Monday, November 14, 2011

"Fibromyalgia – fibromywhat?" Part 1 written by our Guest Physiotherapist Mr Adam Atherton Springfield Ipswich

I will never forget the first time I treated my first patient with “fibromyalgia”. Only Three months into my career in private practice and nothing from my undergraduate degree or university days had prepared me for this stressed out, middle-aged, mother of four trying to run a business and the local sporting club sitting before me begging to be cured her of her all over body aches, especially chronic back and neck pain, headaches and fatigue.    

I had successfully treated these individual conditions before and even in those first few months had saved some of my patients an expensive and risky back and neck surgeries because of significant improvements in function and reduction in pain.  So this lady was going to be a “cinch”, just roll all those previously successful interventions into one and…”voila!  How wrong I was.  My youthful zeal was almost exhausted as she came week after week with symptoms not just in plateau but flaring up after every treatment! (Clinically called “irritability”).  

Thankfully this lady trusted me enough to go on a journey and we ended up arriving at a great balance of combined modalities and physical “hands-on” treatments including therapeutic exercise, gentle joint and muscle manipulation, neurodynamic exercises and CBT principles like pacing to name just a few.  So thanks to this trusting and very patient patient (and others like her), now eight years on I can say my understanding of fibromyalgia has grown immensely but also that of the wider medical community to incorporate the latest pain science, neuroscience research, musculoskeletal evidence based practice and of course biopsychosocial factors.  Now we can combine all this great knowledge and put it to use in the clinic with the latest neuro-orthopaedic physiotherapy techniques and lots of encouragement to keep moving! 

Fibromyalgia appears to be a condition on the rise.  It seems as the years go by, increasing numbers of patients present to my clinic with this condition or at least the label.   I have also “flagged” more than a few first timers who thought they were just depressed or “getting old and achy” and even “going crazy” – some of these things may have also been true but were not the reason for their clinical presentation!

In my experience it is often these exact patients that have had the sad experience of being told “it is all in their head” and because this is seen as a sole cause of their symptoms they were promptly told they will “just have to live with it”.  Ironically, both sentiments are partly true in that latest pain science recognises pain as an output of the brain (not an input from the periphery only) so in a way “it is all in their head” but not in the way that the patients read this as i.e. “I am being told that I am making this up?!  Also in a way they do “have to live with it” but not in the way this statement implies i.e. nothing can help them.  If you are reading this and you have fibromyalgia both these statements are wrong and are often a roadblock to a great health outcome. 

So what exactly is fibromyalgia? 

Most patients have no idea what it is exactly or what it means for them in everyday life.  Interestingly, they rarely present for treatment directly for their “fibromyalgia” but more often than not have pain in one or more joints or parts of the body and have plenty of active myofascial trigger points, abnormal pain processing features with widespread global neural hypersensitivity (often linked to connective tissue dysfunction).  These patients almost always display impaired neurodynamic tension and easy fatigue of muscles, likely due to chronic retention of toxins and stress hormones (like cortisol).

Key Features
  • The term fibromyalgia was coined by researcher Mohammed Yunus as a synonym for fibrositis and was first used in a scientific publication in 1981. Fibromyalgia is from the Latin “fibro” (fibre) and the Greek words myo (muscle) and algos” (pain).  
  • Fibromyalgia has gone by many names over the years, including “muscular rheumatism”, fibrositis”, “psychogenic rheumatism”, and “neurasthenia” were applied historically to symptoms resembling those of fibromyalgia. 
  • Fibromyalgia is seen in about 2% of the general population and affects more females than males, with a ratio of 9:1 by ACR criteria It is most commonly diagnosed in individuals between the ages of 20 and 50, though onset can occur in childhood. 
  • A clinical diagnosis is made when a patient has widespread pain in all four quadrants of the body for a minimum of three months and displays at least 11 of the 18 specified and classic tender points for fibromyalgia. 

In Part 2, I will outline some of the key controversies that surround Fibromyalgia and detail the simplest and best strategies to help you successfully manage this condition and enjoy optimal health. 

In the meantime, if you have fibromyalgia, my first piece of advice is to start today to improve your tissue health and decrease the sensitivity in your body by removal of toxins and improving mobility of the nervous system – how do you achieve this you ask?  EXERCISE!! Yes, get that body moving! 

Try this: Walk daily for 30 mins and drink at least 1 litre of water for 25kg of body weight/day.  Do this for 3 weeks straight and enjoy some early results!  Otherwise consult your local Physiotherapist and GP for some more information and to get an accurate diagnosis and treatment plan.  

Adam G Atherton 
B.PHTY (Hons)  
Director of Orion Family Physiotherapy 
Principal Physiotherapist MAPA MSPA MMPA 
If you don’t have time for good health you won’t have health for a good time”