value in the addition of supplements to the regime. Dr. Fritsch recommends bromelain and chondroitin to reduce inflammation and support joint integrity. Dr. Eckhart is examining the effects of a protein digestion enzyme activating formula and an antioxidant formula, on the basis that many believe the inability to digest proteins adequately and free radical damage are two significant contributors to FMS.
Dr. Sieber suggests the use of Omega-3 fatty acids, using a high protein, low carbohydrate diet, and adding vitamin C and magnesium supplements. Low doses of anti-depressant medications may be useful in pain control, and melatonin for better sleep. Dr. Sieber also touches briefly on the National Institute of Health (NIH) who no longer advocates the use of cortisone injections in CFS or FMS, on trials using Epogen, a medication normally used to treat renal failure and its accompanying anemia in HIV patients [EPO], and on the use of the herb licorice in the regime, but admits to no first hand knowledge of its use. Within herbal communities, licorice is known for its tonic properties, specific to pain [Chen, et al], energy and digestion [Teirra, L, pg.68]
I appreciate that Dr. Sieber suggested, and stressed the fact that herbs are not something most should experiment with, especially when used in combination with medications, as scientific research is just beginning to explore both the efficacy of herbs, and their potential contraindication of use with medications. He in no way discounted herbal effectiveness, but, rather that they are best administered by persons with appropriate training in their use [Sieber].
Dr. David Darbo, a MD at the Indianapolis Medical Center has company in his belief that magnetic therapy is beneficial to nine out of ten people among the general population. Magnets are believed to support overall wellness by supporting the body’s natural processes of relaxation and stimulation, and allowing the cells of the body to function at optimum levels [Rapp; Sahley, et al, pg. 29]. The claim that they work especially in targeting instances of chronic fatigue, pain, and sleeplessness, make the appeal to FMS sufferers great.
Dr. Samuel K. Yue, MD and Director of the Minnesota Pain Center in St. Paul, has been testing the effects of the hormone relaxin as a treatment. His premise is that the onset of FMS is connected to either a systemic deficit of the hormone, or the body’s inability to use the existing hormone because of autoimmune antibodies or faulty cellular reception. Relaxin is known to effect muscle and connective tissue integrity, but tests so far have been inconclusive.
A journey through the WWW with FMS as the topic will reveal literally hundreds of sites with information and/or a supposed cure. Many cyber bulletin boards and chat rooms exist where sufferers exchange information and help each other with treatments that have worked and those that have not, but it is rather like a target shoot. This one is of definite benefit to this group, but has little to no effect on another group. That one works here, but not there. There seems to be no consistency, except that avoidance of simple carbohydrates and increased movement seems to help most with a mild reduction in pain. Some people even claim complete remission of symptoms. When asked the protocol used the list of substances consumed and treatments applied, is appallingly long.
A listing of treatments from a cyber-bulletin board used in the few months since the new millennium started include:
Exercise
Vicodin (pain)
SAMe (S-adenosyl-methionine) works for fibromyalgia by raising levels of glutathione and tumor necrosis factor)( A PRECURSOR TO CYSTEINE, TAURINE AND GLUTATHIONE)
St. John’s Wort (depression & pain)
Neurontin (generally an anti-seizure med)
A full array of liver-detoxification herbs, coupled with treatment for Candida Albicans infection
Rhus-tox (sleeplessness & Restless Leg Syndrome)
Coenzyme Q10 (anti-oxidant)
Electronic muscle stimulation
To just "buck up"
Thyroid (hormone replacement)
Bovine colostrum ( for protecting the immune and growth factors)
Colonics
Guifenesin (promotes excretion of uric acid)
Vioxx (anti-inflammatory)
Bellegal-S (Belladonna/Ergotamine/Phenobarbitol for IBS)
Methotrexate (anti-arthritic)
ENADA/NADH (replenishing cellular energy)
A "package" of Flexoril, Prozac, Vioxx, and a Steroid Shot
And finally, natural diet
In The Herbalist by David Hoffman, Mr. Hoffman recommends treatment with herbs offering the following actions: anti-spasmodic, circulatory stimulant, rubefacient, analgesic, diuretic, anti-rheumatic, anti-inflammatory, and alterative. He also stresses dietary factors appropriate to osteoarthritis, stress reduction and a lifestyle review. The elimination of Solanine containing foods (nightshades: tomato, potato, peppers, tobacco, etc.) from the diet is generally recommended by holistic practitioners [Murray, 1993, pg. 326].
