CF 088: Decoding Fibromyalgia & Fibro Treatment

Today we’re going to talk all about fibromyalgia. How many patients come to you diagnosed with Fibromyalgia? I don’t know about you but I have a lot of them in my practice. How much do you know? What are the treatment recommendations? What’s the cause? 

OK, we are back with some important information to make you better which makes your patients better. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic   Forward podcast.  

You did the hippy hippy shake into Episode #88. does everyone remember that song from the 80s or 90s or whenever the hell that was? 

We can’t get started without mentioning the sponsor of the first half of our show, 

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I just signed up to be at the Forward ’19 event in St. Louis from September 20-22. I’ve been in the FTCA group and a member of the website for some time so it’ll be good to see these folks in person, put some voices to the faces, and learn some good stuff. 

Remember, 10%. 10% better every day, every month, every year. I’ve completed the DACO coursework but trust me, I’m nowhere near knowing it all. Continually attending events like this is the right step toward excellence though. I feel pretty confident in saying that. 

If you want to be at the event, go to https://www.forwardthinkingchiro.com/convention and get yourself signed up. It should be a good return on investment if my information is correct. 

No, I don’t have a secret code, I’m not paid to tell you about the event. It’s just that Forward ’19 is an evidence-informed conference and as a person that considers themselves evidence-informed, I feel like it my duty to an extent to make sure you all know about these things. It is on me to promote evidence-informed events when and if I know about them. 

Before we get into any research on Fibro, for the newbies in the crowd, let’s define fibro shall we? According to the Mayo Clinic website it as follows:

“Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. Researchers believe that fibromyalgia amplifies painful sensations by affecting the way your brain processes pain signals.”

Alright, that’s a good start right there and, if you listened to our free two-part masterclass episodes with Dr. Anthony Nicholson called Decoding Chronic Pain, if you listened to those, you heard a lot about a sensitized or up-regulated central nervous system. Those were episodes 79 and 80 and they are priceless if you are interested in solving the chronic pain enigma. I’m linking them in the show notes. GO LISTEN. Make yourself better. 

Fibromyalgia is thought to be another consequence of this sensitized, up-regulated central nervous system we have discussed so many times here.  

A combination of things are playing a part but, in general, there are five main elements to the causation of Fibro

THE FIVE MAIN ELEMENTS

1. There is a familial and genetic predisposition – family members of fibro patients have an 8 fold increased risk
2. There are environmental stressors acting as triggers – such as physical trauma, psychological and emotional stress, and even infections. 
3. There is dysfunction of the hypothalamic pituitary axis and autonomic nervous system
4. There are functional impairments in pain and sensory processing
5. There are cognitive, behavioral and psychological impairments

According to Dr. Anthony Nicholson from the CDI DACO program, It is a brain that has essentially switched into over-protective mode and now remains caught in that state. 

He goes on to say, “Consider the clinical landscape for a moment…

Chiropractors see patients with painful movement machinery and diagnose functional M/S disorders; Gastroenterologists see this same class of patients and diagnose functional bowel disorders and non-ulcer dyspepsia; dentists diagnose functional TMJ disorders, urologists are confronted with unexplained pelvic pain, vulvodynia and irritable bladder; and neurologists evaluate unexplained facial pain and chronic headache.  

And if all of these conditions could be due to central nervous system dysfunction, it could explain why we see all of them respond together to a management approach that is able to switch this hyper-vigilant central neurology back to a more normal level of sensory interpretation.  

And could it be that that reduces the abnormal motor and autonomic behaviors that are driven by a brain that perceives the body to be in danger or under threat?“

Some of the biggies on the differential diagnosis list are

• hypothyroidism
• anemia
• diabetes
• and undiagnosed cancer

Also middle aged women are the most likely to have fibro so you’ll want to explore 

• Rheumatoid arthritis
• Lupus
• Osteoarthritis
• and Polymyalgia Rheumatica 

Luckily Perrot, et. al. came up with a hell of a screening tool. In fact they found that a positive answer to more than 5 of the following 6 questions had a sensitivity of 90.5% and a specificity of 85.7% when differentiating Fibro from other conditions like RA, ankylosing spondylitis and osteoarthritis. 

Would you like to know the questions? Well of course you would. Here they are

1. I have pain all over my body
2. My pain is accompanied by continuous and very unpleasant general fatigue
3. My pain feels like burns, electric shocks or cramps
4. My pain is accompanied by other unusual sensations throughout my body, such as pins and needles, tingling or numbness
5. My pain is accompanied by other health problems such as digestive problems, urinary problems, headaches or restless legs
6. My pain has a significant impact on my life, particularly on my sleep and my ability to concentrate, making me feel slower generally

A key part to getting these patients well again is to get their brains to un-learn that movement is painful. Introducing the fact that movement doesn’t necessarily hurt can be done through nice, gentle adjustments wouldn’t you agree? When you think about it?

Understanding the difference between hurt and harm. Sometimes, we need these people moving whether it hurts a bit or not and, as confidence, strength, and ability increases, you’ll see they have un-learned that movement is bad and that it hurts. 

One of the biggest things with fibro patients is understanding that they just don’t inhibit pain very well. 

A point of particular interest here is that Evidence suggests that opioid pathways are normal or even increased in activity, which probably explains why opioids are generally ineffective analgesics in these patients

On the other hand, serotonin and noradrenalin systems are under-active, which explains why most compounds that raise both serotonin and noradrenalin (such as tricyclic antidepressants, duloxetine and tramadol) have been shown to be effective in controlling symptoms in FM patients.

