The American College of Rheumatology defines fibromyalgia as “chronic widespread pain and reduced pain thresholds to palpation.” (1) The diffuse symptoms are commonly attributed to central sensitization with enhanced responsiveness to stimuli. (2,78) Fibromyalgia patients perceive pain from noxious stimuli at lower thresholds than healthy patients. (71,72, 78) Offhandedly, the disorder has been termed “irritable everything” due to widespread heightened pain perception.
The specific pathophysiology for this hyperexcitability is not well defined. (3) Various speculations implicate the CNS, ANS, PNS, neurotransmitters, endocrine system, immune system, as well as mitochondrial dysfunction, adrenal fatigue, and psychological origins. (3-10,76,107) Chronic pain from central sensitization is thought to play a primary role. (107,131) Some focus has been placed upon PNS involvement via small fiber pathology. (3-10) Limited recent electrodiagnostic studies have implicated large nerve involvement after identifying muscle denervation and chronic inflammatory demyelinating polyneuropathy (CIDP). (11)
Fibromyalgia’s origins are generally believed to be psychological and neurologic rather than muscular, as the disease shows no pathologic or biochemical abnormality involving the muscles. (71-75) Cumulative mental or physical trauma is believed to be an etiological trigger and exacerbating factor for the disturbed pain modulation seen in fibromyalgia patients. (71-73) Some experts teach that fibromyalgia is a variant of PTSD wherein the hallucination is nociceptive rather than visual or aural. (68)
Fibromyalgia is the most common diagnosis in patients complaining of widespread chronic pain with fatigue. (19,64) Estimates for the prevalence of the condition vary between 0.2% and 8.0% (12,19,61-63) with fibromyalgia patients accounting for almost 1 in 5 rheumatologic visits. (13,14) Approximately two-thirds of fibromyalgia sufferers will seek complementary and alternative treatment options (109), and nearly 40% of fibromyalgia patients choose chiropractic care. (103)
Fibromyalgia may strike at any age; though most people are diagnosed midlife, with increasing prevalence thru age. (15) The condition is at least twice as common in women. (15) There appears to be a strong genetic correlation. (77) Obesity is a known risk factor that is proportionately related to the disease’s symptom severity and diminished quality of life. (16,133) Additional risk factors include repetitive injury, trauma, PTSD, and systemic illness. (15) In more than half of cases, fibromyalgia overlaps with other rheumatologic diseases, particularly lupus, rheumatoid arthritis, and ankylosing spondylitis. (15,17,18,64) Fibromyalgia patients frequently experience concurrent temporomandibular dysfunction. (99)
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What we do in our office to help this condition:
1. Perform a detailed exam, assessing the alignment of the spine. Pain is a last effort response signal from the brain that occurs right before permanent damage. Pain is typically accompanied by inflammation and muscle tension/spasm. Our goal is find the areas of the spine where this is occurring.
2. As indicated, adjust areas of spinal subluxations (misalignments), to restore proper nerve system function, which facilitates healing. Once the brain starts to receive better information from the spine, it can move out of protection mode and into healing mode. It is very common for pain to subside when this happens.
3. Apply electrical stimulation and heat to the muscles surrounding the areas of pain. Applying an electrical current helps strengthen muscles, block pain signals, and improve blood circulation.
4. Perform laser therapy which penetrates to the cellular level of the soft tissues surrounding the areas of pain. This promotes better oxygen and nutrients to these tissues, which can relieve pain and facilitate the healing process.
5. Prescribe stretches and exercises in conjunction with chiropractic care to strengthen the soft tissue in the areas of pain.