Fibromyalgia

By Ray Fosterrlf@mt-rushmore.net

 

This is one of a number of Medical Checkpoints giving information about common conditions and what you can do about it. Your opinion and reaction to these Medical Checkpoints would be valued and appreciated. Medical Checkpoints are published periodically by  STARTHealthcare and are provided as a free service.

 

DEFINITION

The following definition is taken from Harrison's Principles of Internal Medicine, 13th edition, (on CD ROM 1994) 23rd chapter under the heading: Muscle Pains; Section: Diffuse Myalgias.

 

Muscle pain in the absence of muscle weakness can occur in acute infections caused by influenza virus and coxsackievirus. Fibrositis, fibromyalgia, and fibromyositis are synonyms for a disorder associated with pain and tenderness of muscle and adjacent connective tissue. Focal "trigger points" of tenderness can be identified, and systemic symptoms such as fatigue, insomnia, and depression are frequently present. Although patients often identify painful swellings, histologic evaluation discloses no abnormality of muscle or connective tissue. Symptoms may respond partially to amitriptyline or nonsteroidal anti-inflammatory agents, but the disorder tends to be chronic and unrelenting. A supportive program of physical reconditioning is sometimes helpful. Patients whose symptoms persist for months or years are often considered to have a psychiatric disorder, but its nature has not been defined.

 

What is going on:

The pain and sore spots characteristic of FIBROMYALGIA (also known as fibromyositis) can be due to several causes. First of all there may be a local inflammation due to a virus. This is like having a "cold" in your back or neck. Generalized muscle pains may be due to systemic toxins in the blood that results from a viral infection, usually somewhere else other than in the aching muscles or joint capsules. One common cause of localized tender spots is what is called "referred pain". A common site of inflammation due to trauma such as a strain or a sprain is in the many joints in connection with the spine. Because these joints are close to the coverings of the nerves being distributed from the spinal cord, the covering of these nerves called the "dura" may become irritated or inflamed. When this happens, the trouble is not where it hurts, but deeper inside around the inflamed joint linings and nerve coverings. Should the pain and tenderness last for more than a few months, chronic pain and joint stiffness may result. The brain has memory banks. If these memory banks store a lot of pain pattern memories they can be self-perpetuating to some degree. As the body sympathizes by splinting the body part that hurts, stiffness may result. When a part is protected by splinting or guarding it for many months, the muscles can become weaker and the joints stiffer because of lack of full range of motion. Thus the pain, splinting, lack of movement, stiffness, pain cycle may develop which may make the condition chronic.

 

 

Many Faces - common mechanism: The same mechanism occurs in many different body sites. "Tennis elbow", "heel spurs", back, neck, shoulder pain with tender spots are common locations.


What to do:

Most of the time we pay no attention to aches and pains associated with the flu or head colds or just "feeling under the weather". This is the very best thing to do because in the vast majority of times the pain and stiffness goes away without any specific treatment on our part. The body has a wonderful built-in healing mechanism which keeps us in good condition.

 

1. So the first thing to do is to ignore it and most of the time it will go away.

 

For those sore spots that do not go away, the first common sense question is whether this is what has been described here as FIBROMYALGIA or FIBROMYOSITIS or not?

 

2. If in doubt of the diagnosis seek professional medical advice.

 

For the conditions we have described here, most of the time the following suggestions will lead to a large degree of relief, if not a total cure in time (about 1 ? to 2 times the length of time that it took to develop).

 

3. Local heat will have the effect of making it uncongenial for any virus. Alternate hot and cold applied locally will increase the blood flow to the part and have the effect of "washing out" the collection of pain chemicals. Heat will ease the pain and relax the muscles allowing for more normal local blood flow. There are a number of easy ways to apply hot and cold to the part (e.g. 3 minutes hot and ? minute cold): - shower, water baths or hot compress or electric pad and ice locally. Use a thermometer to measure the temperature of the hot water. Start the hot water about 100°F (37.7°C) and increase the temperature by adding more hot water (without burning yourself) to a maximum temperature of 110°F (43°C). Add ice to the cold water to keep it cold and end the treatment with cold (at least three hots and three colds). If you have diabetes, peripheral neuritis, or other disease that makes your body part insensitive to temperature, consult your professional medical providers before attempting to use hot and cold on yourself.

