Ross Hauser MD, documents medical research concerning cervical neck instability as a cause of Fibromyalgia.
Fibromyalgia syndrome (FMS) affects an estimated 6 to 8 million people. A chronic disorder affecting mostly women, the condition is characterized by widespread musculoskeletal pain, fatigue, poor sleeping patterns and multiple tender points that occurs in precise, localized areas, particularly in the neck, spine, shoulders and hips.
When a fibromyalgia patient first seeks help for pain, a diagnosis such as tendinitis is generally given. When the pain continues, an MRI scan or some such study will be ordered. The diagnosis then changes to a “disc problem.” After more unsuccessful treatments, the pain sufferer will be sent to a pain center where the diagnosis of depression will be made. (See our article when depression and anxiety prevent healing). After several thousands of dollars of treatment, diagnostic tests, and a lot of frustration and misery, the person will be given that all-inclusive, “so everyone will know I’m not crazy” diagnosis: fibromyalgia. Nearly anyone who has had pain long enough and seeks enough medical opinions will eventually be labeled with this diagnosis. The diagnosis of fibromyalgia, chronic pain syndrome, or myofascial pain syndrome does not determine the etiology and, thus, the cure for the condition.
The diagnosis of fibromyalgia remains controversial
In recent research, the medical community acknowledges that the diagnosis of fibromyalgia remains controversial. Further that offering a diagnosis of fibromyalgia may lead to a patients’ “over-medicalization,” whereas others have raised concerns of under-diagnosing Fibromyalgia and under treatment for patients.
- Doctors in Korea report that using patient-reported questionnaires (asking patients to answer questions about their health concerns) has helped them make an appropriate diagnosis.1
In other words, fibromylagia is hard to diagnose and it is better to talk to the patient and be proactive in treatment while neither overmedicating nor undertreating.
This understanding of fibromyalgia is circulating into mainstream medicine as judged by a recent paper’s title and the accompanying editorial response appearing in the medical journal Clinical Rheumatology.
In the first paper titled” Is it necessary to strictly diagnose fibromyalgia syndrome in patients with chronic widespread pain? Researchers state: “strict diagnosis of Fibromyalgia will provide little or no significance from the viewpoint of clinical practice.”2
In response and disagreement is Dr. Luis Jose Catoggio a Rheumatologist in Argentina who defended the diagnosis of Fibromyalgia in his editorial Does it mean anything to diagnose (FM) in somebody with chronic widespread pain? 3
Most doctors don’t believe that there is a single cause of fibromyalgia. Rather, medicine points to a number of different factors and this is what makes isolating a single diagnose that can be treated with a single protocol impossible and creates the difficulty in offering a treatment program.
- Some doctors attribute the condition to a reduced amount of serotonin and substance P (an amino acid) in the brain, which also has been linked to depression, migraines, pain and gastrointestinal disorders.
- Some researchers theorize that disturbed sleep patterns may be a cause rather than just a symptom of fibromyalgia.
- An injury to the upper spinal region has been shown to trigger the development of fibromyalgia in some people.
- And still other researchers believe that a viral or bacterial infection may trigger fibromyalgia.
Although these are all possible contributors to the condition, we find that the many of people suffering from fibromyalgia experience this pain as a result of ligament weakness from degenerative diseases like osteoarthritis, injury or repetitive use damage.
In compensating for the ligament weakness, other areas of the body, including tendons and muscles, can be afflicted with referred pain. In this case, the fatigue, poor sleeping patterns and tender points associated with this condition are results of the ligament damage rather than causes of the condition.
Fibromyalgia and Neck Instability
Fibromyalgia is the name for a condition associated with widespread pain in the body and tenderness in multiple joints, muscles, and other soft tissue. Most doctors don’t believe there is one single cause of fibromyalgia. Therefore many treatment options exist, although most of them are symptom management and not curative treatment.
Research is showing a connection between difficult to treat symptoms of fibromyalgia and neck and whiplash injuries, meaning a large number of fibromyalgia patients have neck instability and cervical spine injury causing their problem.
In a study from the University of Aberdeen, one hundred and two neck injury patients were examined. Researchers found that 21.6% were later diagnosed with fibromyalgia syndrome. On average the fibromyalgia symptoms occurred just 3.2 months after injury and they were accompanied with poorer quality of life and an increase in physical functioning.4
Confirming this research, another study showed that 326 patients with three months of persistent pain following a whiplash injury found a greater proportion of neck/shoulder tender points .
When this study compared whiplash injury patients to other non-whiplash fibromyalgia patients seeking treatment, they found that the whiplash patients had the same amount of neck and shoulder girdle tender points but less tender points in other parts of the body.
This suggests a localized injury rather than widespread condition ruling out the fibromyalgia diagnosis.5
The role of anxiety and depression
Doctors in Spain assessed 138 patients with fibromyalgia, selected from a hospital pain management unit for anxiety and depression. The patients were asked to complete questionnaire’s at 6 weeks, 6 months, and 12 months to self-assess their anxiety and depression levels.
