Health Update: Fibromyalgia
Fibromyalgia – Does This Sounds Familiar?
“I am exhausted and hurt all over. I can’t get to sleep at night and when I do, I wake up at the drop of a dime. I went to my doctor and they ran some blood tests and took some x-rays and said that nothing was wrong. I just don’t know what is wrong or what to do about it.”
This is a classic history obtained from a patient suffering from fibromyalgia. Because the onset of fibromyalgia is slow and gradual, it is common for patients to postpone visiting their health care provider until the symptoms are quite significant. The diagnosis may also be delayed as many healthcare providers do not feel fibromyalgia is a legitimate medical condition and minimize the symptoms frequently categorizing them as "depressed," which postpones an appropriate diagnosis and treatment.
The classic definition as defined by the American College of Rheumatology includes at least a three-month duration of symptoms with the presence of 11 out of 18 potential tender points although diffuse, widespread pain not necessarily restricted to these exact locations may also represent an appropriate diagnostic finding in fibromyalgia.
Fibromyalgia is more common in females and affects approximately 2% of the population in the United States. The risk of developing fibromyalgia increases with age, usually developing during early and middle adulthood but can also develop in children and older adults. Other risk factors include a positive family history where one may be more likely to develop fibromyalgia if a relative suffers with the same condition.
A major risk factor of developing fibromyalgia includes is disturbed sleep pattern and this remains controversial as to whether sleeping disorders are a direct cause or simply the result of fibromyalgia. However, in either case, people with fibromyalgia cannot obtain deep "restorative" sleep and feel fatigued and tired upon waking in the morning. Sleep disorders including sleep apnea and restless leg syndrome are often present in patients with fibromyalgia.
Certain conditions such as rheumatoid arthritis, irritable bowel syndrome, hypothyroid, and other endocrine/hormonal conditions may preceded the onset of fibromyalgia in which case the condition is considered "secondary fibromyalgia." Hence, a diagnostic evaluation usually includes a blood test for hypothyroid, autoimmune diseases such as rheumatoid arthritis, and a complete blood count to rule out infections and/or anemia. In most cases, these tests prove negative and the diagnosis is made by excluding other possible primary conditions.
Other causes can include physical and/or emotional trauma where a high-level of stress can trigger this condition. Although experts still debate why patients with fibromyalgia hurt so intensely, the current explanation centers around a theory called central sensitization. This is essentially a lower pain threshold where patients with fibromyalgia feel pain much sooner than those without it because of increased sensitivity in the brain and/or spinal cord to incoming pain signals.
Treatment of fibromyalgia relies on a multidiscipline, multifactorial approach including stress reduction, obtaining enough sleep, exercising regularly, pacing yourself, and maintaining a healthy lifestyle, including diet and exercise. Medications to facilitate sleep, treat depression and any other underlying medical conditions may be appropriate. Other highly effective treatments, according to the Mayo Clinic website, include chiropractic treatment, massage therapy, and/or acupuncture. The concepts of chiropractic treatment includes restoring movement in restricted spinal joints resulting in improved nerve function and subsequently, improved overall function and reduced pain. Chiropractic care also includes soft tissue therapies, physical therapy modalities, nutritional counseling, patient education and many utilized in-house massage therapy. We recognize the importance of including chiropractic in your treatment of FM and realize you have a choice of providers. We would be honored to be part of your management team.
Health Update: Fibromyalgia Fibromyalgia – Important “Fibro Facts”
So you think you may suffer from Fibromyalgia and you’re trying to find out more information about it...but where do you start? Certainly you can “Google” the word “fibromyalgia” and spend the rest of the day, week, or maybe month reading about the symptoms, clinical signs, the many treatment options and the different types of doctors who treat Fibromyalgia patients. You will certainly learn a lot! But you will still most likely remain confused as to what to do about it.
First, what is Fibromyalgia? It is a chronic (long standing) painful condition resulting in widespread pain throughout the body and it’s usually difficult to isolate a cause or reason for such significantly disabling symptoms. It is very common, affecting 3-6% of the general population (global) and 6-12 million Americans (2-4% of the US population). Woman are affected more than men (75-90% are women), and it is typically diagnosed between 20-50 years of age. It affects people physically, emotionally, and socially. The symptoms can fluctuate but it never completely disappears. The cause, though still debated, points to the central nervous system in which a “minor” pain signal reaching the brain is somehow magnified and perceived as more intense (this is called “central sensitization”). This makes the Fibromyalgia patient hypersensitive to normal stimulations like a hug or when hitting a bump in the road with the car.
