Fibromyalgia Frequently Asked Questions
By: Hal S. Blatman, MD

There are many people with chronic pain in their neck, shoulders, or lower back. They may be diagnosed as having fibromyalgia when they ask their doctor during an office visit "I've had pain and fatigue for quite a while, could I have fibromyalgia?" Their doctor may say that fibromyalgia does not exist, or may agree and hand them a pamphlet about fibromyalgia that describes their symptoms very closely. Antidepressant medication is commonly prescribed and exercise may be encouraged. Now there is an alternative approach to treating this disorder that also includes education, bodywork and lifestyle changes.

What is Fibromyalgia?

The condition recognized as fibromyalgia, has a 200-year-old medical history. It was first called muscular rheumatism, then fibrocitis. In 1990, the American College of Rheumatology defined criteria for classifying people as having, or not having fibromyalgia. These criteria include a carefully defined combination of:

• 3 month history of wide spread pain
• pain on both sides of the body
• pain above and below the waist
• pain along the spine or chest
• pain with pushing on 11 of 18 specifically defined tender points

Even with this definition, not all doctors agree as to what fibromyalgia is, or even how it should be treated. Many doctors think that fibromyalgia is a primary disease of muscle tissue. Newer theories discuss involvement of the nervous system and immune system. In addition, there is evidence for a hereditary component.

There are several symptoms that are commonly associated with fibromyalgia. These include bizarre pain, chronic fatigue, sleep disorders, depression, irritable bowel syndrome, chronic headaches, temporomandibular joint dysfunction, morning stiffness, memory impairment, and irritable bladder. Symptoms are typically worsened with changes in the weather, physical activity, and stress.

Fibromyalgia is the diagnosis we apply to people who have symptoms from dysfunction of several organ systems, most likely with no problems severe enough to be diagnosed by medical testing.

Fibromyalgia is not a disease. It does not come from a specific bacteria or a single causative agent. Research will not find a cure in a little white pill that will kill the bad guys or restore the previous genetic structure.

How do we get Fibromyalgia?

The human body is a high performance, biochemical Ferrari. Just like a Ferrari, it is designed to be run on racing oil and racing fuel. Unfortunately, many people try to run this Ferrari on poison oil and 20-octane fuel, and we let the gut leak toxic waste into the body's water supply. These practices wear out the body's reserve, and then the person takes one more hit that it cannot recover from. This hit can be a physical injury, a viral infection, or a psychosocial trauma. Instead of healing from this hit, the body decompensates, and the person develops symptoms in several body systems. When these symptoms become severe enough, the person is diagnosed as having Fibromyalgia.

What causes the pain?

During my career, I have diagnosed and treated many people with fibromyalgia-- men, women, and children. They all have myofascial pain, and I suspect that most of the pain of fibromyalgia is indeed myofascial in origin. There are usually many trigger points, located in diverse muscle groups, all generating pain at the same time. It's like the brain is listening to a large orchestra of trigger points and referral patterns all at the same the time...and all the time. The level of pain is determined by how loudly the trigger point orchestra plays, and the location of the worst pain is related to which solo artist stands up to play. Often, this pain is largely dependent upon what the person has done in the last three days, what the weather is going to do tomorrow, and what the person has eaten.

What is myofascial pain?

Myofascial pain is the pain that is generated by myofascial trigger points in muscle tissue. Trigger points can be felt as nodules or knots of tightness within a muscle. Trigger points form in muscle tissue as a response to injury. They generate pain patterns that are felt as aching, numbness, tingling, and cramping. This pain pattern may be felt in a muscle or a nearby joint. The trigger point will also restrict motion, cause weakness and cause tightness in the soft tissue.

Repetitive strain and repetitive motion cause trigger points to form in the overused muscles. Trigger points in forearm muscles cause the pain of tennis elbow and golfer’s elbow. They also cause wrist pain and tenderness. Trigger points in buttocks muscles cause pain that is often diagnosed as bursitis and inflammation of the hip joint.