Variables that were significant predictors of the long-term impact of fibromyalgia on health-related quality of life in patients who completed a 6-week interdisciplinary treatment (psychological, medical, educational, and physiotherapeutic interventions) were:
- marital status,
- the number of concurrent conditions,
- years since the onset of pain,
- and symptoms of anxiety.
In the longitudinal analysis, patients with symptoms of anxiety had lower rates of improvement than those without symptoms of anxiety.
It should be pointed out that anxiety is a symptom and characteristic of post whiplash pain and neck instability.6
Loss of memory and cognitive performance in women with fibromyalgia
Another team of Spanish researchers found that women with fibromyalgia exhibited a decreased cognitive ability which negatively affected the performance of daily activities, such as:
- upper limb dressing,
- feeding and personal hygiene.
- Patients required more time to perform activities requiring both attention and perception, decreasing their functional independence.7
It should also be pointed out that cognitive difficulties are a symptom and characteristic of neck instability.
The role of chronic opioid therapy
Doctors from the University for Washington published new findings on chronic pain-killer medications and fibromyalgia:
- Many consider chronic opioid therapy to be ineffective for fibromyalgia
- Among patients who discontinued opioids by 12 months, those with fibromyalgia were more likely to report bothersome side effects and less likely to report pain improvement as important reasons for discontinuation
- Among patients continuing chronic opioid therapy, pain and activity interference outcomes were worse.8
Long-Term Effects of Fibromyalgia Pain
Recent research is showing that living with fibromyalgia pain is not a viable option. In fact, it is now known that living with fibromyalgia causes significant changes in the brain. A group of researchers compared brain images of 10 women with fibromyalgia to 10 women without fibromyalgia.(12)Results showed that there was a significantly lower amount of gray matter in the brain in women with fibromyalgia. Gray matter plays an integral role in the central nervous system. Although gray matter loss naturally occurs with age, it appears to occur three times faster in people with fibromyalgia. The researchers stated: “These findings reveal for the first time that patients with fibromyalgia have brain gray matter atrophy. Interestingly, the normal age-related decrease in gray matter was accelerated in fibromyalgia patients and related to disease duration.”
Prolotherapy for Fibromyalgia Pain
The most common reason for chronic pain is joint instability caused by chronic ligament laxity. The second most common reason is chronic insomnia. Other causes of diffuse chronic body pain are multiple chemical sensitivities, hypoglycemia, hypothyroidism, hypoadrenocortisolism, viral infection, yeast infection, increased gut permeability, nutrient deficiency, and poor tissue oxygenation. To cure fibromyalgic-type complaints, these conditions must be evaluated and treated. For this reason, it is recommended that the person suffering from diffuse body pain see a Natural Medicine physician. Prolotherapy is an effective treatment for people suffering from diffuse body pain when tenderness is elicited over muscle, ligament, and tendon attachments to the bone.
Prolotherapy is not an isolated treatment. The physician must investigate all possible factors which may be involved with a person experiencing diffuse body pain.
To make the diagnosis of fibromyalgia, one of the cardinal features is tenderness over specific points on the body. The diagnosis is made when at least 11 of the 18 points are tender. The unilateral sites are the occiput (insertion of the suboccipital muscles), inter-transverse ligaments C5 through C7, trapezius muscle, origin of the supraspinatous muscle, second costochondral junction (ligament), lateral epicondyle (wrist extensor muscle insertions), gluteal area (gluteus maximus muscle), greater trochanter (gluteus medius muscle insertion), and the medial fat pad of the knee (medial collateral ligament). In essence, 14 of the 18 points are located where either a ligament, tendon, or muscle inserts and the remaining four are in the middle of a particular muscle. Prolotherapy grows ligament, tendon, and muscle tissue where they attach to the bone, thus eliminating trigger points and the pain of fibromyalgia.
As we read this study we thought of the many people who just live with their pain. The thought that not dealing with pain doesn’t cause any harm is simply wrong. Not only should you seek help for your pain so that you can live life, you should also seek a cure for your pain to prevent serious health risks. A Prolotherapist’s approach to fibromyalgia involves a multi-layered approach depending on the individual patient. Prolotherapy is almost always part of the treatment as it addresses the underlying ligament laxity behind chronic joint pain. Some Prolotherapy offices have the capability to address hormone levels, diet for fibromyalgia and sleep problems. Resigning to live with your pain clearly has undesirable long-term effects. Chronic use of pain medications also has undesirable long-term effects. A better option is to consider an experienced Prolotherapist who can address the whole patient and underlying causes of fibromyalgia.
