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Shaw Chiropractic
A Medical-Legal Newsletter for Personal Injury Attorneys
by Dr. Steven W. Shaw

Fibromyalgia Syndrome: Give me the facts

During a recent neurologic exam my patient was told that she had Fibromyalgia Syndrome (FS). The attending neurologist called my office to inform me that the findings of the exam suggested this diagnosis and that chiropractic care would provide no further benefit for the patient. The neurologist also indicated that the FS was not related to the trauma. Needless to say I was surprised at the ignorance of this otherwise talented neurologist. I must assume that if a neurologist was confused regarding this syndrome you too might need more information. Ttherefore, this newsletter will touch on information regarding this obscure and "evasive" disease.

Fibromyalgia has had many different names over time. It has been called everything from soft tissue rheumatism to fibrositis. It was thought to be psychological by some physicians but that belief is no longer the prevailing medical opinion. The AMA recognized this entity in 1987 as a real illness and major cause of disability. In 1990 the American College of Rheumatology (ACR) identified criteria for the diagnosis of this condition.

The ACR identified 18 tender points of which 11 must be present to meet the criteria of FS. These tender points need to be reproduced with approximately 4Kg of pressure. With this criteria in place any doctor validating the diagnosis of FM, particularly for medical legal purposes, should be using an instrument called a pressure algometer. This instrument is essentially a pressure gauge and reports at what pressure intensity the patient reports pain.

The 18 points identified by the ACR are located at the base of the skull, lower neck, upper Trapezius, Supraspinatus, second rib, lateral epicondyle of the elbow, buttocks, Greater Trochanter of the hip, and medial knee. Different authors have proposed variations on the number and locations of the tender points but all agree that the findings need to be diffuse in presentation and involving both upper and lower body areas.

In addition to the presence and sensitivity of the tender points some of the symptoms of FM include sleep disturbances, general stiffness, headaches or facial pain (often the result of TMJ), abdominal discomfort, irritable bladder, paresthesias, chest pain, cognitive disorders, and environmental sensitivity.

There are no imaging or laboratory tests for this illness although the physician must rule out other possible causes for the complaints. For example, Lupus, Lyme disease and thyroid disorders may mimic the FM presentation. It is only after these other conditions have been ruled out that the physician should consider the diagnosis of FM.

Treatment for FM may include medication directed towards improved sleep habits. This is because the condition is often associated with Chronic Fatigue Syndrome and sleep disorders. Some researchers have found the use of tricyclics to be effective. Aerobic exercise is also recommended due to the bodies release of chemicals which serve as pain modulators. Many forms of physical therapy are helpful for pain control and Chiropractic Manipulation has been very helpful in restoring proper afferentation which results in the body’s ability to re-calibrate it’s pain threshold. Stress control with Yoga, Tai Chi and biofeedback have been somewhat effective. Unfortunately, despite all these approaches none provide a cure. Rather, they make the condition more tolerable.

Although the cause of FM is unknown the entity is divided into primary and reactive categories. The primary FM is considered idiopathic. This means the cause is unknown. The reactive FM is often known as post traumatic FM. There is no clinical difference between primary and reactive. The only difference is the identification of the precipitating event in the reactive variety. Triggering factors include illness, physical trauma and acute emotional stress. As a physician who frequently treats post traumatic injuries I can share with you my experience which suggests that the physical and psychological trauma of MVAs is often sufficient to provoke the onset FM. Early intervention by a chiropractor will help prevent this condition and at least identify and document it before it progresses.