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HEALTH TOPICS Fibromyalgia

Other Findings

Other endocrinologic and neurologic findings in patients with fibromyalgia include:

·      Brain substance P levels (a neurotransmitter associated with enhanced pain perception) increase to three times normal.

·      There is low overall cortisol. This differs from depression, where a higher-than-normal cortisol level is found.

·       Symptoms are induced during tilt table testing with drops in blood pressure.

How would I know I have fibromyalgia?

You always hurt in many places but tests come back normal.  No laboratory or radiology tests can prove you have fibromyalgia. The diagnosis is likely when the symptoms you have fit the right pattern, but no other problems are found. When your doctor examines you, you'll have many "tender points" where your skin hurts even if you barely touch it. Common tender points are at the front of the knees and elbows, the hip joints and around the neck. Making the diagnosis of fibromyalgia depends on the history and physical examination rather than on diagnostic testing.

In 1990, the American College of Rheumatology (ACR) established criteria for classifying patients with fibromyalgia. Failure to meet these criteria does not absolutely exclude the possibility of fibromyalgia.

As with other rheumatologic disorders, fibromyalgia:

·      Is established on the basis of clinical observations.

·      Is a condition with signs and symptoms that exist across a spectrum – not having all of them doesn’t mean you don’t have the condition.

·      Often requires observation over time to firmly establish the diagnosis.

Pain in many locations is the main characteristic. Although not all areas may be involved simultaneously, pain may occur in the back of the head, neck, shoulders, over and along the upper and lumbar spine, buttocks, hips, elbows and knees. There may be one main area of pain but careful questioning will uncover additional areas of pain. It is not unusual for the most significant area of pain to shift over time.

Physical examination will show tender areas without obvious signs of redness, swelling and heat in the joints and soft tissue. Although tender points are found in many different locations, the ACR has selected 18 sites that are more characteristic for fibromyalgia (Figure 1). To be certain that fibromyalgia is the real problem you must have tenderness on pressing on 11 of the 18 sites and a history as defined in Table 1, although patients with fewer than 11 tender sites still may have fibromyalgia. The number of tender points may change over time.

Skill in finding tender points is critical to establishing a diagnosis of fibromyalgia. Physical changes of the soft tissues include tender points, changes in skin texture, increased resting muscle tension and changes in the texture of the subcutaneous tissue.

FIGURE 1. Locations of standardized tender points of fibromyalgia. Criteria for classification of fibromyalgia: pain on palpation with a 4-kg force (Pain at 11 of 18 sites is necessary to meet the criteria.).

Other possible conditions that can look like fibromyalgia

The diagnosis may be made based on the ACR criteria or on the presence of the characteristic syndrome, or both. A minimum of tests need to be done when somone looks obvious. The thyroid-stimulating hormone level should be checked routinely because hypothyroidism can mimic the symptoms of fibromyalgia. Other diagnoses to consider include drug-induced muscle problems (especially those from statin class of cholesterol-lowering drugs), polymyalgia rheumatica and other rheumatologic syndromes.

Myofascial pain syndrome may be confused with fibromyalgia and may be seen in patients with fibromyalgia. Myofascial pain syndrome is also mostly diagnosed clinically. While the pain of fibromyalgia is widespread with changing areas of emphasis, myofascial pain arises from trigger points in individual muscles. The pain pattern is limited to a particular region over time. Fatigue is less likley to be as great.

Myofascial pain syndrome is based on having trigger points vs tender points. Trigger points and tender points are often in similar locations. Trigger points are found in taut bands of muscle, whereas tender points are not. Pressing on trigger points often reproduces the pain radiation pattern and can cause a twitch in the muscle. The pain from pressing on a tender point is local to the area under palpation and does not elicit a jump or twitch. Also, trigger points often have a lumpy or dough-like texture similar to a pencil eraser, whereas tender points are no different from surrounding tissue.