Michael Murray suggests eating a plant-based, predominantly vegetarian diet, stressing the limiting of fats and refined sugars, low sodium and high potassium intake, elimination of food allergens and maintenance of ideal body weight. He also advocates using a combination of 5-HTP 100mg., St. John’s Wort 300mg. of 0.3% hypericin to increase serotonin levels, and magnesium 200-250mg., three times daily, as most sufferers are found low in these [Murray, 1998: pg. 462-463].
Chinese medicine refers to many of the symptoms associated with FMS as "Arthralgia Syndromes". There are four different types of arthralgia: 1) migratory, is not fixed or stationary, and may involve pain in any/or all large joints. 2) aching, is fixed with severe, stabbing pain, and difficulty with flexibility. 3) fixed & swelling, is fixed with numbness and/or swelling of joints, lack of flexibility. 4) heat, consists of redness and swelling of joints, burning sensations, impaired movement, excessive thirst, and depression. All forms are considered diseases of wind and dampness, though 1-3 are also diseases of cold, and #4 is a disease of heat [Chen, et al].
Some of the herbs used to dispel wind-dampness-cold, and known to western, as well as eastern [Tierra, L, index; Tierra, M] practitioners include: gentian, cinnamon, dried and/or fresh ginger, angelica, licorice root, ma-huang, peony, aconite, atractylodes, and astragalus. Those specific to pain include: pueraria, atractylodes, ginseng, and licorice. To dispel heat, relax muscles and tendons: angelica, rehmannia, atractylodes, citrus peel, licorice, forsythia, aconite, bamboo shavings, and gentian [Chen, et al]. Not to be treated lightly, these herbs must be prepared and administered by a professional practitioner, not the patient or novice, as many may have significant side effects, toxic levels, and/or other health implications, if used incorrectly.
Herein lies a problem for many sufferers. The disabling effects of FMS, both physically and mentally, are so profound that many are unable to maintain employment. The supplements used are usually so expensive as to be cost prohibitive to the unemployed. For those who are fortunate enough to have health coverage, treatments such as these are considered to be alternative by mainstream medicine, therefore not covered by health insurance. Combining lack of funds with the ever-increasing number of non-supported treatments available to choose from and the FMS sufferer begins to wonder if there is any hope of relief, at all [Smith; Sahley, et al, pg. 33].
Disability
Disability is a subjective issue with FMS. The pain of FMS often causes functional disability similar to that of rheumatoid arthritis [Goldenburg]. Though pain may remit for periods, employers are often reluctant to hire individuals who may require extended absences.
Given the lack of medical findings, and/or up to date information, many insurers do not offer coverage for the disorder, even if the attending physician feels onset of FMS was directly related to a specific work injury. As an example, the state of Washington allows a maximum of 90 days of treatment specifically targeted to FMS, but only as it impedes healing from a primary work injury [S of W].
As FMS presents an individual face in each patient, medically endorsed disability may or may not be present. Many sufferers self-assess disability as FMS may feel as though movement or activity may cause further damage. However, there remains no conclusive evidence to scientifically back this belief. Certainly, psychosocial factors, along with comorbidities, chronicity and severity should be acknowledged in the determination of disability, as functional disability will be present to some degree, whether "clinical" evidence agrees or not. Approximately two thirds of diagnosed patients are able to continue with some type of work, while one third receive some type of disability benefit, which may include Social Security Disability [Goldenburg].
Though there may be times of remission, FMS is chronic and not likely to go away.
It is important for the patient to realize that they can decrease their level of disability through the use of self-monitoring techniques. Many health professionals and pain clinics offer services teaching clients how to overcome states of disability, and lead the highest quality, most productive lifestyle possible.
My Holistic Approach
I advocate an approach, which incorporates a medical model with an holistic approach. No one approach will be effective for every client, therefore I feel an explorative approach to determine optimum relief is appropriate.
1. DIET: The first step in establishing protocol for this disorder would be a complete dietary and medical history, including all medications currently used. A minimum of three days of diet records would then be run through software to establish specific nutrient deficiency, with suggestions as appropriate.
Monitoring diet and greatly reducing (for most) the intake of meat, dairy, refined carbohydrates and sugars, and increase fiber intake through the use of whole foods, including fruits, vegetables, nuts, seeds, and healthy (non-rancid) fats (flax seed, virgin olive oil, cold-pressed vegetable oil, fish oil) will greatly improve overall health, stimulate metabolism, and support pain reduction.
