Many patients have also found a technique called myofascial release to be effective. If you decide to see a physical therapist, make sure that you pick someone who is both knowledgeable and gentle. It’s a good sign if they know the spray-and-stretch technique of Dr. Travell discussed earlier. I have seen too many patients made worse by physical therapists who were too rough. With fibromyalgia, gentleness is often much more effective than roughness.
Acupuncture is another type of treatment that can be helpful. Because it approaches health and illness from a different perspective than traditional medicine does, it can often be effective for illnesses that resist traditional measures. Many practitioners combine acupuncture with herbal and homeopathic remedies to make their treatments even more effective.
Chiropractic also can be helpful in releasing the muscles. Unfortunately, however, if you don’t treat the perpetuating factors that caused the muscles to shorten in the first place, they’ll go right back to being shortened a few days after the treatment. That’s why so many excellent chiropractors add nutritional, hormonal, antifungal, and other natural treatments to their practices. A special form of chiropractic, called Atlas chiropractic, focuses on the atlas vertebrae in your neck. This may be especially helpful if you have overactive knee reflexes or if your symptoms get worse when you turn your head upward to look at the ceiling for twenty seconds (if you have these symptoms, also read about cervical stenosis and the Chiari I Malformation in Chapter 9).
Additionally, yoga and many other forms of body and energy work have been very helpful for our patients. Try several and see which feels best to you. Many patients find that bodywork also releases suppressed feelings and memories from their muscles. Experience, feel, and embrace these. Your awareness, experience, and release of these feelings are important parts of the healing process.
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Trigger Points and Myofascial Pain in Fibromyalgia
Because trigger points and their role in pain management are poorly understood, I have asked the preeminent pain specialist Dr. Hal Blatman to discuss these. Dr. Blatman is president of the American Holistic Medical Association, director of the Blatman Pain Clinic in Cincinnati, and author of Winners’ guide to pain relief (available online at www.winoverpain.com). His book contains many examples showing where to look for the cause of each specific area of pain you are having, and local treatments that may be helpful in reducing the pain pattern.
Structural Aspects of Pain Treatment
Medical students learn theories about what causes pain and then go on to practice medicine and treat and teach their patients. Unfortunately, most people do not know that what doctors are taught about the mechanisms of pain are just theories. While these theories may work and be helpful, they do not deserve their automatic credibility and often lead people to unnecessary surgeries and medications.
The first theory of pain concerns inflammation and includes words like “arthritis,” “tendonitis,” and “bursitis.” Indeed, when we go to the doctor complaining of pain in a joint, we often expect to be told we have a “touch of arthritis.” Additionally, we sometimes like to speak to the doctor like we know something about our condition. This often leads us to say we have inflammation instead of pain, because as consumers we are taught to assume that pain must come from inflammation. The truth is that unless the body part is red and swollen, it may be more accurate to simply complain of pain.
The focus in medical training on inflammation and arthritis leads doctors to believe that if they can show an abnormality on an X-ray that is close to the location of the pain, then they can attribute the pain to the abnormality noted on the X-ray. Except for fractures, this is generally a mistake and requires a leap of faith that physicians have no right to make. The more I see and learn, the more I am convinced that pain mostly comes from muscles and not from arthritic changes in joints, which may have more to do with restricting motion than causing pain. As a resident in orthopedic surgery, I saw patients with bone-on-bone hip X-rays who had very limited hip motion yet no hip pain.
Another theory of pain that doctors are taught involves depression, and this is true—just not in the way most doctors think. Doctors are presented, for example, with a case study of a middle-aged woman who has “hurt” for a few years. What’s the diagnosis for this vague chronic pain? Depression. However, in this instance it is most likely that the cause and effect—depression to pain—is backward. Pain physiologically causes depression, as the mood and depression center in the brain is bombarded with pain darts from the muscles. When the level of pain is high enough, it will cause depression no matter what else is going on in life. The part of the muscle that sends this pain dart is the myofascial trigger point, and this is a common cause of pain in fibromyalgia patients.
Doctors are also taught about neuropathic pain, the pain that comes from nerves. It was originally thought that nerves had to be cut or otherwise injured to cause this kind of pain. Doctors are only starting to make the connection among neuropathic pain, myofascial pain, and fibromyalgia. The referral pain pattern from myofascial trigger points is sometimes diagnosed as neuropathic pain. Most drug therapy for this condition is based on using seizure medications, and many times these are helpful.
Another pain theory that doctors are taught is that pain radiating from the neck down the arm, or from the lower back down the leg, must come from a disc in the neck or lower back that is pushing on a nerve. However, so-called sciatica, for example, is more often caused by trigger points in the buttock muscles than by a slipped disc or pinched nerve. A stiff neck is caused more often by trigger points in the neck and upper shoulder/back muscles than a pinched nerve in the neck. But doctors know how to look for the slipped or compressed disc, and unfortunately for many people, they also know how to fix it. For every person helped by spine surgery, there are more who are just as miserable afterward.