Conditions

Patients with fibromyalgia often have one or more related conditions:

·      Migraine headache

·      Chronic fatigue

·      Irritable bowel syndrome

·      Depression

·      Restless legs syndrome

·      Temporomandibular joint syndrome

·      Myofascial pain syndrome  

The basic actions of magnetic fields that can help fibromyalgia:

·      reducing muscle tension

·      improving circulation

·      reducing pain

·      stimulating the immune system

·      improving cell function

·      helping the body to detoxify

·      improving the uptake of nutrients

·      helping nerve function

·      helping liver function

·      balancing the acupuncture meridians

·      improving sleep

·      reducing stress

·      balancing the endocrine system

·      reducing trigger point tenderness  

Taken together all these actions of magnetic fields help the body stay well and rebalance problems before they will ever become noticeable by you at the cellular level, the physiologic level and the emotional level.

Balancing actions of magnetic fields

All these effects of magnetic fields happen at the same time. The ones that get turned on depend on what the body needs at the time. They are not specifically “tunable.”  That means you can’t decide which ones will be activated at any given time. They are all potentially active all the time. If the body is healthy and balanced for any given action, it will not be turned on. That means you won’t notice that particular effect. The body will decide what it needs. This is the beauty of magnetic therapies – they will work with the body’s own systems. In this respect they act like acupuncture therapy. They only act to stimulate the body’s own systems. They will not create actions the body isn’t capable of.

Actions depend on field characteristics

What will determine what actions happen in the body is dependant on the characteristics of the magnetic system used. These include:

·      the types of frequencies,

·      the strength/s of the field,

·      size of the magnetic field,

·      the time it is for and

·      how often it is used for.

For fibromyalgia the best effects would happen with:

·      whole body exposures,

·      daily use and

·      low intensity ELFs

·      cranial electrical stimulation (Liss Machine)

Small area ELF devices, that you may already own, can help the overall body as well, from the treatment of any local problem. But, this whole body reflex action is incidental and not as effective for fibromyalgia as whole body treatment.

Static Magnets

Static magnetic mattresses are helpful but whole body pulsed fields are better. Also the pulsed fields tend to be more flexible and offer multiple uses for the same cost. They may cost more initially but are a better health investment in the long run and may be better if myofascial pain is present or one of the associated conditions.

Small permanent magnets, used on acupuncture points or tender/trigger points are also helpful for health maintenance but you have to know where to put them. These can sometimes be useful to wear during the day over the worst tender or painful spots. Using them over acupressure points is one way to start. An acupressure book that could be helpful to locate and use these points is Acupressure's Potent Points: A Guide to Self-Care for Common Ailments. Even so, whole body balancing, by using whole body treatments takes away the guesswork of which points to use at any given time. Some of these points may be helpful for anxiety or depressive symptoms too.  The Large Intestine 4 point, Spleen 6 or Stomach 36 can help especially.  Pressure massage over GV 24.5 and GV 20 are very helpful and a handheld tens/acupoint stimulator can be used to stimulate several ear acupoints (zero point and shen men) as well as GV24.5 and GV20. 

Various kinds of magnets may be combined depending on where the tender/trigger points are. The size of the magnet, will depend on the area needing treatment.

·      Back of head: acupuncture magnets, large neodymiums, magnetic collars, head band or necklace

·      Neck: acupuncture magnets, large neodymiums, flexible wraps or discs, magnetic, head band or necklace

·      Shoulders: acupuncture magnets, large neodymiums, flexible wraps or discs, magnetic, head band or necklace

·      Ribs: acupuncture magnets, large neodymiums, flexible wraps or discs

·      Elbow: acupuncture magnets, large neodymiums, flexible elbow wraps or discs, magnetic band or bracelet

·      Buttocks: acupuncture magnets, large neodymiums, flexible wraps, discs or boards, even shoe inserts used over the pain or in the shoes

·      Hips: acupuncture magnets, large neodymiums, flexible wraps, discs or boards, even shoe inserts used over the pain or in the shoes, or belts

·      Knees: acupuncture magnets, large neodymiums, flexible wraps, discs or boards, even shoe inserts used over the pain or in the shoes

Remember not to use these all day long every day. I suggest giving the body a break for 8 or more hours each day to avoid tolerance happening. Of course, pain anywhere else can be treated with these as well. Permanent magnets can be used along with the PEMF systems. Remember also that permanent magnets can harm credit cards, tapes and should not be used with pacemakers, etc. See the contraindications section.