 

4. Local stretching of the joints and muscles will regain or maintain the normal range of motion.

 

5. Exercise will increase the local muscle blood flow and keep the muscles from becoming atrophied by disuse. Walking is without doubt the best exercise. We recommend walking little by little to increase your tolerance. Exercise appropriate to your age and station (e.g. walk 2 -3 miles a day 3 - 5 days a week).

 

6. Eat an unrefined, whole plant diet. Complex carbohydrates are the best source of fuel for your body. (This would consist of whole fruits, vegetables, grains, legumes, etc.)

 

7. Other remedies include:

  1.  
    1. local massage of the tender "trigger points";
    2. special physiotherapy methods which have been developed to "stretch and hold" a tender, tight, sore muscle;
    3. putting the joint through a full range of motion may stretch and relax the muscles and

regain lost range of motion. Consult your professional medical personnel regarding

other physiotherapy modalities of treatment, if necessary.

 

Additional Information:

This is additional information for those who want to go "further over in the book"! The "book" is the 13th edition of Harrison’s Principles of Internal Medicine on CD. There is a whole complex of painful conditions that have in common that they last a long time and are difficult to treat with simple measures, with medication usually of little help, if at all. The best understanding of the basis of these conditions is that the immune system is not doing its job as it should and is in some way related to these conditions. These are some conditions quoted from the book that you may want to consider further yourself or ask your doctor about:

 

 

Polymyalgia rheumatica occurs in patients over age 50 and is characterized by stiffness and pain in shoulder and hip musculature. Despite symptoms of pain localized to muscles, there is convincing evidence that the disease includes a proximal, inflammatory arthritis; joint effusions (fluid in joint) are often present in knees and other peripheral joints as well. Patients often develop profound disuse atrophy (a wasting or diminution of size) of muscles and complain of weakness, giving rise to a suspicion of polymyositis (inflammation of many muscles).

 

Dermatomyositis and polymyositis are conditions of presumed autoimmune etiology (cause of disease) in which the skeletal muscle is damaged by a nonsuppurative inflammatory process dominated by lymphocytic infiltration. The term polymyositis is applied when the condition spares the skin and the termdermatomyositis when polymyositis is associated with a characteristic skin rash. One-third of cases are associated with various connective tissue disorders, such as rheumatoid arthritis, lupus erythematosus, mixed connective tissue disorder, and progressive systemic sclerosis, and one-tenth with a malignancy.

 

The precise cause of these diseases is unknown, but interplay between host genetic factors, viral infection of muscle, and autoimmune mechanisms is probably contributory. Familial occurrence of these diseases, and the increased frequency of HLA-DR3 and -DRw52 antigens in patients, suggest an underlying genetic and immunologic predisposition. Experimental viral myositis can be induced in animals by coxsackie virus. A mild inflammatory myopathy can occur with influenza and coxsackie viruses in humans. However, the several electron-microscopic observations of virus-like particles in muscle fibers in dermatomyositis or polymyositis have not been confirmed by virus isolation or demonstration of rising viral antibody titers, and the disease has not been passed into animals by injection of extracts of skeletal muscles.

 

Myalgias are also frequent in other rheumatologic disorders, including rheumatoid arthritis, systemic lupus erythematosus, polyarteritis nodosa, scleroderma, and the mixed connective tissue syndrome. Patients with polymyositis and dermatomyositis may have myalgias (muscular pains), although in the majority muscle pain is lacking or minimal.

 

What the above is saying is that there are a whole group of painful conditions affecting the skin, tendons and ligaments, and the muscles of the body that are not clearly understood yet today but thought to be related to an improper functioning immune system. The best guess the medical profession has today is quoted above. Sometimes it is known, at least in part, what has caused the painful condition. For instance (more quotes):

 

Fever and pain may follow a tick bite.

