Lady Gaga has been on the news recently promoting awareness of fibromyalgia.
Fibromyalgia (FM) (Myalgia meaning pain in muscles) is a chronic condition that affects up to 8% of the population. It is a disorder which is more common in females and its prevalence increases with age. Symptoms of the condition can be described as widespread musculoskeletal pain (usually effecting; the neck, buttocks, shoulders, arms and upper back) and aching which intensifies under human touch and can cause muscle spasms. Additionally, there is the presence of multiple “tender points”, disturbed sleep and fatigue as well joint stiffness in the morning which can last for over an hour.
Today, the cause of fibromyalgia is still somewhat an unsolved mystery. However, it is considered to have multifactorial roots, stemming from anxiety, physical or mental trauma and sleep disturbance. Although it is considered a rheumatic condition, it does not originate from an inflammatory response and may be related to chemical changes in the way the body transmits its pain signals.
York Clinic’s osteopath Niall Walsh writes that, “Fibromyalgia interests me as it is difficult to diagnose, varies in severity and sometimes follows peculiar symptom patterns. It can also debilitate and considerably lower a person’s quality of life. It is a diagnosis which is becoming increasingly frequent in patients presenting to osteopathic practices, yet still extremely misunderstood and underestimated.”
Depression & stress
One of its peculiar characteristics, is that 70% of patients diagnosed with fibromyalgia, also suffer from depression. Referring to the osteopathic principle “structure governs function” or “function governs structure”, it is unclear whether depression triggers a response which leads to symptoms of fibromyalgia or whether fibromyalgia leads to symptoms associated with depression. An example would be; someone suffering with pain due to fibromyalgia may become predisposed to the negative emotions of depression due to the constant battle against pain. Alternatively, depression may heighten the bodies sensitivity to pain.
It’s also possible that there is a stress related link. This concept is becoming ever more plausible, as patients diagnosed with FM also commonly suffer from abdominal pathologies such as irritable bowel syndrome, chronic fatigue syndrome and multiple chemical sensitivity. Some of which are common even in non-sufferers during high periods of stress. Changes in the hypothalamic pituitary axis, a key component of the stress adaptation response have also been detected in patients with fibromyalgia. This disturbance leads to increased stress induced symptoms e.g. IBS, anxiety etc.
In my experience of treating patients with fibromyalgia, patients are often able to touch the painful area themselves with sufficient pressure, whereas they feel the pain more when someone else touches the area, even if the pressure is less. Sometimes to a point where they will scream out or attempt to avoid being touched. This points further to a psychological link between anxiety and pain.
Osteopaths take a detailed case history and are encouraged to discuss the topic of stress with their patients. Specifically, those they feel may benefit from finding a coping strategy, or lifestyle modification. Although stress is a complicated subject itself, certain measures can be taken to help relieve the burdens of life. Simple things such as exercise, meditation, taking part in activities you enjoy (going out with friends, or fishing), talking to someone about your stress and making sure you express yourself to your employer if you feel your workload is becoming too much, can really make a difference.
The mechanism behind the pain experienced with fibromyalgia is not typical of the pain mechanism of other conditions, as no structural change or injury need occur for pain to be felt e.g. no fracture, disc dysfunction of muscular strain. Changes in the pain processing mechanisms may result in pain becoming a chronic phenomenon. Central sensitisation, diminishing of the inhibitory pain pathways and the alteration in neurotransmitters, can all cause a lowering effect on the threshold of pain and amplification of normal sensory signals. This means that every day stimuli, such as being patted on the back or putting on clothes, results in the brain feeling pain around the location of contact.
A study published in the Journal of the American Osteopathic Association (JAOA) investigating osteopathic treatment in conjunction with medication for FM patients, used a pain threshold test, participant pain rating scale and self-evaluation questionnaire as outcome measures to distinguish whether medication combined with osteopathy held more efficacy over medication alone for lowering pain in fibromyalgia patients. Results found that those who used both medication and osteopathic techniques combined, gained more relief from pain than those on medication alone.
Management of Fibromyalgia
A journal article “Fibromyalgia—Management of a misunderstood disorder” states that the patients understanding of the condition is crucial in overcoming it and controlling the pain. Osteopaths are trained in the skill of differential diagnosis and are experts at spotting and testing for the signs and symptoms of conditions such as fibromyalgia syndrome. You can use an osteopath to gain information and clarification if you suspect or have previously been diagnosed as having FM. Osteopathic treatment and advise will offer relief and management skills as well as someone to talk to and question.
Things to do if you’re suffering from fibromyalgia or know someone who is:
- Attempt to reduce or manage the stresses in your life, one at a time.
- Use calming strategies such as yoga, meditation or Pilates.
- Get some form of physical activity (weight training, cardio or a non-contact sport like swimming)
- See an osteopath for treatment and advise.
- Discuss with your GP whether you should take medication or not.
- Talk to other sufferers or think about counselling or hypnotherapy to help accept and control the pain
To book an appointment with Niall, please contact the York Clinic on 01904 709688. Reception is open from 9am to 6pm on weekdays, and from 9am to 2pm on Saturdays. Alternatively, email us at firstname.lastname@example.org or use our contact form. We will respond to you as quickly as possible.
Gamber, R., Shores, J., Russo, D., Jiminez, C. and Rubin, B. (2002). Osteopathic manipulative treatment in conjunction with medication relieves pain associated with fibromyalgia syndrome: results of a randomized clinical pilot project. The Journal of the American Osteopathic Association, 102, pp.321-325.
Hare, B. and Okifuji, A. (2013). Management of Fibromyalgia Syndrome: Review of Evidence. Pain and Therapy, 2(2), pp.87-104.
Jahan, F., Nanji, K., Qidwai, W. and Qasim, R. (2012). Fibromyalgia Syndrome: An Overview of Pathophysiology, Diagnosis and Management. OMAN Medical Journal, 27(3), p.192.
Patterson, E. (2007). Fibromyalgia—Management of a misunderstood disorder. Journal of the American Association of Nure Practitioners, 19(7), pp.341-348.