Paul A. Goldberg MPH, DC, DACBN, DCBCN
Fibromyalgia is a "Wastebasket Diagnosis" not because sufferers with these types of symptoms do not have real and serious discomforts, but rather because the title is used by physicians to describe symptoms without understanding the causes behind them.
DEFINITION & RESOLUTION
To clearly define Fibromyalgia is a tedious task. It is a diagnosis used by practitioners to describe patterns of muscle pain, aching and general discomfort when other diagnostic titles do not fit conveniently. Much like the diagnostic title Chronic Fatigue Syndrome, which commonly accompanies it, it is a diagnosis of exclusion.
HOW DO WE RESOLVE FIBROMYALGIA?
By understanding that the symptoms are indicative of underlying systemic poor health and that the symptoms can, therefore, be best addressed and effectively resolved by uncovering the specific, individual, reasons behind the fibromyalgia in each patient's case. This is a task that most practitioners are poorly oriented about, and poorly prepared to handle.
Every patient with fibromyalgia warrants a thorough case history, physical examination and appropriate laboratory functional studies. The initial interview process takes priority and must be thorough. The history of patients with Fibromyalgia type symptoms is often lengthy and many doctors, medical and alternative, have often been seen and many "treatments" tried. The patient usually has a long list of accompanying symptoms e.g. fatigue, indigestion, irritability, problems in sleeping, etc. All of this exemplifies the need to address the patient's overall health and vitality and to pinpoint the individual causes behind the problems.
With the large number of persons suffering from fibromyalgia symptoms, the market for all types of treatments, including so called "natural treatments", has exploded including megavitamin therapies, mineral potions, acupuncture, aromatherapy, anti-microorganism therapies, massage therapies, acupressure, special drinks, magnesium chloride, juice therapies, apple cider vinegar, iron supplements, electrical modalities, light beam generators, salt water baths, saunas, a wide variety of herbs, homeopathy, magnetic therapy, infrared therapy, Chinese energy work (Qigong), reflexology, an abundance of multilevel marketed products, etc. Unfortunately, this endless list of nostrums, potions, pills and therapies rarely plays any constructive role in returning the patient back to a state of reliable good health.
FIBROMYALGIA - CAUSES
Underlying fibromyalgia symptomatology is impaired health i.e. the patient's overall well-being has become impaired and the fibromyalgia symptoms are an indication of it. The solution? Address the causes of poor health in the individual as opposed to "treatment" of symptoms.
Some of the general areas fibromyalgia symptoms originate from include:
These (and other causal) factors combine with the patient's genetic makeup leading to metabolic imbalances resulting in fibromyalgia symptoms. Over time, should nothing be done to address the causal factors, increasing biochemical imbalances and more complex endocrine, digestive and neurological problems ensue.
FIBROMYALGIA - "TREATMENT"
What can we do for fibromyalgia?
Simply put, we must determine the causes of the patient's poor health and address those causes thoroughly at their roots. When the patient's overall health is improved and their vitality elevated, their symptoms of fibromyalgia will dissipate and good health will be restored. I have witnessed this repeatedly.
What seems to be a complex mystery that so many theories have been postulated about is in realty intimately related to the very ways we conduct our lives in combination with our own personal makeup.
The following case study will help illustrate the points made above.
CASE STUDY: FIBROMYALGIA
A 41-year-old female presented to our office with the diagnosis of "fibromyalgia", received from her medical physician. She suffered from diffuse muscle discomforts in the shoulders, neck, knees, thighs and intermittently throughout the upper back.
Her physician prescribed non-steroidal drugs along with an antidepressant. He encouraged her to seek psychiatric counseling if the problem did not improve. The patient was also seeing a doctor of chiropractic and was receiving massage and spinal adjustments.
The patient pointed out to me the different areas of her body that hurt, being particularly concerned about the pain in the muscles of her shoulders, neck and back. She noted that the pains had begun five years previously and although varying in intensity, they had increased greatly over the years.
In addition to having had extensive physician care, she had taken a multitude of "remedies," including homeopathic potions, herbal formulas and multi-level marketed products. While the patient's complaints centered on her muscular discomforts, questioning brought out that she suffered with fatigue, poor bowel function and mood swings varying from anxiety to depression.