 

In a small percentage of patients, infection with B. burgdorferi may triggerfibromyalgia, which is thought to be a variant of the chronic fatigue syndrome. It is important to distinguish this diffuse pain syndrome from active Lyme disease, since the pain syndrome does not respond to antibiotic therapy. The risk of infection with B. burgdorferi after a recognized tick bite is so low that prophylactic antimicrobial treatment is not routinely indicated. If the patient is quite anxious or if the tick is engorged, 10 days of amoxicillin or doxycycline therapy is likely to prevent the occurrence of Lyme disease.

 

But in the great majority of cases, the exact cause is not known as quoted here:

 

There are several factors that can cause, perpetuate, or exacerbate chronic pain. First, of course, the patient may simply have a disease that is characteristically painful for which there is presently no cure. Arthritis, cancer, migraine headaches, fibromyalgia, and diabetic neuropathy are examples of this. Such diseases may be sufficient to explain chronic pain without invoking other factors. Second, there may be neural and somatic perpetuating factors that are initiated by a bodily disease and may persist after that disease has resolved. Examples include damaged sensory nerves, sympathetic efferent activity, and painful reflex muscle contraction. Finally, a variety of psychological conditions can exacerbate or even cause pain.

 

While the best medical authorities know of no cure for these conditions as stated above, there are a number of very simple things that the individual who has these symptoms can do for themselves and in many cases a complete relief of symptoms is experienced. The suggestions at the beginning of this Medical Checkpoint will in most people give a large amount, if not complete relief of symptoms. For those "resistant cases" more suggestions follow:

 

 

Three Requirements to Health:

 

 

A: Blood flow – at a capillary level – enhanced by exercise and water. What that means is that the blood must flow satisfactorily at the cellular level - through the capillaries – the smallest, microscopic vessels. The things that promote good blood flow at the microscopic level are exercise (such as walking, swimming, cycling) to get the blood moving, drinking water (10 or more glasses of water a day) to give the blood enough fluid in order to carry the blood cells around satisfactorily. When the body is dehydrated (lacks water) the blood is thicker because it does not have enough water in it and the microscopic circulation is impaired. Good breathing is needed to oxygenate the blood from the lungs. So stand, sit, and walk straight with an erect posture to give the lungs space to move, and breathe deeply and regularly. One of the great advantages of exercise is that it forces deep breathing. By deliberately breathing deeply, the same advantage may be experienced at rest. A positive mental outlook and attitude of gratitude is important to good microscopic blood flow. If you feel that you have been wronged, if you carry a grudge, if you "have a chip on your shoulder", the microscopic blood flow is interfered with and cannot be adequate for health. Whatever it takes, make peace with your environment, with those around you, and with God. It is not possible to have good health while you are mentally "on the run" or if you are angry to some degree the whole time.

 

B. Balance of Rest and Stress/Exercise. If you are working two or three jobs a day; if you work different shifts during the month; or if you are tired all the time or "stressed out" more or less continually, your balance between rest and stress/exercise is unbalanced on the stress/exercise side. There is no medication, no surgery, nothing that can restore your health except to mend your work habits. What you need is to get the stress/exercise demands in your life into balance with the rest that your body needs. It is not possible for me to tell you what you need to do – but whatever it is – do it! The greatest need mankind has is quality time of communion with family and with God. The body and the mind require rest.. This means seven or eight hours of sleep regularly. This means at least one day a week in which to relax – and ideally spend quality time with God and your family.