Static Magnetic Mattresses

Research has shown benefit from using these for fibromyalgia. They may be used in combination with PEMF systems, so don’t throw away your magnetic mattress if you already like to use one. The two together should help even more. It may be worth experimenting to see how they work together or not, since every body is unique in it’s reactions.

Electrosmog

Electrosmog is a powerful energy drainer and strong stress inducer. People with Fibromyalgia, Chronic Fatigue and Chemical Sensitivity tend to also have electrical sensitivity. Electrosmog is important to control in these individuals.

Electrosmog is pervasive and insidious. It is all around us – and goes right through us, all day, every day. Computer terminals, hair dryers, TVs, electric stoves, the wiring in the house and our cars, stereos, microwave antennas, wireless systems, all strongly act on our bodies. They can’t be blocked – anywhere on the planet. We can only decrease them or add frequencies to the body that balance the body. They throw off body systems continually – day and night. Cell phones are the newest “societal need.” They deliver very powerful effects to the brain and are like sticking your head in a microwave oven. As the brain goes, so goes the rest of the body.

Devices that offer to keep the body from being thrown out of balance by harmful “electro-smog” may be useful to wear throughout out the day, whether in our own homes where we have a lot of wiring and TVs, stereos or radios playing, driving/riding in a car, sitting in front of computer terminals, using cell phones in office settings with a lot of electronics, in stores or in urban areas. These devices (see www.mybiopro.com/drpawluk) don’t specifically block out magnetic fields - it’s unlikely that anything can significantly - but probably stimulate the body to maintain frequencies that will make the body more resistant to the effects of the “electro-smog.”

How to use PEMF devices for Fibromyalgia

Since the recommended devices can have complicated set-ups and treatment regimens and often do not come with explicit directions, consultation is the best way to get individually tailored protocols, specific to any given individual’s unique overall health issues or needs.  Otherwise, the manufacturer’s directions can be a starting place.

Always check for sensitivity when you start. If you think you may be sensitive, or know you are, start low and go slow in advancing the settings.

In addition:

q    Always treat your day’s water ration on the system with you in the morning – preferably in a glass container without a metal lid.

q    Take your morning supplments before you get on the system. There are no supplements I know of no supplements that have to be avoided with these treatments.

q    Have a drink of water – at least 10-16 ounces before you get on the system.

q    Have your breakfast first to stimulate digestion. 

q    Let your body tell you what it needs in terms of settings, length of treatments and/or placements of applicators.

q    Wear and/or use your BioPro (www.mybiopro.com/drpawluk)

daily to counteract the effects of electrosmog, so that the fatigue effects of this electro pollution won’t wear you down and create additional stress.

q    It doesn’t matter when supplements are taken relative to magnetic field therapy. In the ideal circumstance they should be taken about half an hour to one hour before the magnetics treatment.

q    Key is daily use – twice a day if you can. In the morning to wake up the cells. In the evening to clean out the effects of the day’s stresses on the body. You can still use the system mid-day if needed for any other given problem/s. Health Maintenance settings may be combined at any given treatment session with treatment settings and pillow/pad placements as needed.

q       In the morning:

o      If sensitive, start at the lowest setting and gradually- typically every 3-4 days -  increase the settings until the strongest setting is reached.

o      If not sensitive, typically start the mid-range and increase the settings, by one or two every day until the strongest setting is reached.

o      Once the highest setting is reached is reached, you can stay at that level or whatever level seem sto produce the best results from then on, unless you have a reaction or your intuition tells you another setting is preferred.  

q       In the evening:

o     Always use the lowest setting for at least 20 minutes just before bedtime. This is always the last setting to use for the day. It is the “finishing” treatment – the “finishing” touch.

o     You can combine any other settings in a separate treatment session if you want just before ending the day with the finishing treatment.