How important is nutrition?

I often hear fibromyalgia sufferers say: “I gave up my life for this disease, I'm not giving up my food!”

This attitude is so unfortunate. So many times, food contributes to both the disease and healing. In many people, nutrition is absolutely important for the healing process to even be possible.

Nutrition plays an important role in the treatment of fibromyalgia. We get out of our bodies only the quality of what we put into them. "Whole foods" such as grain bread and brown rice are better for our bodies than processed food such as white flour and white rice. Refined sugar is perhaps the worst of the processed foods for us to eat. Many people feel better if they do not eat wheat.

In addition, there are dietary supplements that can help to reduce fatigue. A good multiple vitamin, vitamin C, magnesium, vitamin B-12, and folic acid, are examples of dietary supplements that can be helpful. Co-enzyme Q may be helpful in some people. Less conservative treatment that centers on chronic yeast (candida) has also been helpful in many patients. Active allergic states can also cause the pain of fibromyalgia to increase and treatment for allergic conditions can also be helpful.

What can be done to help the person with Fibromyalgia?

There are many things that can be done to help adults and children with fibromyalgia. Pain can be treated with body work that includes myofascial release, Chiropractic, acupuncture, stretching and myofascial trigger point injections. Other injection techniques include prolotherapy and neural therapy. Pain, stress, anxiety and low mental functioning can be treated with Thought Field Therapy, BioFeedback, and EEG BioFeedback. Other important modalities include Healing Touch, Lymphatic Drainage, Environmental Detoxification, Aroma Therapy, Photon Therapy, Massage Therapy, Reflexology, and Feldenkrais.

Nutrition is also important for reduction of pain, relief from fatigue and improvement in total body wellness. Nutritional supplementation and various therapies can make a tremendous difference in giving the body an advantage. Since nutritional change is likely to be very important for a change toward health, we provide one on one sessions under Dr. Blatman's direction to help our patients make these changes as easily as possible. In addition, food allergy testing can be added to the healing program for further reduction of bowel problems, headache, pain, fatigue and mental cloudiness.

Another consideration is stress management. There are central nervous system mechanisms that make muscles generate more pain when we are under more stress. Since we do not live in a stress free environment, we can often be helped by techniques that change how we respond to stress. A good night's sleep is also very important in healing our bodies. Sleep deprivation in normal people causes fatigue and diffuse pain patterns to occur. Medication that is not addictive may be prescribed to help restore normal sleep patterns. This often has a beneficial effect on the pain level and fatigue of fibromyalgia.

Aerobic exercise and general muscular conditioning are very important parts of treatment. Fibromyalgia patients need to learn how to use their bodies in such a way that activity can be fun, without paying for this fun with days of pain. In addition, pain can often be reduced with bodywork. Most fibromyalgia patients will respond to the same kinds of body work that help people with myofascial pain. Hands on myofascial release techniques and massage therapy are usually beneficial. Healing Touch, energy healing, Feldenkrais therapy and Chiropractic can be very helpful. AquaMed Hydrotherapy has also been very helpful for many patients. Specific treatment of myofascial trigger points is also usually helpful. This includes accupressure and myofascial trigger point injections using local anesthetic agents.

Is there hope?

Of course there is hope.

Research is helping doctors to understand more about body mechanisms involved in causing the symptoms of fibromyalgia. New medications are being developed as a result of this research that will continue to improve the quality of life for the many people who suffer from this condition.

Individualized holistic treatment has been shown to be effective for the majority of fibromyalgia sufferers. Myofascial medicine has much to offer the person who has fibromyalgia. Healing Touch, Thought Field Therapy, Photon Therapy, and Massage Therapy can all be helpful. We offer people an opportunity for education and direction for getting better.

You are not alone.

There are many people with fibromyalgia, and there are support groups in different areas of town. Dr. Blatman and his staff give educational talks for some of these programs. Dr. Blatman is the medical advisor to the Fibromyalgia Support Group that meets at Mercy South Hospital in Fairfield, Ohio.