 

C. Nutrition is the third of the "big three" – exercise, rest, and nutrition – that are required for health. The body was designed to "run" on complex carbohydrates (whole grain, whole fruit, or vegetable carbohydrates). Many and varied, and impossible to determine the cause exactly, are the diseases that result from improper nutrition. Nutrient supplements may help but are not the first line of defense. In the most simple terms an unrefined, plant-based nutrition is what is required for health. Those countries of the world where an unrefined, plant-based diet are largely eaten, the degenerative diseases so prevalent in the industrialized world are not seen. For example the big killers of the Western world – heart disease, strokes, diabetes, and cancer - are little or unknown in the Third World. The "take-home" message is that if you want to live, suffer and die "fashionably" that is your choice; however you do not need to. It is also your choice to change your health status. The three most important things that will improve our health are to "move it", "rest it", and eat a simple, unrefined, plant-based diet.

 

For resistant fibromyalgia sufferers (and everyone looking for better health!) – avoid the "fashionable poisons"! Did you know that a cup of coffee (because it increases your urine output chemically) dehydrates your body by one cup of water. Not only the cup of water that the coffee was in is lost in the urine, but also a second cup of water because of the diuretic effect of the coffee. The same thing is true for soft drinks! It could be that if you would stop the "brown drinks" (and also the soda pops) and drink 10 glasses of pure water a day, that your fibromyositis would "go away". Nicotine in cigarettes and chewing tobacco constricts the blood vessels and results in poor local blood flow throughout the whole body and contributes to many diseases on this fundamental basis. All flesh foods – meat, fowl, and fish - increase the inflammatory chemicals in the body and directly contribute to all the "itis" diseases. Not only are flesh foods unnecessary for health, but they interfere with health for many reasons, including that they have no carbohydrates – the main fuel the body needs. Even the dairy products and eggs have more fat and protein than needed, not to speak of hormones, antibiotics, and disease, which are harmful.

 

Health is the result of a total package lifestyle of health. For those who may require specific instructions and a "list" of things to do, here is a partial list of suggestions. The complete list for you – only you can produce. Best yet, don’t have a list at all. Learn and follow the principles of good health because you love them!

 

Suggestions for fibromyalgia and other immune compromised syndromes including chronic fatigue syndrome:

 

  1. Get 7 or 8 hours sleep (regularly – at least half before midnight if at all possible. Sleep before midnight is twice the value to you compared to sleep after midnight).

     

  2. Drink 8 – 10 glasses of water a day (not tea, coffee, soft drinks!).

     

  3. Choose an attitude of gratitude and stay with that choice. There is always something to be grateful about. "I complained that I had no shoes, until I met a person with no feet".

     

  4. Since no drug therapy has had lasting benefit in the scientific studies, save your money and turn your attention in another direction. One direction to direct attention is how to be of help and blessing to others. Benevolent service to others is a principle of good health. Read Isaiah 58 where this principle was outlined a few thousand years ago.

     

  5. Controlled trials have demonstrated improvement in fibromyalgia patients who underwent cardiovascular fitness training. Low-impact exercises such as fast-walking, biking, swimming, or water aerobics with stretching techniques have been the most helpful.

     

  6. For local symptomatic treatment (things to make the pain less) ice seems to help some patients while heat may make things worse. One suggestion is to turn a heating pad on high until it is warm. Then turn off the heating pad and lie down with our back on it, then put ice packs on the hips and thighs. You can try hot and cold showers – one cycle (hot or cold which ever helps most) 3 minutes and the other 30 seconds. Alternate three times and end usually with the cold. It is best to do this when you can go to bed and sleep afterwards (then make the last shower tepid – not hot or cold – so you can be relaxed in order to sleep).

     

  7. Find out where your muscle knots (trigger points) are and do stretching, starting with these painful muscles first. Hot packs will help relax them, and then massage and stretching will make them go away (for a while). Getting rid of the knots eliminates a lot of pain. If you do not know how to put the maximum stretch on the muscle, visit a library carrying books on muscle stretches. Several visits to a massage or exercise therapist for the purpose of learning how to stretch out your muscles may be worthwhile.
  8. Try a three month course of oral magnesium chloride. The pharmacist can make it up in a 25% solution for you or the health food store may carry tablets. Best yet eat foods high in magnesium such as green vegetables, (chlorophyll contains magnesium) nuts, seeds, dried beans, and whole grains. Whole grains are best. Grinding them or making flour is fine, but refining the grain results in loss of most of the magnesium.

