Fibromyalgia and Sleep

Fibromyalgia (FM) is a condition that has produced more diverse opinions from researchers and physicians than almost any other condition. This has made finding a health care provider who is willing to manage the FM patient very challenging. Similarly, patient perceptions vary widely from those who strive to live a normal life despite their symptoms vs. those who are unable to cope and “give in” to the disorder. FM occurs in about 2% of the population with the majority of sufferers being women.  Common symptoms include muscle aches, joint pain, sleep disturbance and widespread body tender points or areas. The term “fibrositis” was first reported in 1904 to describe patients with these symptoms with many names being used including myositis, myalgia, fibrosis, myofibrositis, psychogenic rheumatism, and probably others!  Not until the mid 1970’s did the term “fibromyalgia” become the accepted term, getting rid of the “-itis” suffix which means “inflammation” and adopting the “-algia” suffix, which means condition or pain. In the 1990s, the American College of Rheumatology published distinct criteria for diagnosing FM requiring 11 of 18 tender points to be identified on examination, but this too has been criticized with new recommendations to accept widespread pain, sleep disturbance, and long-term or chronic symptoms as being appropriate to establish the diagnosis.  Most recently, a central nervous system (CNS) origin rather than a localized inflammatory condition is now the current accepted area of the body that is the focus of cause and treatment.

Sleep or, the inability to get to deep sleep (which takes 3-4 hours of continuous sleep), has been identified as a major symptom of FM. Similarly, many of the symptoms of poor sleep coincide with the symptoms of FM such as fatigue, poor concentration, irritability, and diffuse pain.  While certain medications and herbal remedies have been focused on and discussed, little has been reported on the changes the patient can make to facilitate sleep. The first order of business to help the sleep pattern is to make sure there are no underlying conditions such as sleep apnea or thyroid disease. Second, what is the FM patient’s sleep habit(s) or routine? This includes the time they go to sleep, the time prior to falling asleep once in bed, how many times do they wake up at night and the length of time to fall back asleep, how rested do they feel in the morning and how long does it take “to wake up” and what has to be done – coffee, meds, etc., to feel “awake.” Third, identify other reasons for waking – pets in bed, a snoring partner, babies/kids or elderly care, and/or working swing or night shifts.  The “treatment” of the FM patient for sleep disturbance includes discouraging daytime long naps – short naps are OK limited to 30 minutes max and at least 8 hours before bedtime.  Here’s a summary list of recommendations:

1. Reduce room distractions (no pets, no TV);
2. Comfortable sleeping temperature and noise level – consider a white noise or “sound machine;”
3. Establish a bedtime and awakening time based on the number of hours that it “usually” takes for that person to feel “rested;”
4. Start a “wind-down” 60-90 min. before bedtime – reading, writing – to relax and “let go” of the day’s events;
5. Avoid stimulating books or movies before bedtime;
6. Writing down cares or worries of the day in a journal 45-60 minutes before bedtime;
7. Avoid next day planning during the “wind-down” time period;
8. Perform deep breathing exercises at bedtime;
9. Avoid caffeine, nicotine, and alcohol pre-bedtime;
10. Limit exercise after 3 hrs before bedtime;
11. Avoid longer than 30 min. naps less than 8 hrs pre-bed time;
12. Avoid eating 3 hours before bedtime;
13. Avoid clock watching;
14. If unable to fall asleep within 15-20 minutes, get up and engage in relaxation exercise and return to bed when feeling sleepy;
15. Consider a softer mattress (harder is NOT always better);
16. Some sleep centers advocate at least 40 minutes of strong light exposure after rising in the mornings.

We recognize the importance of including chiropractic in your treatment planning and realize you have a choice of providers. If you, a friend or family member requires care for FM, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR FIBROMYALGIA! FOR MORE INFORMATION LOG ON TO: www.stopyourfibronow.com

Fibromyalgia: How Do I know I Have It?

To answer this question, let’s first define fibromyalgia (FM).  FM is a condition that is diagnosed basically by eliminating all other possible causes, including inflammatory joint conditions. Lab testing includes tests for rheumatoid arthritis, gout, lupus, and infection.  X-ray and MRI’s may be ordered to rule out disc problems, fractures, tumors and infections.

There are essentially no blood tests, imaging studies or neurological tests that can specifically diagnose FM.  It is when all these tests come back negative, that the diagnosis of FM is used. The history is probably the most important tool that helps to diagnose FM.  Most of these patients will report that the onset is gradual, often present for years. There is usually no specific cause, though there are specific conditions (such as irritable bowel syndrome, trauma, rheumatoid arthritis and others) that can result in “secondary fibromyalgia”.

