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Fibromyalgia, Myofascial Pain

We could discuss that the air of the medical world today is filled with, among other things, dissension regarding the diagnosis of fibromyalgia (FMS). Does such a disease entity really exist? Are we seeing a physical problem complicated by depression, or simply the physical manifestations of depression? A significant portion of the medical community does not acknowledge FMS as a legitimate disease entity. So I thought this might be an appropriate moment to revisit this topic and to address some issues.

The respected American College of Rheumatology has put forth criteria for the diagnosis, including the major criteria which must be present for the diagnosis to be confirmed: widespread pain, in all four quadrants of the body, lower and upper extremities. The pain must be of at least 3 months duration. Almost all FMS people have sleep disturbance characterized by alpha wave intrusion in delta sleep. Consequently, they awaken unrefreshed, stiff, and in pain. They usually complain of severe mid-day fatigue, often of headaches, jaw pain, gastrointestinal disturbance such as irritable bowel syndrome, cognitive dysfunction, etc. On physical examination, diagnosis is confirmed by finding 11 of 18 paired "tender points" at specific locations on the body. (See diagram). These people often feel depressed and frightened, not understanding their condition. Why should they be so sick? Is there something really serious going on?

This is precisely where some of the most important problems and conflicts lie. There are no laboratory or blood tests to tell us "Yes, you have FMS" or "No, you don't have FMS" OK, so you're sick; your doc says you have FMS; you accept this and know there is no cure. You depend on supportive measures: massage, acupuncture, medications, both over the counter and prescription- and thus you are now a captive of the System. You are dependent on health care givers indefinitely. Have you been helped by this diagnosis? Does the knowledge lead to improvement in the quality of your life? Not at all. Conventional medical wisdom says you'll schlepp this baggage around for the rest of your life.

But is that all necessarily true? What if FMS is a limited condition or not even a discrete entity in itself? What if the disabling signs and symptoms are controllable and alterable to the point at which life becomes livable again? We don't know what causes fibromyalgia (if we acknowledge that it does exist -and I happen to be one of the believers.), but frequently in our practice we note concurrence of FMS, myofascial pain syndromes and dysfunctional postural mechanics charcterized by anterior weight bearing, abdominal, and gluteal weakness and psoas major tightness. If this relationship is valid, then maybe we can do something positive and constructive about FMS.

In past issues of this newsletter we have discussed postural changes associated with psoas dysfunction/insufficiency: swayed lower back due to tight hip flexors, weak abdominal and gluteal muscles and lax ligaments connecting the spine to the pelvis. Furthermore we know that this dysfunctional alignment generates tightness of the pelvic muscles and those of the upper back and neck in an effort to compensate for the resultant postural imbalances.

What's the connection? Well, people with fibromyalgia have widespread, chronic pain involving the upper and lower back and often both upper and lower extremities. People with postural back pain exhibit a similar distribution. Both groups frequently suffer from headaches, stiff necks, temperomandibular joint dysfunction. Both suffer disturbed sleep and feel stiff upon awakening. Characteristic of psoas dysfunction/insufficiency is the development of myofascial pain syndromes (see previous newsletters and my website) with associated trigger points. Certainly it is well within the realm of possibility that dysfunctional postural mechanics as described above can predispose to the development of and/or perpetuation of the fibromyalgia syndrome, as well. If that is true, then modification or elimination of the perpetuating factors should facilitate improvement. To that end, the program at CSOM is directed. This includes osteopathic manipulative therapy, neuromuscular retraining, postural modification, trunk stabilization, strength and flexibility training (in some cases, Pilates) trigger point and tender spot injections and needling, correction of foot mechanics with orthotics as indicated. These measures should give FMS patients what they need most: a modicum of control over their condition, liberating them from dependence on questionably effective and often expensive therapies, medications, nutritional products, etc. There's more to come.

All of these treatment modalities are available at the
Center for Sports & Osteopathic Medicine

The information contained in this website is for educational and informational purposes only and should not be regarded or interpreted as anything else. Diagnosis and treatment of disease, injury, pain or disability is the province of your health professional who should be consulted in regard to any medical symptoms or conditions before adopting any course suggested in this website. By proceeding to the table of contents page, you agree to accept the provisions of this disclaimer.

Copyright © 1996-2006 Dr. Richard M. Bachrach
317 Madison Avenue, NY 10017 - 212-685-8113

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