Car accidents and fibromyalgia
One study showed a relationship between car accidents and chronic widespread pain, that is pain that occurs at various points throughout the body.(10) Of the 2,069 patients questioned, 11.6% of them (241) reported cases of chronic widespread pain following a car accident. Researchers stated that, “persons exposed to an RTA [road traffic accident], but not those exposed to other traumatic events, experienced an increase in the likelihood of CWP [chronic widespread pain] onset. . . .We have demonstrated that persons with new-onset CWP are 34% more likely to report a prior, recent, and traumatic event than individuals who remain without CWP.”(11)
This is of interest because many car accidents cause some sort of trauma, namely whiplash, that potentially leads to a ligament injury. Ligament injury is a source of many chronic pain conditions and therefore is best treated with Prolotherapy to strengthen the injured ligament and alleviate pain.
Prolotherapy for treatment for fibromyalgia related to whiplash injury
Seeing that most tender points following whiplash tend to be located in the neck and shoulder girdle indicate cervical instability caused from the trauma of the whiplash.
The most effective treatment for cervical instability, or any joint instability, is Prolotherapy. Prolotherapy is an injection technique that stimulates a mild inflammation in the injured area. This inflammation mimics the body’s natural healing process.
While the diagnosis may be controversial, the pain is real and patients suffering from symptoms of whiplash injury are looking for a cure. Prolotherapy could be the cure for many of these patients.
In his research, Dr. K Dean Reeves published his findings that:
Trigger injection of ligament and tendon with proliferant (TILT therapy or Prolotherapy) offers the advantage of creating increased strength of the connective tissue in the region of injection as well as affecting the pain cycle. Reduction in pain levels and increased functional abilities were seen in excess of 75% of patients with severe fibromyalgia in this study. 9
Fibromyalgia and myofascial pain syndrome may be diagnosed in the same patient due to their overlapping and vague descriptions, both involving pain throughout specific tender areas or trigger points that cause both local and referred pain. Digging a little deeper into a patient’s health can help the clinician and the patient understand if the pain is due to issues that can be helped with Natural Medicine, such as food sensitivities, low hormones, poor sleep, and/or infections, among others. On the other hand, the physical exam may demonstrate undiagnosed joint instability in the areas exhibiting tender muscles and trigger points. The latter cases have good success with Prolotherapy as a standalone treatment. Oftentimes, a combined approach is necessary to help the patient fully recover. As the joints repair, the muscles can relax and the pain is alleviated. With the pain-relief, sleep is improved and the vicious cycle is stopped
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2. On, A.Y., Aykanat, D., Atamaz, F.C. et al. Is it necessary to strictly diagnose fibromyalgia syndrome in patients with chronic widespread pain? Clin Rheumatol (2015) 34: 1473. [Pubmed]
3. Catoggio LJ. Does it mean anything to diagnose fibromyalgia (FM) in somebody with chronic widespread pain? Clin Rheumatol. 2015 May 29 [Pubmed]
4. Jones, G. T., Nicholl, B. I., McBeth, J., Davies, K. A., Morriss, R. K., Dickens, C. and Macfarlane, G. J. (2011), Role of road traffic accidents and other traumatic events in the onset of chronic widespread pain: Results from a population-based prospective study. Arthritis Care Res, 63: 696–701. [Pubmed]
5. Buskila D, NeumannL, Vaisberg G, Alkalay D, Wolfe F. Increased rates of fibromyalgia following cervical spine injury: a controlled study of 161 cases of traumatic injury. Arthritis and Rheumatism [Pubmed]
6. Martín J, Torre F, Aguirre U, Padierna A, Matellanes B, Quintana JM. Assessment of predictors of the impact of fibromyalgia on health-related quality of life 12 months after the end of an interdisciplinary treatment. J Affect Disord. 2016 Oct 11;208:76-81. [Pubmed]
7. Pérez de Heredia-Torres M, Huertas-Hoyas E, Máximo-Bocanegra N, Palacios-Ceña D, Fernández-De-Las-Peñas C. Cognitive performance in women with fibromyalgia: A case-control study. Aust Occup Ther J. 2016 Oct;63(5):329-337. [Pubmed]
8. Turner JA, Shortreed SM, Saunders KW, LeResche L, Thielke S, Von Korff M. Does association of opioid use with pain and function differ by fibromyalgia or widespread pain status? Pain. 2016 Oct;157(10):2208-16. [Pubmed]
9. Reeves DK, Treatment of Consecutive Severe Fibromyalgia Patients With Prolotherapy. The Journal of Orthopaedic Medicine Vol 16 1994 No 3 [Pubmed]
10. Jones GT, Nicholl BI, McBeth J, Davies KA, Morriss RK, Dickens C, Macfarlane GJ. Role of road traffic accidents and other traumatic events in the onset of widespread pain: results from a population-based prospective study. Arthritis Care and Research 2011; 63:696-701.
11 Buskila D, NeumannL, Vaisberg G, Alkalay D, Wolfe F. Increased rats of fibromyalgia following cervical spine injury: a controlled study of 161 cases of traumatic injury. Arthritis and Rheumatism
12. Kuchinad A, et al. Accelerated Brain Gray Matter Loss in Fibromyalgia Patients: Premature Aging of the Brain? The Journal of Neuroscience,11 April 2007, 27(15):4004-4007