The elimination of tobacco, alcohol, products containing artificial sweeteners (Nutrasweet, etc), MSG, caffeine, and sodium reduction are indicated in cases of chronic pain. These are muscle stimulants and/or affect blood pressure, headaches, sweating, diarrhea, and other symptoms.
Allergic response to foods or environmental substances may increase stress and physical symptoms. It is therefore helpful to determine and eliminate any allergens present in the diet and/or environment through metabolic assessment, hair analysis, food sensitivity tests, nutritional kinesiology, and lifestyle evaluation [Bauman, NC, 4:115 & 5:76]. A slow transition towards Dr. Bauman's '"Eating for Health" model will be appropriate for most [Bauman, DC; 1:20].
Digestive and liver support decreases abdominal irritation and discomfort. An essential amino acid formula (Digestive enzymes)and an anti-oxidant formula daily between meals for digestive enzyme activation. These may also be supportive in cases of chronic pain and inflammatory response. Bromelain is also reported to produce a similar effect. A liver support tonic made of dandelion root, oatstraw, cleaver’s herb, plantain, and catnip tinctured in glycerin works well to control feelings of acid-reflux through stimulation of hydro-chloric acid(HCL, contrary to TV commercials, your body REQUIRES HCL for proper digestion, heart burn is a general indicator of not enough HCL!), taken ½ hr. before meals. This MUST be done under the supervision of a qualified professional. Prior allergy testing may be necessary as many of the herbs may provoke an allergic response. It is also essential to use a professional to insure appropriate balance of herbs and doseages.
For general health support, a multi-vitamin with minerals, a phytochemical preparation, to strengthen and support the immune system, and 1-2 TBS ground flaxseed daily for Omega-3 & 6 fatty acids.
If arthritic symptoms are a significant factor, there are a number of products available to support joint and/or soft tissue integrity. A preparation containing Glucosamine Sulfate and Chondroitin may be helpful.St. John's Wort oil, applied topically, helps relieve sore joints/muscles and is especially beneficial to sciatic pain.
2. SLEEP/MOOD: Meditation before going to bed may be useful in helping the mind to relax enough to fall asleep. Behavioral changes may also be implicated, such as the avoidance of watching TV or reading in bed, establishing a set routine of when to retire, and when to get up, or not eating for several hours before going to bed. If waking up during the night to urinate, then having difficulties returning to sleep is an issue, avoid taking any liquids for at least 1 ½ hours before bedtime, as well.
St. John’s Wort [Bauman, NC; 5:85-88] (SJW)/valerian/Siberian ginseng formula for mood/sleep difficulties. I like a product which contains 300mg of SJW, taken 3xdaily. This is adequate to treat mild to moderate depression. For extreme cases, medicinal anti-depressants, prescribed by a medical doctor, may be appropriate. A tincture of scullcap and valerian, ½ hour before bedtime is useful for insomnia, but again, only under appropriate supervision [Tierra, L, pg. 212].
Herbal teas may be taken to help relax physically and mentally, and help with pain reduction. beneficial herbs include: catnip, basil, lobelia, and licorice root. Follow your practioner's instructions, as some of these herbs may have a strong blood thinning effect [Tierra, L, index].
3. PAIN: For pain reduction, I prefer the avoidance of steroidal pain medications due to their debatable efficacy in FMS treatment. For the client who chooses to use medication, acetaminophen, or aspirin, is appropriate. Efficacy has not been proven for either steroidal or non-steroidal pain medications in relation to this disorder.
An herbal approach might include: valerian to relax and reduce pain (if not using valerian in other formulas), ginseng, astragulus, and siberian ginseng[Tierra, L, pg. 211] for fatigue; moxibustion with mugwort herb is helpful in reliving a variety of symptoms, depending on where on the body it is used. Specifics would be for poor digestion, arthritic-type pain, muscle spasms, and low energy, among others [Tierra, L, pg.156-157].
4. STRESS: To help monitor body reactions to stress or intense situations, use a product called "Bio-dot" or "Bio-Band". These stick to the hand and change color when emotional or physical stress response occurs. They work as a trigger to remember to breathe mindfully, and bring muscles down to a more relaxed state.
Meditation, visualization and subliminal tapes help in controlling pain and stress levels to a degree, and boost self-confidence. Another common problem is that after feeling so bad for so long, many sufferers lose self-esteem and self-confidence [Sieber; Sahley, et al, pg. 33]. There is, for some, a need to go through an actual grieving process to let go a previously favored lifestyle, and enjoy the discoveries of the lifestyle ahead. Both meditative practice and self-help tapes can help focus attentions on other than the physical self and broaden positive self-expression of the changed-by-necessity person.
