If you or a loved one have been diagnosed with fibromyalgia, you have probably noticed many changes taking place in you/your lives. This condition tends to afflict people in many different ways, from mild cases to debilitating. Many times another condition, known as chronic fatigue syndrome (CFS), is present as well.
“In the science fiction book I wrote, I created a world where
everyone knows what to do for FMS and CMP. That’s the way I
felt when I spent a few days at the Pittsburgh School of Pain
Management in Pittsburgh, PA. One of the best things you can do
for yourself would be to persuade one of the graduates of this
school to practice in your locality. That’s what I did…”
At The Pain Treatment & Wellness Center, we treat the muscular aspect of the condition by working with the muscles and soft tissue in a specific way which increases the flow of oxygen rich blood in the body. We also gently stretch the tissues to help keep the circulation increased for longer amounts of time resulting in longer enjoyment of therapy.
Trigger points are many times present in people with fibromyalgia and treatment of the trigger points can help in a tremendous way. This is because trigger points may cause much in the way of pain, which is usually deep, dull, and aching, all over the body.
Devin Starlanyl is a physician who suffered the effects of myofascial pain syndrome (MPS) and chronic fatigue syndrome (CFS). She then wrote a book called, Fibromyalgia and Chronic Myofascial Pain – A Survival Manual, which has touched the lives of many people who suffer this condition. The National Association of Myofascial Trigger Point Therapists (NAMTPT) recognizes Dr. Starlanyl’s work to be an invaluable tool in the management of MPS and CFS. In the second edition and on page 236 of her book she writes, “In the science fiction book I wrote, I created a world where everyone knows what to do for FMS and CMP. That’s the way I felt when I spent a few days at the Pittsburgh School of Pain Management in Pittsburgh, PA. One of the best things you can do for yourself would be to persuade one of the graduates of this school to practice in your locality. That’s what I did…” At The Pain Treatment & Wellness Center we recommend to anyone with fibromyalgia to at least get checked out for trigger points by someone who is familiar with them and how they cause pain.
In their text, Myofascial Pain and Dysfunction: The Trigger Point Manual, Drs. Janet Travell and David Simons alert us to be sure that we have differentiated between fibromyalgia and Myofascial Pain Syndrome (MPS). They state that trigger points (TrPs) are present in the majority of people who suffer with fibromyalgia and that it is easier to distinguish which is the proper diagnosis while the pain is still in its acute phase. The text leaves us with a comparison between TrPs and fibromyalgia.
Clinical Features Distinguishing Myofascial Pain due to Trigger Points from Fibromyalgia.1
| Myofascial Pain (TrPs) | Fibromyalgia |
| 1 Female : 1 Male | 4-9 Females : 1 Male |
| Local or Regional Pain | Widespread, general pain |
| Focal tenderness | Widespread tenderness |
| Muscle feels tense (taut bands) | Muscle feels soft and doughy |
| Restricted range of motion | Hypermobile |
| Examine for trigger points | Examine for tender points |
| Immediate response to injection of TrPs | Delayed/poorer response to TrP injection |
| 20% also have fibromyalgia | 72% also have active TrPs |
Myofascial Trigger Point Therapists, though not clinical diagnosticians, may be able to provide symptomatic relief to those suffering from fibromyalgia since 72% of fibromyalgia patients have active TrPs.
We also work to help empower our fibromyalgia patients by making them aware of the groundbreaking research and most current therapies for their condition. We will also serve to connect them with doctors who truly specialize in the condition and who will take the time to not only treat them well, but listen to them.
Some of the people we have had in the practice with fibromyalgia actually had other conditions that looked like fibromyalgia because of the pain and fatigue. This is not to say, in any way, that everyone diagnosed with fibro falls into this category, but that it simply does happen. Since we request that our chronic pain patients see their doctors for some specific blood analysis, which can identify a medical condition that commonly goes overlooked. These are:
- Low thyroid
- Low Iron levels (ferritin)
- Low vitamin D
Low thyroid or hypothyroidism can greatly affect your body in many ways because the thyroid hormone affects the way every organ, tissue, and cell works. What you need to know about your thyroid is that the reference range on TSH is a little too broad. The range, depending on the lab, runs from [0.3 – 5.0]. When looking at TSH, it is important to realize the higher the number the lower the thyroid function. So based on this range, a TSH of 6.5 would be considered LOW thyroid and a TSH of 4.5 would be considered NORMAL.
This is where it is important to know what is going on in medicine. The American Academy of Clinical Endocrinologists released a 2003 statement regarding the evaluation of TSH tests. They determined that if a person presents with symptoms of low thyroid and their TSH is greater than 3.0 then they should be treated for hypothyroidism. We know physicians who treat if the TSH is greater than 2.0 and they would like to see the high end of the range at 1.5! The key here is to find a doctor who is “in the know” on these guidelines.
Ferritin is the preferred test to determine the true levels of iron in the body. Ferritin is the binding protein to iron and tells us how much iron is actually stored in the liver and bones, which is a much better test than iron alone. You do not have to be anemic to have iron deficiency.
Vitamin D is something that is getting a lot of press right now due to the increasing evidence which links low vitamin D levels to unexplained muscle and bone pain, seasonal affective disorder (SAD), certain cancers (breast, colo-rectal, prostate), etc. Many people seem to scoff at ‘the term vitamin’ for some reason so we are here to let you know that vitamin D, despite its name, is not a vitamin! Vitamin D is actually considered a secosteroid hormone, which has a systemic effect on the body. Many physicians are now referring to vitamin D as the “vitamin D endocrine system”. Vitamin D is made when ultraviolet B radiation (UVB) strikes the skin, hence its nickname “the sunshine vitamin”. Unfortunately in many regions, the exposure we get to sunlight is limited, whether because of the actual climate or because some people spend most time indoors. On top of that, dermatologists are constantly telling people to stay out of the sun!
Note:
this information is not a license to move to the beach and tan or go to the tanning bed every day! Besides, tanning beds do not produce the needed ultraviolet B (UVB) radiation necessary to make vitamin D.
Vitamin D can be supplemented easily and is extremely cheap. It is important to have a blood test done to determine the levels in the body and it is important to test the correct form of vitamin D – vitamin D3. The way you will see this written on a blood test is:
25-OH Vitamin D; or
25-hydroxy Vitamin D
Please see more on medical conditions which may cause pain and lethargy on our perpetuating factors page.
Again, fibromyalgia can be a debilitating and difficult condition to battle, but with the right people working with you – may be much easier to cope with.
For more information regarding these tests, please visit our Perpetuating Factors page where you can see more detailed information on both symptoms and testing.
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Reference:
1. Simons D G, Travell J G: Myofascial Pain and Dysfunction--The Trigger Point Manual Vol 1. 2:39.