     

  9. Nutrition is one of the most important elements in building up the immune system and overcoming the immune-related syndromes. The principles of an immune-building nutritional program are simple: "Eat natural foods!" What this means is "Get your nutrition from unrefined plant sources". The whole grains need to be sprouted or well cooked before eating. The fresh fruits and vegetables can be eaten raw with benefit. Food from the plant kingdom comes with high fiber, high carbohydrate, and low protein and low fat. This is just exactly the needs for best nutrition. The worst you can do for your body is to eat highly refined foods that are largely lacking in the essential elements of life – including fiber, vitamins and minerals. The fact that the refined foods have been "fortified" should be a red flag telling you that they have lost those elements that have been added back!

    Meat, chicken, and fish are all devoid of carbohydrates and fiber. There is zero carbohydrates, and zero fiber, and almost zero vitamins and minerals in meat, fish, and fowl. The fact is that meat, fish, and fowl are almost pure fat and protein - both of which we get too much of, and which is the cause of much, if not being the major cause, of our modern degenerative diseases. They are also a prime carrier of disease, parasites, harmful bacteria. In addition, harmful sprays, chemicals and antibiotics are involved in meat production.

     

    Dairy products and eggs are also high in fat, protein, hormones, and other substances. These substances can increase the inflammation and pain on a direct chemical basis and, in addition, can be allergenic.

     

  10. Some patients note improvements in pain and fatigue when they take vitamin supplements of Vitamin B-1 (100 mg) daily, B-6, B-12, folic acid and vitamin C. Try a three month course of supplementation and then continue with the fresh plant sources of food that are naturally high in these vitamins. Natural sources of these vitamins are:

     

    Vitamin B-1: Oranges, tangerines, melons, figs, raisins, whole grains, nuts, spinach, dry beans, limas, peas, lentils, soybeans, smaller amounts widely distributed in natural foods.

    Vitamin B-6: Whole grains, legumes, potatoes, bananas, and oatmeal. Small amounts in vegetables and fruits.

     

    Vitamin C: Raw fruits and vegetables, salads, cooked potatoes and cabbage, etc.

     

    Magnesium: Nuts, well cooked whole grains, legumes and peanuts, carrots, spinach and other greens.

     

  11. Try using one tablespoon of flaxseed twice a day or a handful of walnuts once a day. The flaxseed may be made into meal by a blender or coffee grinder, and sprinkled on cereal or used in cooking, if desired. These is a good natural source of the omega-3 essential fatty acids that are essential to nerve physiology.

     

  12. Research by Dr. James Penland revealed that those on low copper diets requested pain medications more often than those on diets containing normal levels of copper. The normal amount of copper required is 2 mg. per day. Good food sources are cauliflower, green peas, all beans and peas especially soy beans and peanuts, kale, molasses, green beans, all nuts especially pecans and walnuts, wheat germ, and seeds.

     

  13. Worsening of symptoms is often associated with anxiety, guilt, hostility, anger, stress, or consumption of coffee or tea.

     

  14. Garlic also helps. Use 1 to 5 fresh cloves sliced thinly at each meal for a 4 week trial, or use 3 kyolic capsules, 3 to 4 times a day.

     

  15. If your weight is normal or above, a day or two of fasting per week can do you a lot of good. It is especially important to drink enough water when you are fasting. Drink your usual 10 glasses a day plus a few more if the weather is warm.

Sixty percent of those with 11 or more, tender points (the standard definition for fibromyalgia) did not have chronic widespread pain. Counts of tender points rose with age and were significantly higher in women. They were correlated with depression, fatigue and poor sleep patterns. American Journal of Epidemiology, 138(8):641 Oct 15, 1993.

----------------------------------------------

This information is provided for self-help purposes.  Should you want professional help based on the principles portrayed above you can contact the

Black Hills Health and Education Center

by visiting online http://bhhec.org or

calling 1 (800) 658-5433.