5. REST: It would seem that alot of FMS sufferers are overachievers, hyperactive, or otherwise non-stop people. Though I doubt it is a causal factor, I believe it might be a commonality. Convincing the client to take the time to rest when tired is essential. Power naps [Sieber] of 15-20, taken throughout the day as necessary provide a great deal of relief from many of FMS symptoms.
6. EXERCISE!: A program of aerobics, water exercise, and strength training, may be a drastic approach. The intense regime may increase pain levels to intolerable amounts. Using a large exercise or physio-ball daily, walking, or gentle water exercise may prove more effective in building muscle mass and gaining strength and flexibility. Start any program, even if for just a few minutes everyday, and build up length and intensity of sessions as tolerated. The point is to get the body moving again.
7. BODY/MIND/SPIRIT: Massage, as often as possible, is extremely effective in relieving much of the pain associated with FMS [Sieber], even if only temporarily. However brief the relief, it is preferable to the unremitting pain without massage!Chiropractic adjustment is helpful for many.
Sweats or saunas also provide some relief. The communal/ritualistic/spiritual benefits of a traditional sweat lodge may prove the most emotionally uplifting. Yet, "just" a sauna should provide much relief, too.
Developing a network of friends and/or family for emotional, social and spiritual support is necessary to the healing process. Emotionally, a support group may be essential.
8. EDUCATION: Arming the client with the most up to date information available should help them in better understanding their condition, abilities, and limitations, as well as to actively participate in establishing an appropriate treatment plan.
9. PACING: Many household chores become near to immpossible for the severely affected. A support group may be willing to help with some of the harder chores.
Learning to break tasks down into smaller, do-able, chunks is essential for FMS sufferers. Spread chores out throughout the day. For example, when preparing meals, break it down into smaller amounts instead of trying to fix the whole meal at one time. Wash all the vegetables, then rest. Do any chopping required, then rest. Cook one portion, put it in the oven to stay warm, then rest, etc. until the task is completed.
With housework, vacuum for 15 minutes (0r 10, 0r 5, 0r even 3!), rest 10 minutes, then try some more, until the room is completed. If necessary, get through half one day and half the next, and learn to enlist the aid of family and friends when possible.
Very few things in life have to be completed at a given moment. It would be nice to have an always-spotless house, with all chores done at a specific time, but that may not be a realistic goal for these people. It is vital to their quality of life to be educated in tools and techniques to help them say, "no" to activities, friends and family when needed, aid in relaxing attitudes and self-expectations, and establishing smaller, shorter term goals that they are able to accomplish.
Conclusion
Fibromyalgia is a chronic, intensely painful disorder affecting millions worldwide. Often confused with other syndromes and disorders, it is identified by a specific set of diagnostic criteria.
In diagnosing FMS, it is important to distinguish between FMS alone and comorbidity with serious illness such as Lyme Disease, or rheumatic illnesses, as treatment will be different. It may not be necessary to differentiate between CFS, IBS, or undifferentiated chronic pain, as treatments will follow a similar course.
Though psychiatric considerations may play a large role in treatment, the majority of FMS sufferers do not experience concurrent psychiatric disorders, eliminating the theory that it is strictly a psychiatric illness.
To date there is no known cause of FMS, but recent research indicates there are a number of significant physiological components present in all sufferers. Now that physical correlations are becoming known, continued research is bound to soon determine specific causal factors.
No one treatment is deemed most effective. There are a vast number of treatments available, and each bears its own claim to fame. An approach addressing pain perception, sleep, stress reduction, and mood, combined with exercise, diet and educational programs appears most effective, whether it follows a mainstream medical or more holistic approach. Maintaining a balanced and active lifestyle proves most beneficial to quality of life.
Until specific causal factors of FMS are identified, there is not likely to be any one definitive approach to treatment. It is, therefore, up to patients to work with a qualified health professional to safely educate and experiment for themselves, and discover the most effective course of treatment.
Pain or no pain, attitude plays an important role in everyone’s response to life. To people suffering from FMS, the issue becomes even more critical. Symptoms are not likely to intensify over time, so the best a provider can give is helping the client or patient find the course to their greatest relief of symptoms and establish a positive self-image to help them move forward.
©2000Thorp,E.,C.N.E.,C.D.C.,C.L.P.T.; Nutribytes, a division of WINTU WORKS;CA