The big differentiating feature is the presence of widespread, whole body pain – NOT just low back pain or neck pain or headaches, etc.  In FM, there is often pain in the legs, arms, torso, back and neck.   These people basically, “…hurt all over.” Typically there is no radiating pain down the leg or arm that follows a specific nerve pathway.

Another unique feature of FM includes sleep dysfunction. In many cases, sleep interruptions occur 2, 3 or more times a night, often with difficulty in returning back to sleep. The quality of pain is often described as numbness, tingling, burning, achy, deep, boring, and most importantly generalized in location (all over the body). The intensity is usually reported as high (>6/10 pain scale scores).  The past history usually includes multiple visits to many different types of doctors.   Many attempts at different medications is common.   Most medications do not help.

Even with these unique historical features, it is still necessary to “rule out” other conditions by running tests. This is especially important when FM is secondary to other conditions as FM can overshadowed by other conditions.  It is important to find doctors that have the experience to diagnose it and treat it effectively.

Treatment for FM includes many of the same methods for treating other musculoskeletal conditions.  Spinal manipulation, various forms of physical therapy and low level laser therapy – LLLT, can improve function, reduce pain, and reduce the need for medications.  In addition, dietary management using an anti-inflammatory diet (gluten free diet) and supplementation (a multiple vitamin, calcium/magnesium, omega 3 fatty acids, Vit. D, and CoQ10) can be very effective.

YOU MAY BE A CANDIDATE FOR DRUG_FREE RELIEF FROM FIBROMYALGIA! FOR MORE INFORMATION LOG ON TO: www.stopyourfibronow.com

Fibromyalgia: Vitamin Recommendations

Fibromyalgia (FM) can be characterized by pain that is widespread, not limited to a single anatomical area but rather can affect the arms, legs, trunk, head and neck. This Health Update will concentrate on a few specific vitamin recommendations with the understanding that a “good” diet such as one low in glutens (wheat, corn, barley, rye), rich in fruits, vegetables, and lean meats, with an emphasis of omega 3 rather than omega 6 fatty acids, can be highly effective in and of itself.  More importantly, it doesn’t make sense to abuse your diet and expect any vitamin recommendation to be highly effective.  So the plea is, PLEASE practice a good “anti-inflammatory” diet, such as that briefly outlined above PLUS take the following vitamins:

1. Multivitamin/mineral: This captures a little of everything and serves as a foundation (like the base of a pyramid) for more specific vitamin recommendations.  In most cases, it is wise to skip iron as this is not usually a missing nutrient for most people and can be toxic for some.  If however, iron has been recommended for you, feel free to include it.
2. Magnesium (Mg): Magnesium is a missing nutrient as most foods do not include Mg and it is a vital nutrient in many of the pathways where proteins, fats, and carbohydrates are broken down in the body.  Since it cannot be easily obtained through the diet, a supplement of Mg is wise.
3. Omega 3 fatty acids: There must be a balance between the anti-inflammatory omega 3 and the pro-inflammatory omega 6 fatty acids.  Most people consume far more omega 6 vs. omega 3 fatty acids (instead of the other way around) by consuming things like fast foods and potato chips.  There are long lists of omega 3 and omega 6 foods available on the internet – just “search” these and try to achieve a 3:1 omega 3 vs. omega 6 ratio. When choosing this supplement, many options will be available such as, “1000 mg of Fish Oil.”  But, take a careful look at the label to determine how many pearls/pills are recommended per day as this can vary quite a bit. There are two primary active ingredients abbreviated EPA and DHA that are the important part of “fish oil.”  Generally, about 1000mg of each per day is ideal, which usually requires 3-4 pearls per day (which may mean 3-4000mg of “fish oil” — not “one-a-day”).
4. Vitamin D: Even if you don’t read magazines or newspapers, you probably have heard some of the many wonderful things about Vitamin D.  Some of these benefits include anti-cancer (cervix, prostate, and others).  It’s also been reported as an anti-depressive and more effective for reversing the symptoms of SAD (Seasonal Affective Disorder) than stimulation using the correct type of light. It is a strong anti-inflammatory and hence, has a role in the treatment of most diseases as most conditions include an inflammatory component.  The FDA has recently raised the minimum recommended daily allowance from 400 IU to 2000 IU/day.  It has been reported that 70% of people living in the sunbelt are Vitamin D deficient as the ONLY good source of Vitamin D is from sunlight and most of us avoid too much sun for skin cancer reasons.
5. CoQ10: This is a very strong anti-oxidant and it’s been highly recommended for anyone with any heart related conditions.  Anti-oxidants have MANY health benefits! Try 100mcg/day.