The most unfortunate theory doctors are taught is the supratentorial theory of pain. It basically states that if all tests are normal and you still think you hurt, you must be making it up. Doctors should never assume that something is not real just because it cannot be proven with the results of a test. There are so many potential causes of pain that there is no way current diagnostic testing can reveal everything. The shameful part of this theory is that many patients are told that their pain is in their head. Their families don’t take them seriously, and they even start to doubt themselves.
During my years of practicing medicine, I have come to understand that these theories are incomplete and don’t help us diagnose or treat pain as well as we would hope. Many times these theories allow insurance companies to justify denying claims, and cause patients and their families untold grief and doubt about the reality of a loved one’s symptoms. When most people with fibromyalgia go to the doctor, the actual cause of their suffering doesn’t match anything their doctor has been taught. This means that even well-meaning doctors are usually unable to help their FMS patients beyond prescribing a few medications for depression and sleep.
The diagnosis of fibromyalgia can be tricky. Patients and physicians are taught to use “tender points” as a significant examination finding. It is assumed that the number of tender points can be used to determine the diagnosis of FMS and response to treatment. Unfortunately, tender points are highly overrated and not very important; they are simply specific places on the body that medical doctors have agreed cause pain when pressed. They have meaning in research, and little meaning in medical practice. What are much more important are the causes, diagnosis, pain referral patterns, and treatment of myofascial pain. Unfortunately, physicians are not taught much about myofascial pain in medical school or in training programs.
In my experience, at least 60 to 70 percent of fibromyalgia pain is caused by trigger points in muscle. These trigger points are small knots that form in the muscles as a tissue response to injury. The injury can be a strain, bruise, or cut. The knots create taut or ropy bands of muscle. They restrict motion, cause spasms, and g
enerate a tremendous amount of pain. Sometimes this pain feels like a sharp hot poker, and other times like burning, numbness, tingling, and aching. There can even be more than one sensation at the same time. What is more significant than the trigger point itself is that every trigger point causes pain in, or refers pain to, some other place in the body. Trigger points in the upper shoulders and back of the neck, for example, cause headache from the back of the head to the forehead and sinuses. Lower back pain and sciatica pain down the leg are caused by trigger points in the buttocks.
No one with FMS has only one trigger point. In general, most of the overall body pain is caused by referred pain from the entire “orchestra” of trigger points, all playing at the same time. The reality is that how you feel depends on how loudly the orchestra of trigger points is playing, and which solo artist or ensemble just stood up to play. This is determined by how you have used your body in the past three days (which muscles you overused), what the weather is going to do tomorrow, how you slept last night, and what you have eaten in the past few months.
Fortunately, there is a lot that you can do to help reduce myofascial pain, which comes from these trigger points. There are some fundamental dietary considerations that I have found to be universally true in my patients. Foods that always increase pain and inflammation include soda, sugar, wheat, white potatoes, and fruit juice. Aspartame and partially hydrogenated oil are ingredients to be totally avoided. If you are treating your FMS and do not see favorable results, these foods and chemicals can be to blame. In some cases, one soft drink (or even a glass of OJ) per day can insure that your body will not be able to heal. If you proceed to make these changes in your lifestyle, cutting out sugar and wheat should be done gradually over a couple of months. Otherwise, you may go through an unpleasant withdrawal period.
Dealing with the trigger points themselves is fairly straightforward. The more “active” the trigger point, the more pain it causes locally and the more pain it refers. There are several techniques that will make trigger points less active. These techniques include:
Acupressure (pushing on the trigger point)
Myofascial release (bodywork that stretches the muscles)
Stretching
Application of medication through the skin over the trigger point
Trigger point acupuncture
Chiropractic adjustment
Injection of trigger points with lidocaine
In my experience, the quickest and most effective treatment to inactivate trigger points is a trigger point injection with lidocaine (Novocain). There is no added benefit in most people to injecting cortisone. Novocain is generally helpful, but dry needling and acupuncture also work.
The most important technique for people at home and at work is to push on the trigger points. This is called acupressure, and it makes trigger points smaller. Be careful when you push on these tender knots in your muscles, and only cause a level of discomfort that you can relax with. This is called a “good” hurt. After pushing on the trigger points, they will be less active, and the muscles will then be a little softer. At this time, the muscles are more ready to be stretched.
Slowly and gently stretching the muscles will help keep them from tightening back up. Working on yourself in this way for a few minutes several times each day will give you more control over the pain that runs your life.