I’m not going to pretend to be a genius here. This is all info from my DACO learning and Dr.s Anthony Nicholson and Matthew Long with CDI in Australia. THEY really are the geniuses in my opinion. 

They say, “a useful approach with patients be to encourage exercise to stimulate her CNS system but avoid activities that are too intense as this may sensitize them further.  Also, improving posture and movement habits is likely to reduce the effect of fatigue on the major postural muscles that drive a constant nociception.”

They point to a systematic review by Schneider (2009), strong evidence supports aerobic exercise and cognitive behavioral therapy (CBT); moderate evidence supports massage, resistance training, acupuncture and spa therapy; and limited evidence exists for spinal manipulation, movement re-training, vitamin and herb supplements and dietary approaches.

Overall, the evidence strongly recommends a multifactorial approach that emphasizes education, targeted medications, exercise and cognitive therapy.

Let’s get to a few papers real quick and then we’ll wrap up our Fibro episode, shall we? I have papers covering resistance training and chiro when treating women with fibro, I have tobacco use in fibro patients, and I have acupuncture for fibro…..

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Item #1

The first one is called “Tobacco Use in Fibromyalgia Is Associated With Cognitive Dysfunction: A Prospective Questionnaire Study.” by L. Ge, R D’Souza, and T Oh and published in Mayo Clinic Proceedings: Innovations, Quality & Outcomes in February 2019(Ge L 2019). Hot stuff, stand back…

Why They Did It

To evaluate the association between smoking and cognitive function in patients with fibromyalgia

How They Did It

• They surveyed 668 patients with fibro. 
• They were categorized by smoking status
• They did outcome measures on all sorts of things including cognitive function, symptom severity, quality of life, fatigue, sleep, anxiety, and depression. 

What They Found

“In patients with fibromyalgia, smoking is a risk factor for cognitive dysfunction. Moreover, smokers with fibromyalgia were more likely to report increased severity of fibromyalgia symptoms, worse quality of life, more sleep problems, and increased anxiety compared with nonsmokers with fibromyalgia.”

As a sidenote

Did that one surprise anyone? Smoking is awful. It’s awful all around for everything, every condition, and even the way you smell. It’s awful. If you smoke like I used to years ago, get a book called, “The Easy Way To Quit Smoking” by Alan Carr and start seeing it for what it is. 

You smoke because you’re bored? How boring is it to stand outside in the cold wind smoking a cigarette by yourself?

You smoke because it gives you confidence? How confident are you when are anxious about how you smell or what smoking is doing to your health on a daily basis. 

Smoking does the exact opposite of what you think it’s doing, basically. 

Exit sidenote

Item #2

The second paper I have here is called “Effects of Resistance Training and Chiropractic Treatment in Women with Fibromyalgia” by Lynn Panton, Arturo Figueroa, and a gaggle of others. It was published in The Journal Of Alternative and Complementary Medicine in March of 2009(Panton L 2009). Old man river….

Yes it’s 10 years old but that doesn’t matter. 

Why They Did It

The objective of this study was to evaluate resistance training & resistance training combined with chiropractic treatment on fibro in women.

How They Did It

Both groups finished sixteen weeks of resistance training consisting of 10 exercises performed two times per week. Of course, one group had only the resistance training while the other added in chiropractic treatment two times per week. 

What They Found

“In women with FM, resistance training improves strength, FM impact, and strength domains of functionality. The addition of chiropractic treatment improved adherence and dropout rates to the resistance training and facilitated greater improvements in the domains of functionality.”

Item #3

Our last item is called “Acupuncture therapy for fibromyalgia: a systematic review and meta-analysis of randomized controlled trials” by Xin-chang Zhang, Hao Chen, Wen-tao Xu, et. al. published in Journal of Pain Research in January of 2019(Zhang X 2019). Hot potato, get ‘em while they’re hot. 

Why They Did It

The stated goal here was to determine the effect and safety of acupuncture therapy on the pain intensity and quality of life in patients with FM.

How They Did It

There was a search done through PubMed, the Cochrane Library, Embase, the China National Knowledge Infrastructure, the Chinese Science and Technology Periodical Database, and one and on. They were collecting randomized controlled trials to performa  meta-analysis according to the Cochrane systematice review method. 

They identified 12 studies that fit the criteria

What They Found

The meta-analysis showed that acupuncture was significantly better than sham acupuncture for relieving pain and improving the quality of life. At long-term, the effect of acupuncture was also superior to that of sham acupuncture without any serious adverse events. 

Payah

So there you have it. Tell me you learned something. Tell me you picked up a fibro nugget and tell me you’re better for having listened.  Send me an email at [email protected] 

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Part of making your life easier is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at [email protected] if something is out of sorts or isn’t working correctly. 

If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders. 

Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it. 

The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment instead of chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm.

That’s Chiropractic!

Contact

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Connect

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. 

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About the Author & Host

Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

Bibliography

• Ge L, D. S. R., Oh T, (2019). “Tobacco Use in Fibromyalgia Is Associated With Cognitive Dysfunction: A Prospective Questionnaire Study.” Mayo Clin Proc Innov Qual Outcomes 3(1): 78-85.
• Panton L, F. A., Kingsley JD, (2009). “Effects of Resistance Training and Chiropractic Treatment in Women with Fibromyalgia.” J Altern Complement Med 15(3).
• Zhang X, C. W., Xu W, (2019). “Acupuncture therapy for fibromyalgia: a systematic review and meta-analysis of randomized controlled trials.” J Pain Res 12: 527-542.

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