We recognize the importance of including chiropractic in eliminating your fibromyalgia pain.

YOU MAY BE A CANDIDATE FOR TREATMENT THAT ELIMINATES YOUR FIBROMYALGIA PAIN ! FOR MORE INFORMATION LOG ON TO www.stopyourfibronow.com

How Do You Know If You Have Fibromyalgia?

Fibromyalgia (FM) is a chronic condition where there is widespread / whole body pain that is often difficult to diagnose.  Some patients may spend years of going to different doctors, undergoing many tests (of which most, if not all, are “negative”), and they may be diagnosed with different conditions such as rheumatoid arthritis, hypothyroidism, or mononucleosis before a diagnosis of FM is finally given.  Needless to say, this process can be very frustrating!

The reason for this dilemma is that there is no single diagnostic test (blood test, x-ray/image finding, etc.) that verifies the diagnosis of FM, leaving doctors in a position to “rule out” all other possible “diagnose-able” conditions first, before considering FM as “the” diagnosis.  Another challenge is the fact that FM symptoms vary widely from one person to the next and even vary within the same person at different times of the year.  There are a few “guidelines” doctors can use to help secure the diagnosis of FM.

One such guideline is from The American College of Rheumatology (ACR) which requires that “widespread” pain be present throughout the body for at least 3 months (“widespread” is defined as pain on both sides of the body, above and below the waist).  The ACR also has identified 18 points on the body of which at least 11 of the 18 “tender points” must be present to secure the diagnosis of FM.  There is debate as to the accuracy of this rather stringent criteria as FM symptoms can come and go and vary, making the 11 of 18 tender point findings sometimes change between visits.  Hence, widespread pain above/below the waist on both left/right sides of the body for at 3 months has become a more accepted indicator for diagnosing FM.

Yet another challenge in pinning down the diagnosis is that the FM sufferer may experience signs and symptoms seemingly unrelated to FM, such as stomach ache/digestive problems or headaches. This can lead the doctor down other paths before considering FM as a diagnosis.

Fibromyalgia can be primary (no other condition caused it) or secondary (other condition(s) lead to the development of FM).  Hence, the diagnosis process focuses on identifying conditions which can be identified through standard diagnostic tests, often overshadowing the diagnosis of FM.  Testing for conditions such as lupus, multiple sclerosis, sleep apnea, diabetes, Crohn’s Disease, and/or others, often makes sense to both you and your doctor, but adds to the delay in diagnosing FM.  Here are some suggestions to help your doctor through this diagnostic maze:

• Ask questions:  Ask about what each test is for and what the next plan is if the tests are negative.  By increasing your understanding, this will reduce your frustration in this process.
• Keep records:  Obtain a copy of EVERY test you have and share the information with any new doctor or specialist.  This can save time and money!
• Find the “right” doctor:  Find a doctor you can trust and “talk to.” Not all doctors “believe” FM exists and some are close minded to considering it.  Try to locate a doctor with a lot of experience with FM cases and is willing to “…work with you.”
• Build a good relationship: Be open, honest and avoid anger, skepticism and don’t be confrontational.  Be upfront about what is frustrating you about your symptoms.
• Take care of yourself: Ultimately, “success” of treating FM demands a “team” effort between you and your doctor.  Managing stress (eg., deep breathing exercises), obtain care that works (eg., chiropractic, massage), eat a healthy diet (eg., gluten-free), exercise regularly but don’t overdo it, and get plenty of sleep and rest.

We recognize the importance of including chiropractic in your treatment planning and realize you have a choice of providers. If you, a friend or family member requires care for FM, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

For more information on how we treat fibromyalgia, log on to: www.stopyourfibronow.com

Fibromyalgia – Important “Fibro Facts”

So you think you may suffer from Fibromyalgia (FM) and you’re trying to find out more information about FM…..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 FM 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 FM patient hypersensitive to normal stimulations like a hug or a 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 FM.  There are no blood tests, x-rays, biopsies, EEG’s, EMG’s or other tests for FM.  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, but perhaps most important is education – about FM 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). 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 multiple vitamin, calcium/magnesium, fish oil (omega 3 fatty acids), Vit 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 FM.  If you, a friend or family member require care for fibromyalgia, we would be honored to offer our services.

YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR FIBROMYALGIA!
For more information log on to www.stopyourfibronow.com