By Dr. Mark Gallant and Dr. Colin Bartoe
This week, we are going to be talking about Fibromyalgia. I [Dr. Gallant] once had a conversation with a doctor (long before I ever became one) about a friend of mine who had fibromyalgia. He told me that in actuality, doctors don’t really know what causes it, and it’s just a diagnosis for body pain that they can’t figure out. AS it turns out, that’s not exactly right. Fibromyalgia is a syndrome, which means that it is a condition that can be caused by many different things.
Let’s talk a little bit about how fibromyalgia should be diagnosed. The official guidelines for diagnosing fibromyalgia include tenderness or pain in 11 out of 18 specific points and widespread pain in all four quadrants of the body for at least 3 months. What this means is that there are 18 specific points on the body, and there will be pain if you apply 4 kg of pressure to at least 11 of them. There also needs to be widespread pain for at least three months on both sides of the body above and below the waist. This is how you diagnose FM. Without those symptoms and pain reactions during a tender point examination, you can’t have a valid diagnosis of FM.
Besides the tender points and global pain, we should look a little bit at some of the other symptoms of FM. People with FM often also experience fatigue, morning stiffness, headaches, insomnia, irritable bowel syndrome, joint pain, memory problems, leg cramps, problems with concentration, and nervousness. These other symptoms can often cause an improper diagnosis. Chronic Fatigue Syndrome is often confused with FM, and vice versa, because both syndromes often share the same symptoms. Also, FM can be missed when the doctor focuses on some of the other symptoms listed above without checking the tender points for FM.
So what can you do to treat FM? Well, this is a tricky question, because as we discussed earlier, it can be caused by several different things. As functional doctors, we look for the cause of the problem, rather than trying to alleviate the symptoms. With a condition that has many different causes, we have to be able to figure out which one or ones are actually creating the problem. We’ll talk about a few of the main ones now. First is autoimmune. Autoimmune means that your immune system attacks your own body because it doesn’t recognize certain parts of itself. You can have antibodies against your own muscle cells leading to pain and trigger points or against your digestive tract cells causing irritable bowel syndrome (IBS) which is often seen with FM. The second cause of FM we want to address is myofascial. Fascia or Myofascia is sort of like a biological cling wrap that covers nearly every part of our body under the skin. From bone to muscle, around organs, and even around our nervous system, fascia is continuous and should move freely. Trigger points, which are areas of the muscle that get tight and sore may be caused by myofascial adhesions; something like small tack-welds or glue bombs that lock different layers together. Common trigger points match up with the tender points of FM. So that means that those 11 out of 18 tender points that the doctor finds might need some myofascial work (a special kind of massage). The last main cause that we will talk about is called central sensitization. This is when the brain gets too good at experiencing pain. Our brain is plastic, which means that it is able to change and adapt its structure and the way it functions. As we do things and make neurons fire, we strengthen those pathways and make them more efficient. This plasticity is how we learn, mature, and grow wiser as we age. Sometimes, though the wrong things get repeatedly activated and become more efficient in our brain, like how we experience pain. When that happens, you need someone like a functional neurologist who understands how this happens, so they can work to change the brain back to the way it is supposed to work. So, these are three of the main causes. There can be others, so the key is to find a doctor who is familiar with FM and can start getting to the root of the problem.
In the grand scheme of things, the fibromyalgia diagnosis is just that – a diagnosis. It is a way to categorize a group of symptoms. It really only matters to insurance companies what the diagnosis is because along with all other conditions, the treatment begins with finding what the actual cause is and removing that. Remember that with any compromise to your health, the symptoms should not be the focus of treatment, but rather a tool to guide your physician to the cause of the problem. Then, and only then can we begin to treat the cause and help a patient return to a healthier state of being. For more information please contact Dr. Mark Gallant or Dr. Colin Bartoe at (727)-733-6501 or at backnbalance.com.