What is Fibromyalgia?
The best description I have found about this condition is found on the “Patient” website for medical articles and was written by Dr Colin Tidy in 2014. He states that Fibromyalgia is a chronic pain disorder of unknown origin with some evidence of genetic predisposition and links to abnormal stress response or hormonal response with a possible triggering event.
Put simply, if a family member has had (or has) it, you may be more likely to develop it. It may lay dormant until a single stressful event occurs in your life or where a hormone change is prevalent such as menopause. The above is not a recipe for developing this condition, it appears that research have shown these specific links with a higher percentage of people. It commonly develops in women (10:1 ratio to men) between the ages of 20 and 50 though it is not limited to this group and has been diagnosed in a wide age range of people.
Symptoms of Fibromyalgia are:
- Pain at multiple sites on the body or a feeling of pain all over
- Fatigue
- Morning stiffness
- Sleep disturbance
- Feeling that the joints are swollen
- Being a little less “sharp” than usual (commonly referred to as brain fog)
- Headaches
- Light-headedness
- Inability to maintain a stable weight
The problems with this list of symptoms is that they overlap with other conditions such as hypothyroidism, menopause, arthritic conditions and chronic fatigue syndrome. Just because you have these symptoms does not mean that you specifically have Fibromyalgia. A correct diagnosis is very important and seeing your GP will ensure that any more serious conditions are ruled out. Other conditions may be able to be treated with drugs whereas Fibromyalgia does not respond very well to them.
How is it treated?
Fibromyalgia symptoms is often treated medically with muscle relaxing drugs such as pregabalin or gabapentin or neurological inhibitor drugs such as amitriptyline or duloxetime. Other drugs are available to help with this condition and options should be discussed with your GP.
Fibromyalgia symptoms can be treated by manual therapy. Osteopathic treatments involve movement of fluid throughout the body, relaxation of the nervous system via cranial work or isometric muscle techniques to activate and calm the nerve supply.
What is Chronic Fatigue Syndrome?
This layman’s’ term for Myalgic Encephalomyelitis (ME).
Myalgic = muscle pain
Encephalo = of the brain
Myelitis = inflammation of spinal cord
= Muscle pain caused by insufficient transmissions from the brain and spinal cord due to nerves being inflamed.
It is a condition of unknown origin and can effect anyone of any age but statistics show a higher prevalence in women (2:1 ratio with men). The condition is described as distinctive muscular symptoms specific to an exertional event (e.g. after exercise) with symptoms listed as:
- Body-wide pain
- Digestive disorders
- Light and sound sensitivity
- Inability to move muscles/limbs on demand
- Neurological disturbance such as tingling or numbness
- Enlarged and tender lymph nodes
- Inability to recover for up to 48 hours following exercise
- Unrefreshing sleep
This condition is not defined initially with regard to specific pain or fatigue reported by the patient. Symptoms do vary leading into the condition developing so a diagnosis may be an extremely lengthy process.
How is it treated?
NICE guidelines suggest that Cognitive Behavioural Therapy (CBT) should be introduced to a personalised treatment plan to allow the patient to accept and live with the condition. This should be given in conjunction with Graded Exercise Therapy (GET). GET is an exercise programme tailored to the patient with a view to gradually increasing the amount of exercise they can do without instigating a symptomatic reaction.
As an osteopath, I would treat very conservatively as any movement, however passive, could generate a neurological response and exacerbate symptoms. In these cases I would recommend cranial treatments to work with nervous system components without physical exertion being an issue.
How are Fibromyalgia and Chronic Fatigue Syndrome separated at diagnosis?
As you can see, symptoms of these two conditions are very similar. The most obvious difference being the neurological symptoms in Chronic Fatigue Syndrome (CFS) that are not evident in most cases of Fibromyalgia. Whilst fibromyalgia should not be diagnosed because others have been ruled out (called a diagnosis of exclusion), it is the case with CFS. However it could be argued that other conditions must be investigated as some could be a lot more severe and life limiting.
Other conditions that have to be investigated, can be ruled out with medical testing:
Hypothyroidism : Blood test for hormone imbalance
Diabetes : Blood and Urine tests for sugar levels
Anaemia : Blood test for iron levels
Arthritic conditions: Blood tests for inflammation markers
It is unlikely that your GP will be in a position to order all of these tests in one go and therefore delays in diagnosis are often due to just ticking the list of the most likely and serious conditions until they are ruled out. It can also be argued that paying first to test for the most likely condition could save lots of money which you can imagine is important with the constant struggles the NHS face.
Can an Osteopath diagnose?
Legally, an osteopath is allowed to diagnose however it is not best practice as we are not able to prescribe any necessary medications or add this diagnosis to your NHS medical records. What we can do is perform recognised manual tests and ask pertinent questions in relation to your condition and then report these findings to your GP via letter. This has many benefits as we are able to spend a lot more time with you than your GP can and therefore test in many different ways to ensure we have the right information for your perceived condition. Letters that are written enable you to see your GP armed with the right information that is relevant to your symptoms and give you the peace of mind not to miss anything out.
The main fact to remember when seeing an osteopath is that we are trained to recognise things that you may dismiss as not relevant. Just one appointment with an Osteopath may allow you to start on the road to recovery or to ensure that the correct diagnosis is obtained. – How much will you pay to get out of pain quickly or ensure your health is maintained? Look into treatments with The Garden Clinic and you will get excellent service, no hard sell and contact with your GP should you request/need it at no extra charge!
Shelley James
M.Ost