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Sunday, June 10, 2012
Fibromyalgia (FM) - A new understanding
The following illustrates how research can dramatically improve outcomes for individuals suffering complex pain disorders.
Not long ago Fibromyalgia was thought to be an inflammatory condition of the muscles. Individuals hurt pretty much all over. They would also commonly have other conditions such as headache, gut disturbance and odd limb sensations and they would be prone to depression and anxiety.
These people were often labelled hypochondriacs and Dr shoppers and unfortunately the frustration and sense of helplessness often magnified the problem.
Now FM is classified as a genetically linked condition involving abnormalities in the dopamine pathways of the brain, resulting in widespread allodynia and multiple sensitivities.
Allodynia is a pain due to a stimulus which does not normally provoke pain so FM is actually a 'pain processing problem'
According to one FM website it still takes an average of 5 years for this collection of apparently unrelated symptoms (co-morbidities) to be recognised as manifestations of the single disorder.
What can a chiropractor offer? There is a body of information regarding FM which should determine treatment choices irrespective of which profession the individual consults.
Officially there is actually a paucity of literature for the support of chiropractic care in the management of this condition. According to Schneider et al "Strong evidence supports aerobic exercise and cognitive behavioral therapy. Moderate evidence supports massage, muscle strength training, acupuncture, and spa therapy (balneotherapy). Limited evidence supports spinal manipulation, movement/body awareness, vitamins, herbs, and dietary modification." (courtesy of CDI).
Perhaps the main role of physically based modalities in the co-managment of FM is to reintroduce normal movement in a non painful way. Traditional spinal and joint manipulation is generally not tolerated well in these cases and usually leads to aggravation. Gentle joint and muscle movements, often in areas of the body not badly affected are followed by more robust manouvers as tolerance increases.
Education and reassurance are vital while the individual gradually increases exercise and attends to any psychological issues which may exist.
What we have to offer is only part of a much broader approach and communication with the medical practitioner and other providers is essential to form a tailored, coherent and effective approach which gives the individual the tools to understand and effectively self manage their problem.
It's perhaps useful to consider that the brain is just one organ of the body and while it may malfunction we do possess the ability to control it's reactions. Our responses to pain (technically nociception) is a function of many processes we cannot directly control however pain 'levels' are strongly determined by learnt responses. In essence our minds experiences.
Ultimately we are in the drivers seat where the brain is concerned.