How is it diagnosed? Prior to 1987, it was not recognized by the AMA as an illness or cause of disability. In 1990, The American College of Rheumatology (ACR) reported the initial criteria for diagnosing Fibromyalgia. There are no blood tests, x-rays, biopsies, EEG’s, EMG’s or other tests for Fibromyalgia. Hence, a thorough history (frequently revealing fatigue, sleep problems, mental fog, depression, headache, and bowel problems) and examination ruling out other disorders is appropriate. Diagnosis includes a history of widespread, chronic pain and the presence of multiple tender points (at least 11 of 18) located all over the body.
What is the treatment? Pain management has been the focus and this can include medication, ice/heat, exercise, lifestyle adjustments, counseling when anxiety/depression are issues, dietary strategies, sleep management, and perhaps most importantly, education – about Fibromyalgia and how to “live with it.” That is, learning how to “control it” since no one has found the “cure.” Exercise in short durations of time by walking or swimming (not too strenuous) is recommended. Expect post-exercise soreness, so don’t overdo it initially or you’ll be “convinced” you shouldn’t be exercising. Diet – avoid glutens/grains and emphasize fruits, vegetables, lean meats (grass fed chicken, beef, and fish), and consider nutritional support from a multi-vitamin, calcium/magnesium, fish oil (omega 3 fatty acids), vitamin D3, and Co-Q10. Find a good “team” of doctors – chiropractic, family doc, and rheumatologist who YOU are comfortable with and who will work together for you. Don’t expect miracles – it may lead to disappointment.
We recognize the importance of including chiropractic in the team to help those suffering with Fibromyalgia. If you, a friend or family member require care for fibromyalgia, we would be honored to offer our services.
To schedule a FREE Consultation with Dr. Falkenroth, simply call (831) 475-8600
Health Update: FibromyalgiaFibromyalgia Diet?
There has been much discussion about Fibromyalgia regarding the symptoms, various medications, exercise, and more, but there is not a lot of discussion about a very important daily activity – eating! It’s such a simple thing… so simple it seems to have been overlooked.
One Fibromyalgia diet suggests a 3:3:4 ratio for fats, carbs, and protein, respectively, and to eat 6 small meals per day rather than 3 larger meals. The “don’t” list includes chocolate, carbonated beverages and alcohol. The “do” list mandates lots of water consumption – 8 glasses a day, or more.
Another approach called the Paleodiet (also known as the “Paleolithic diet,” “caveman diet,” “hunter-gatherer diet,” “Garden of Eden diet” and more) makes a lot of sense! Grains, beans, and potatoes, though full of energy (calories), are not edible in the raw state due to the many toxins that exist in them. About 10,000 years ago, it was discovered that heating/cooking these otherwise inedible foods (which also include wheat, corn, barley, rice, sorghum, millet and oats) made them edible, thus marking the Neolithic or New Stone Age era. Though these foods are high in calories and can be stored longer, they are limited in their nutritional value, lead to glycemic spikes (high blood sugar), and can result in intestinal related conditions if under cooked or in those whose tolerance is lower (immune deficiency).
The Paleodiet is based on our genetic code being limited to grass fed animal products and naturally grown products – fruits and vegetables. The basic “paleodiet” includes consumption of grass fed meat, fowl, fish, and the roots and fruits of many plants, including nuts. This approach eliminates grains (wheat, oats, barley, rye - also know as glutens), or anything using flour. This includes breads, pasta, crackers, cookies, most baked products….a lot of what we frequently consume. Dairy products, sugar, and salt are included in the “don’t” list. The unique feature of the Paleodiet is that all major dietary components are covered – vitamins, fats, protein, carbohydrates, antioxidants, phytosterols, and more. This is the only diet that is coded for our genes – our body utilizes and relies on these substances.
With this approach, there is no need to “detoxify” our systems or take a surplus of vitamins, though certain vitamins “insure” a nutritious environment for our bodies. These include magnesium and Vitamin D, both of which are difficult to obtain from the food we eat and, Co-Q10 (a strong anti-oxidant), and high levels of EPA/DHA (the active ingredients in fish oil).
The bottom line is that Fibromyalgia can be positively impacted by a strictly dietary approach and, when coupled with exercise, adequate sleep, and stress reduction, Fibromyalgia sufferers benefit greatly! We can help guide you in these approaches if you, a family member or friend are struggling with Fibromyalgia.
Health Update: Fibromyalgia
Fibromyalgia Exercises – What You Can Do!
Fibromyalgia is a condition characterized by generalized pain distributed in a non-anatomical pattern. That is, the pain is widespread, possibly in all four limbs, the trunk and/or head. It can be primary (not associated with another/different condition) or secondary (a specific condition like irritable bowel syndrome, trauma, post-surgical, etc. gives rise to Fibromyalgia). Some studies suggest a central nervous system origin to the condition exists that may explain why the symptoms seem so random and unrelated. Some common symptoms shared by most Fibromyalgia patients include non-restorative sleep with frequent interruptions, extreme fatigue, as well as the widespread pain pattern.