Her diet habits were inconsistent but included a high-refined carbohydrate intake including "sports bars", which the patient thought were healthful. She carefully picked out foods that were "fat-free" on the advice of a local medical dietitian, whom she consulted with "to keep her weight down". Coffee was utilized as an "energy booster" which in turn ran her down even more.
She slept poorly and often went to bed with the television on to "help her fall to sleep": Her relationship with her husband was strained and she reported no interest in sexual activity which created further tension with her spouse with whom she frequently argued. Her periods had been irregular and uncomfortable for the past several years. She had two children in their teenage years. She avoided exercising since it caused her muscular discomforts.
I had the patient obtain laboratory tests including a blood chemistry (SMA), lipid profile and blood count (CBC). Functional testing included a stool microbiology, an indican test and a food allergy panel. While the CBC was normal, the lipid profile showed a depressed cholesterol of 103 and an elevated triglyceride level of 400. The fasting blood glucose level from the blood chemistry was at 108 indicating glucose-regulating issues.
The patient's delight at having a cholesterol of 103 was dampened by my pointing out that cholesterol is a normal constituent produced by the liver and that while elevated levels posed a risk, depressed levels were not necessarily consistent with good health. I explained that triglycerides were fats in the blood, which surprised the patient as she "only ate fat-free foods". I explained that triglyceride levels were affected by many factors, including emotions, refined carbohydrates and caffeine and that fats of the right type were essential to good health.
In light of the elevated fasting blood sugar level a six-hour glucose tolerance test was done as a follow-up. During the fourth hour of the test, the patient's blood sugar fell to 38, while simultaneously the patient felt a dramatic increase in her muscular pains and discomfort and felt very fatigued. By the fifth hour of the test, the blood sugar was still low at 58. Subsequent testing of the HgA1C level, a marker of the body's ability to control the blood sugar, showed it to be elevated.
The bowel flora tested abnormal, the indican test (for bowel toxicity) was elevated and a number of food sensitivities were present.
After reviewing the results of the tests and reviewing the patient's lifestyle with her the following actions were taken:
1. All refined carbohydrates, including the sports bars and fat-free foods her dietitian had advised to "lose weight" were eliminated. These were replaced by fresh vegetables, raw nuts, modest amounts of fish, brown rice and millet. A moderate amount of fresh fruit was also allowed. She was to eat slowly and to chew her food well. Allergens she tested sensitive to were eliminated.
2. Bed time was set at 10 p.m., with no television to precede or accompany it.
3. Coffee was eliminated. The patient was instructed to drink water.
4. A program of light swimming was implemented.
5. I advised the patient not to focus on her symptoms and to get busy with activities that she enjoyed doing.
6. We discussed the possibility of having hormonal testing performed if the patient's overall health did not improve over the next 60-90 days. This turned out to be unnecessary in her case as improvement occurred prior to this time.
7. Periodic office visits included dietary reviews, stress reduction, counseling and gentle massage and trigger point therapy.
8) A program to regain normal flora/intestinal balance was initiated including a short liquid diet and appropriate flora replacement.
9) We discussed her marital situation and the need to resolve the disharmonious situation through appropriate counseling.
During the first 10 days, the patient felt worse as withdrawal from the caffeine and junk food took place, but by the second week a significant improvement occurred. By the end of the sixth week, her pains had diminished by 80 percent and she had become more receptive to communicating and being physical with her husband. As she felt better she was better able to relate to her husband and became emotionally warmer which he responded to favorably. Further counseling was not required.
She has become a swimming devotee and lost 20 pounds without any special "fat-free foods" or special reducing plans. She sleeps soundly, has noted much improved digestion by the altering of her diet and by changing her habits. She describes her mood as being much more upbeat. Her menstrual discomforts have lessened.
The patient recovered her health, not by "treating" her fibromyalgia, but by a comprehensive health program directed at her specific health picture. After several months of monitoring, the patient was dismissed from care with the knowledge and tools necessary to maintain herself in a good state of health for the present and to prevent health problems in the future.
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Each patient is different and therefore the program for each patient must differ as well. Once, however, the causes of ill health/fibromyalgia are identified and addressed, the symptoms of Fibromyalgia can be ended and good health can be restored.