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
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
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
1. Wang SM, Han C, Lee SJ, Patkar AA, Masand PS, Pae CU. Fibromyalgia diagnosis: a review of the past, present and future. Expert Rev Neurother. 2015 Jun;15(6):667-79. [Pubmed]
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]