Exercise has long been recommended as part of the treatment approach to Fibromyalgia. When choosing an exercise approach, it is important to START OUT SLOWLY so as to not overdo the initial few sessions. This can minimize the normal post-exercise soreness that usually occurs with all of us with or without Fibromyalgia due to lactic acid and other metabolite build up when muscles are utilized in a way that they are not used to. In the Fibromyalgia patient, the post-exercise pain is usually 2-4 times more intense that non-Fibromyalgia subjects so, DON’T OVERDO IT! The second important point is BE CONSISTENT! After 2 to 4 workouts, the muscles become acclimated to exercising and the post-exercise soreness becomes a non-issue. In order to avoid this, be consistent with the exercise routine. The frequency of 3 times per week and after a few weeks, daily or 5 out of 7 days works well. The intensity of the exercise process can be gradually increased so starting out with a 15-minute session and gradually building to 30 minutes and later up to an hour is appropriate.
There are many types of exercises to choose from. Some good choices include yoga, Pilates, biking, and walking. Since Fibromyalgia includes depression and anxiety issues, yoga is a good choice given the breathing emphasis and mental concentration included in the process. Mixing up several types of exercises is a good concept such as, yoga for 15 minutes followed by biking or walking for 15 minutes, gradually increasing the duration, frequency and intensity over time. Specific exercises for a certain activity, such as simulating a movement that is performed while working or playing a sport, performed in both the “normal” direction as well as in the opposite direction is very helpful. For example, if the patient likes to play sports, try holding a medicine ball cradled in the arms next to the chest and simulate a golf swing both forwards AND backwards in the opposite directions (as if twisting for a normal right-handed shot followed by a left-handed shot). This helps build motor control and coordination as well as strength and flexibility. Incorporating balance during the exercise process is very important as well.
Try a test: Stand on one foot with the eyes open for up to 30 seconds and then switch legs. This should not be too difficult. If it is, you REALLY need balance-retraining exercises. If this is easy, next, try it again but with the eyes closed and count, “…1001, 1002, 1003, etc., until you have to put your foot down. This really challenges your “proprioception” (motor control) system! If you are under 60 years old, you should be able to stand on 1 foot with the eyes open for 30 seconds and eyes closed for 25 seconds. How did you do??? It’s very common to fail with the eyes closed. The good news is that you can regain your balance by performing balance-challenging exercises. Performing this test daily is a simple approach. Learning different exercises on a rocker or wobble board and gym/exercise ball also speeds up the process. Exercise is the key to managing Fibromyalgia as well as many other conditions, not to mention to maintain wellness. It gives us a sense of well-being and accomplishment due to the endorphins, enkephlins, and hormone balancing like serotonin and adrenalin. If you, a friend or a family member suffers from Fibromyalgia, Pro-Adjuster treatment and a heated dry hydrotherapy massage may help relieve your pain, and allow you to sleep better and have more energy.
To schedule a FREE Consultation with Dr. Falkenroth, simply call (831) 475-8600.
Does Diet Make a Difference with Fibromyalgia?
Fibromyalgia is a complex condition that includes widespread symptoms of muscle and joint pain, where everything seems to ache and is associated with severe exhaustion and fatigue. It affects up to 4% of the population (woman > men), with no known cause or known cure. With these facts, it’s not surprising that many sufferers have turned to diet as a means of trying to improve their quality of life. Unfortunately, there are many conflicting dietary recommendations for Fibromyalgia, some completely contradicting the other, leaving the patient and doctor confused as to who or what to believe.
Fibromyalgia can be primary (of unknown cause) or secondary (caused by a different specific condition). Because many conditions can give rise to Fibromyalgia, it’s not surprising that there is no one diet that works universally for all Fibromyalgia patients. However, many Fibromyalgia sufferers respond from eliminating one or more of several types of foods according to experts interviewed by WebMD, and utilizing these recommendations can prove highly effective. They specifically identified 7 foods to avoid in the management of Fibromyalgia, which include the following:
1. Aspartame (NutraSweet): All of the experts interviewed by WebMD agreed a large majority of Fibromyalgia patients could worsen by eating or drinking foods sweetened by aspartame.
2. MSG (monosodium glutamine) and nitrates: MSG is a common additive to enhance flavor in many processed and frozen foods as well as in some Asian (eg., Chinese) foods. Hence, lunchmeats like ham, bologna and bacon should be avoided.
