Fibromyalgia – Movement and Wellbeing Clinic

Fibromyalgia (FM) is something I commonly encounter, whether it’s by making the diagnosis myself, or patients left rather flustered by the number of tests they have experienced, only for them to only be told, ‘sorry, but we can’t help you any further’.

FM is a chronic widespread pain syndrome, which means that the patients suffering from it have had pain for longer than three months and suffer from pain in all limbs (1). The reason we are writing a blog on this topic, despite the fact that osteopathy doesn’t cure it, is that the patient usually tries osteopathy and massage for pain relief, alongside a nutritionist to reduce inflammation caused by diet and a psychotherapist to help resolve possible stress causes of FM.

Delving into the murky waters of FM is a complex, but very interesting adventure.

The complexities of Fibromyalgia – Central Sensitization

To investigate FM, we first need to discover the nature of chronic widespread pain and central sensitisation. Central sensitisation is a nervous system condition that is related to the initiation and continuation of chronic pain (2). Although most people think pain is a problem of the skin or the region specific to the pain, pain can be amplified through the brain. Have you noticed that the more stressed you become, the more fatigued you are, or the worse pain feels? Numerous studies have been published showing an increase in stress decreases pain tolerance, and the reverse is also true. To read about this in more depth, please click on the link to the blog do I have a high or low pain threshold?

Here is the physiology behind sensation:

Sensory stimulation, such as a pin prick, or heat, gets picked up by receptors in the nervous system.
Depending on the type of touch, the nerves excite certain parts of the spinal cord, which carry the signal up to the brain stem.
The sensation goes through a filter, the thalamus, which is part of the limbic system (the part of your brain that processes sensation, emotions and memory). This filter adds emotions into the recipe before directing the sensation further.
The signal then goes to the part of the brain which gives the location of the sensation, the sensory cortex.

Through this system of filtering sensation with the same apparatus that processes emotions and stress, we can understand why excess stress and anxiety can affect physical sensation.

How do we diagnose this?

FM is a diagnosis of exclusion, which means that there are no scans or blood tests to rule it in, you can only conduct tests to rule everything else out. The reason you may have scans and blood tests is to rule out anything systemic, such as rheumatoid arthritis, Vitamin D deficiency and hypothyroidism. If all tests are clear and the symptoms match FM symptoms, we can strongly suggest that is what it is.

One clinical test stands up however; there are typically 18 tender spots over the body that an osteopath can press with approximately 4kg of weight that will be very sensitive for FM sufferers (3).

Research suggests dietary factors are to be considered – a high ratio of Omega 6 fatty acids over 3, or too much arachadonic acid in the diet. Omega 6 fatty acids are found in processed food, poor quality spreads and oils and corn. Omega 3 is found in fish and certain seeds.

List of clinical symptoms

For your ease of understanding, here is a list of common clinical symptoms:

Widespread pain (all four limbs, back and jaw)
Tenderness to touch
Unrefreshing sleep/insomnia
Fatigue
Mood swings
May appear stressed
Altered cognition (forgetfullness/fog)
Painful periods
Joint stiffness
Visual problems
Bowel problems
Stimulation sensitivity (bright colours, odours, noises) (4)

So I have Fibromyalgia, is it the end of the world?

The short answer is; it depends on your mindset. A massive part of treatment of FM is reassurance. Some patients feel better because they have a diagnosis, although some patients don’t. Some patients are willing to try the coping mechanisms, some patients aren’t. It goes without saying the patients that actively engage in their management strategies feel better.

Treatments involve pain reduction modalities (osteopathy is great for this, but patients will also be prescribed pain medication), nutritionists sleep hygiene, psychotherapy and CBT, to name a few options. The research suggests a multidisciplinary approach, so a few therapists all working alongside each other, sharing the responsibility of your care is the best approach.