Conventional Treatment of Fibromyalgia

Treatment is by trial and error. Experience and small clinical studies have found some benefit from low-dose antidepressant therapy, cyclobenzaprine (Flexeril) and/or exercise. A significant portion of patients on anti-depressants find their symptoms may worsen.

Fibromyalgia Resources

Most resources are very conservative because of their medica advisors and do not recommend complementary approaches as much as they should. Cranial electrical stimulation and magnetic therapies are mostly unknown by them. They are given here for completeness.

Stress review paper

·      Alfano, AP, Taylor , AG, Foresman , PA ,Dunkl, PR, McConnell, GG, Conaway, MR, Gillies, GT.

·      Static magnetic fields for treatment of fibromyalgia:  a randomized controlled trial. J Altern Complement Med 7(1):53-64, 2001.

·      Brown, C.; Ling, F.; Wan, J.; Pilla, A. Non-invasive static magnetic field therapy reduces chronic pelvic pain:  a double-blind pilot clinical study. Bioelectromagnetics Society, 24th Annual Meeting, 23-27 June, Quebec City, QC, Canada, Abstract No. 8-3, p. 49-50, 2002.

·      Colbert, A P, Taylor, AG, Foresman , PA , Conaway, MR, Alfano, AP. Magnetic-field studies encouraging - discussion of magnetic sleep pad study (letter and reply).  J Altern Complement Med 7(5):393-399, 2001.

·      Colbert, AP, Markov , MS , Banerji, M, Pilla, AA. Magnetic mattress pad use in patients with fibromyalgia:  a randomized double-blind pilot study. J Back Musculoskeletal Rehabil 13(1):19-31, 1999.

·      Goldenberg DL. Fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome. Curr Opin Rheumatol. 1995 Mar;7(2):127-35.

·      Hausotter, W. Modern illnesses from the critical viewpoint. Versicherungsmedizin 53(4):177-181, 2001.

·      Janssens LA. Trigger point therapy. Probl Vet Med. 1992 Mar;4(1):117-24.

·      Khramov, RN, Vorobiov, VV, Yarkov, AV. Difference in the effects of millimeter radiation by rats in norm and after a pain stress caused by electric stimulation.  Fundamental and Applied Aspects of the Use of Millimeter Electromagnetic Radiation in Medicine.  Abstracts of the 1st All-Union Symposium with International Participation.  10-13 May, 1989, Kiev , Ukraine , p. 155, 1989.

·      Lautenbacher, S. The role of pain perception in the etiology of chronic pain and the causation of sex differences. Bioelectromagnetics Society, 24th Annual Meeting, 23-27 June, Quebec City , QC , Canada , p. 39, 2002.

·      McCray, RE, Patton , NJ . Pain relief at trigger points:  a comparison of moist heat and shortwave diathermy. J Orthop Sports Phys Ther 5(4):175-178, 1984.

·      Miriutova NF, Levitskii EF, Abdulkina NG. Electromagnetic and mechanical vibrations in the therapy of myofascial pains. Vopr Kurortol Fizioter Lech Fiz Kult. 2000 Jan-Feb;(1):14-6.

·      Panagos A, Jensen M, Cardenas DD. Treatment of myofascial shoulder pain in the spinal cord injured population using static magnetic fields: a case series. J Spinal Cord Med. 2004;27(2):138-42.

·      Pilla, AA. Static magnetic field therapeutics:  state of the art. Bioelectromagnetics Society, 23rd Annual Meeting, 11-14 June, St. Paul , MN , Abstract No. P-71, p. 159-160, 2001.