Additionally, everyone with fibromyalgia should try a ten-to fifteen-minute detoxification bath using a cup each of sea salt and baking soda. Rinse off afterward. This will be helpful when your skin hurts, when you are miserable, and when changing your diet leaves you feeling more achy.
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In the thousands of pain patients I have treated over the years, there are less than a dozen whom I’ve not been able to help get adequate pain relief. Unfortunately, most physicians are simply not taught how to treat pain effectively. The good news is that there is a new specialty called physiatry, which specializes in pain management, and many other practitioners have also taken special training to learn how to effectively treat you. I recommend going to a member of the American Academy of Pain Management (www.aapainmanage.org) to find a pain specialist. In addition, physicians at the Fibromyalgia & Fatigue Centers nationally (see Chapter 12 and www.fibroandfatigue.com) are specially trained in treating fibromyalgia pain.
Important Points
Most CFS/FMS pain can be eliminated.
Getting eight hours of solid sleep a night, and treating low thyroid function, nutritional deficiencies, and underlying infections (especially yeast) often eliminate the root causes of the pain.
The Revitalizing Sleep Formula herbal is an excellent muscle relaxant, and the End Pain natural herbal formula is good for relieving many kinds of pain. I would use the two together, or develop a similar herbal plan, allowing six weeks to see the full effect.
Try natural and prescription treatments individually and/or in combination, as needed. Dozens of effective ones are available. For more detailed information, see my book Pain Free 1–2–3 and/or the From Fatigued to Fantastic! notes at www.vitality101.com.
Ultram, Skelaxin, Neurontin, and Lyrica are excellent pain medications for CFS/FMS. Avoid Tylenol and Advil family medications.
If you have severe or persistent localized pains, get the book Winners’ Guide to Pain Relief (available online at www.winoverpain.com) to learn about structural treatments you can do on your own for pain relief.
I recommend going to a member of the American Academy of Pain Management (www.aapainmanage.org) to find a pain specialist. In addition, the guidelines in Chapter 12 will help you find a physician near you or at the Fibromyalgia & Fatigue Centers nationally who is specially trained in treating fibromyalgia pain.
Questionnaire
1. Do you have widespread FMS pain?
If yes, check off #12, 64, 65, 70, and 75.
2. Do you have a few localized areas of pain that are especially problematic? If yes, check off #71 and 72.
3. Do you have severe vaginal or bladder pain? Read the sections on vulvodynia and interstitial cystitis in my Pain Free 1–2–3, and check off #17, 22, and 83.
4. For other pains such as back pain, carpal tunnel syndrome, migraines, arthritis, nerve pain, and indigestion, see my book Pain Free 1–2–3 and/or the Pain Free 1–2–3 notes at www.vitality101.com and check off the recommended treatments and #83.
8
More Natural Remedies
After the highly technical information in earlier chapters, I think you’ll be happy to join me in exploring more simplified, down-to-earth natural remedies. These treatments are often dramatically helpful for CFS/FMS.
It pleases me that there has been an increase in the use and acceptance of herbal remedies. This renaissance has been especially true in Europe and Asia, where the explosion of interest in herbal remedies has been associated with a major increase in scientific research. In Europe, the German government’s Federal Health Agency has created the Commission E, an independent group that evaluates the safety and effectiveness of various herbal therapies. It has published a series of more than four hundred articles that help physicians make informed decisions on how to use these tools (available from the American Botanical Council; see Appendix E: Resources). As a result, Germany uses more than three times as many herbal remedies as the United States does. Hopefully, this country will eventually catch up with both Europe and Asia. While the German government actually promotes education and awareness for its physicians, the U. S. Food and Drug Administration (FDA) has prohibited manufacturers from making any therapeutic claims for herbal remedies or even directly supplying the scientific data supporting the use of herbal remedies or information on their proper use with the products unless the company pays the more than $400 million dollars it takes to go through the FDA process. Unfortunately, this is not financially feasible for a product that is not patentable.
Because the quality control of herbals is quite variable, a movement is under way to standardize herbal preparations b
y making sure that they have a specific amount of the active agent. So if the label says standardized, you have a better chance that the herbal will be effective. If it has the complex wording I use in discussing that herbal product—for example, 24 percent glycosides—better yet. Except for looking to see if these complex words are on the label of the herbal remedy, feel free to ignore the few complex names in this chapter.
Let’s review the use of herbal remedies to treat some problems often seen in CFS/FMS.
For Anxiety
Given the severity of the illness and the difficulty finding a physician familiar with CFS/FMS, anxiety is often a common problem in these syndromes. In addition, many of the metabolic problems (such as hypoglycemia from an underactive adrenal or chronic pain) that accompany CFS/FMS can also accentuate anxiety.
From Fatigued to Fantastic! Page 26