Fibromyalgia: The Challenge of Treatment

Fibromyalgia (FM) is a disorder involving chronic pain that has no known cause. It is characterized by widespread musculoskeletal pain, sleep disturbance, fatigue, and mood disorders. FM affects about 2% of the US population with a prevalence between 1% and 11% in other countries. It is more common in adult women than men (3.4% vs. 0.5%), particularly as they age—the highest occurrence is between 60-79 years of age. The criteria for the diagnosis of FM was established in 1990 by the American College of Rheumatology as widespread pain of at least 3-month duration and pain on palpation (pushing with the fingers) of at least 11 of 18 specific tender sites on the body. Pain, fatigue, and sleep disturbance are observed in all patients with FM. Additional features can include: stiffness, skin tenderness, post-exertional pain, irritable bowel syndrome, cognitive disturbances, overactive bladder syndrome or interstitial cystitis, tension or migraine headaches, dizziness, fluid retention, paresthesias (numbness), restless legs, Reynaud’s phenomenon (white finger disease), and mood disturbances. FM is also strongly associated with anxiety, depression, chronic fatigue syndrome, myofascial pain syndrome, hypothyroidism, and many of the inflammatory arthritic diseases. Though there are no specific tests for FM, neurotransmitter deregulation including serotonin, norepinephrine, and substance P can result in an abnormal sensory processing in the brain and spinal cord. This results in a lower pain threshold commonly seen in FM.

The treatment of FM may be best looked at from three specific goals which include: 1. alleviate pain; 2. restore sleep; and 3. improve physical function. Thus, the most successful approach to the treatment of FM has been reported to be multidisciplinary or involving several different types of healthcare providers. Clinical tools often used by doctors to monitor symptom change include a 0-10 pain scale; a body function scale called the Fibromyalgia Impact Questionnaire (FIQ) which measures physical function, common FM symptoms, and general well-being; and, for measuring the physical and emotional side of FM, the SF-12 or SF-36 (SF = “short form” and either a 12- or a 36-item tool).

Though medications are reported as an important treatment option (such as an anti-inflammatory, analgesic, anticonvulsant, hypnotic, corticosteroids, opiates, various injections, and more), the focus of this discussion is aimed at the alternative or complementary treatment approaches, as many FM patients cannot tolerate the side effects of the many different medications. Alternative approaches include cognitive behavioral therapy (counseling), exercise (strength and flexibility), acupuncture, and chiropractic treatment, particularly manipulation but also soft tissue therapies and guided exercise training. Physiological therapeutic approaches frequently used in chiropractic clinics include low-power laser therapy, hydrotherapy such as whirlpool, Balneotherapy—using minerals and oils in the moving water, pulsed electromagnetic field, traction and massage therapy. Another exercise approach that can have great value in managing stress and facilitating sleep is Yoga. The key to a successful treatment outcome requires finding a team of healthcare providers who are willing to listen to the patient and work together to improve the patient’s quality of life. Through this concerted team approach, in addition to the patient taking responsibility by performing exercises on a regular basis, following a proper diet, and getting adequate restful or restorative sleep, FM can become “controllable” and a relatively normal lifestyle can be enjoyed.

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