·      Rauscher, E, Van Bise, WL. Pulsed magnetic field treatment of chronic back pain. Bioelectromagnetics Society, 23rd Annual Meeting, 11-14 June, St. Paul, MN, Abstract No. 10-3, p. 56-57, 2001.

·      Sandstrom, M, Hansson Mild, K, Lyskov, K, Wilen, J, Bergdah, J, Eriksson, N, Hoog, J, Marqvardsen, I,  Marqvardsen, O, Stenberg, B, Widman, L. Electrical hypersensitivity - a multidisciplinary study.

·      European Bioelectromagnetics Assoc. (EBEA), 4th International Congress, 19-21 November, Zagreb , Croatia , 1998.

·      Smania N, Corato E, Fiaschi A, Pietropoli P, Aglioti SM, Tinazzi M. Therapeutic effects of peripheral repetitive magnetic stimulation on myofascial pain syndrome. Clin Neurophysiol. 2003 Feb;114(2):350-8.

·      Thomas, AW, White, KP, Drost, DJ, Cook, CM, Prato , FS. A comparison of rheumatoid arthritis and fibromyalgia patients and healthy controls exposed to a pulsed (200 ut) magnetic field:  effects on norma l standing balance. Neurosci Lett 309(1):17-20, 2001.

·      Vallbona, C, Hazlewood, CF, Jurida, G. Response of pain to static magnetic fields in postpolio patients:  a double-blind pilot study. Arch Phys Med Rehabil 78(11):1200-1203, 1997.

·      Vallbona C, Richards T. Evolution of magnetic therapy from alternative to traditional medicine.  Phys Med Rehabil Clin N Am. 1999 Aug;10(3):729-54.

·      Weintraub, MI, Vallbona, C, Hazlewood, CF. Magnetotherapy:  a new intervention? (letter and reply).

·      Arch Phys Med Rehabil 79(4):469-470, 1998.

Other Fibromyalgia references – no abstracts provided

·      Berman BM, Ezzo J, Hadhazy V, Swyers JP. Is acupuncture effective in the treatment of fibromyalgia? J Fam Pract 1999;48:213-8.

·      Blunt KL, Rajwani MH, Guerriero RC. The effectiveness of chiropractic management of fibromyalgia patients: a pilot study. J Manipulative Physiol Ther 1997;20:389-99.

·      Haanen HC, Hoenderdos HT, van Romunde LK, Hop WC, Mallee C, Terwiel JP, et al. Controlled trial of hypnotherapy in the treatment of refractory fibromyalgia. J Rheumatol 1991;18:72-5.

·      Harding SM. Sleep in fibromyalgia patients: subjective and objective findings. Am J Med Sci 1998; 315:367-76.

·      Keel PJ, Bodoky C, Gerhard U, Muller W. Comparison of integrated group therapy and group relaxation training for fibromyalgia. Clin J Pain 1998;14:232-8.

·      Moldofsky H. Sleep and fibrositis syndrome. Rheum Dis Clin North Am 1989;15(1):91-103.

·      Pillemer SR, Bradley LA, Crofford LJ, Moldofsky H, Chrousos GP. The neuroscience and endocrinology of fibromyalgia. Arthritis Rheum 1997;40:1928-39.

·      Sandstrom MJ, Keefe FJ. Self-management of fibromyalgia: the role of formal coping skills training and physical exercise training programs. Arthritis Care Res 1998;11:432-47.

·      Schneider MJ. Tender points/fibromyalgia vs. trigger points/myofascial pain syndrome: a need for clarity in terminology and differential diagnosis. J Manipulative Physiol Ther 1995;18:398-406.

·      Singh BB, Berman BM, Hadhazy VA, Creamer P. A pilot study of cognitive behavioral therapy in fibromyalgia. Altern Ther Health Med 1998;4:67-70.

·      Wigers SH, Stiles TC, Vogel PA. Effects of aerobic exercise versus stress management treatment in fibromyalgia. A 4.5 year prospective study. Scand J Rheumatol 1996;25:77-86.

·      Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, et al. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum 1990;33:160-72.

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