3. Sugar, fructose, and simple carbohydrates: Though no study has clearly identified that these foods directly worsen the symptoms in Fibromyalgia patients, eliminating foods like cake, white bread and sugar in general, will decrease the risk of developing secondary conditions such as yeast infections that can give rise to Fibromyalgia. Eliminating foods with high levels of fructose corn syrup has been reported to help some Fibromyalgia patients.
4. Caffeine (coffee, tea, colas/soda, & chocolate): After a brief stimulating effect (energy boost), there is a longer lasting sedative affect, which is amplified in FM patients. The good news is that most of the caffeine is out of the body within a week of discontinuing use.
5. Yeast and glutens: These two are not related but are frequently used together in foods like cake, donuts and bread and both contribute to Fibromyalgia symptoms. Yeast gives rise to yeast fungus where an overgrowth may cause or exacerbate Fibromyalgia symptoms resulting in joint and muscle pain. Glutens can cause stomach and other GI problems, which in turn can give rise to fatigue.
6: Dairy: Regardless if its low or high fat, some reports indicate that dairy products, particularly milk can increase the symptoms of Fibromyalgia and avoiding these can help.
7. Nightshade plants: Tomatoes, chili and bell peppers, potatoes and eggplant can trigger flare-ups of Fibromyalgia and various forms of arthritis.
Some GOOD diet approaches include a heart-healthy diet – that is, one that is low in saturated fat and includes lean meats & poultry, fresh fruits and vegetables. This diet improves one’s overall health, thus reducing the risk of secondary Fibromyalgia and allowing the body to better fight off other disease processes. This diet is also anti-inflammatory, the common link found in many health conditions. A vegetarian diet comprised of mostly whole foods was also reported as helpful. High potency vitamin supplement and specifically Omega 3 fatty acids (main ingredients – EPA & DHA) included in fish oil, flax seed, walnuts, some fortified cereals, and eggs also help reduce inflammation. These recommendations are research supported and we can further discuss the nutritional approaches that benefit patients suffering with fibromyalgia.
Where Can I Find Information About Fibromyalgia?
Fibromyalgia is a very common condition that affects approximately 5% of the female population. A partial list of symptoms associated with Fibromyalgia include widespread pain and includes fatigue, non-restorative sleep, generalized stiffness, memory problems, poor balance, headache, numbness/tingling, painful muscle cramps/spasms, depression, anxiety, back pain, jaw pain, and hypersensitivity to: noise, lights, odors (perfumes), and weather changes. It is important to note that Fibromyalgia is NOT a psychiatric disorder, and can be diagnosed and treated, though promising a cure is not realistic.
There are many websites and articles that one can access through the internet. This is not an endorsement for any one site but rather, a review of one site that is available. The “Fibromyalgia Information Foundation” (www.myalgia.com) offers a lot of information that is very informative and usable. This includes information on the condition, the diagnosis, treatment, exercise advice and more. For example, under “Treatment of Fibromyalgia,” it is stated that there is no “cure” for Fibromyalgia. Rather, the goal of treatment is to teach the patient to gain “control” over the condition rather than to have the condition control the patient. There are four major areas of treatment to concentrate on which include pain management, exercise, sleep, and psyche. For pain management, there are lists of different medications, manual therapies and physical agents that can be of benefit. Exercise is emphasized to be gentle stretching after warming up and not to exercise too aggressively, so as to avoid irritation. In addition to stretching, light non-impacting aerobic exercise such as walking, water exercises, and/or stationary bike are recommended with a gradual increase in dose. Starting out at short 3-5 minute sessions, 2-3 times per day and gradually increase the session duration to three, 10 minute sessions/day, then to 2 -15 minute sessions and eventually one 20-30 minute session/day may be wise.
Regarding sleep, all Fibromyalgia patients complain of interrupted, non-refreshed sleep and improving this pattern is important. If an underlying condition such as whiplash, back, neck, or shoulder pain is the cause of interrupted sleep, that condition should be managed. A sleep study to determine if sleep apnea is an issue and the use of a C-pap unit can be quite helpful in gaining restorative sleep. Multiple medications are listed with dose recommendations that can be shared with your primary care provider. Regarding the “psyche”… Because chronic pain can result in depression, anger, fear, withdrawal and anxiety, management of these issues is important. Early detection and treatment is ideal. Interventions can include activity management such as ergonomic modifications both at work and home such as weight lift/carry limits, computer station re-design, the use of headsets vs. phones, and modifying other irritating postures should be considered. A de-emphasis of medications and long-term health care provision without clear goals is important. Unless an underlying psychological condition is present, counseling may be non-productive. However, biofeedback and some behavior modification may benefit some patients that are having trouble coping with the pain and it’s effect on their life.
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