Fibromyalgia (Defined)

What is Fibromyalgia (FM)? Let us review the information on Fibromyalgia available from National Institutes of Health website.

“Fibromyalgia is a common syndrome in which a person has long-term, body-wide pain and tenderness in the joints, muscles, tendons, and other soft tissues. ...The cause is unknown.”

What exactly constitutes FM? How is it really diagnosed? What blood tests, imaging studies or other tests does a physician order to diagnose FM? FM is a ‘diagnosis of exclusion’.

Blood and urine tests are usually normal. However, tests may be done to rule out other conditions. Pain is the main symptom of fibromyalgia. It may be mild to severe.

Painful areas are called tender points. Tender points are found in the soft tissue on the back of the neck, shoulders, chest, lower back, hips, shins, elbows, and knees. The pain then spreads out from these areas.

The pain may feel like a deep ache, or a shooting, burning pain.

The joints are not affected, although the pain may feel like it is coming from the joints.

These ‘tender points’ are sore and painful areas in the muscles themselves rather than from the joints as in arthritis.

Pain may get worse with activity, cold or damp weather, anxiety, and stress.

Pain from hypertonic, over worked and tired muscles get worse with the above factors, don’t they? How do these ‘tender points” differ from “trigger points’ that late Dr. Janet Travel had described in her seminal book?

To be diagnosed with fibromyalgia, you must have had at least 3 months of widespread pain, and pain and tenderness in at least 11 of 18 areas, including:

  • Arms (elbows)
  • Buttocks
  • Chest
  • Knees
  • Lower back
  • Neck
  • Rib cage
  • Shoulders
  • Thighs
10 out of these 18 are places in head and neck that I palpate as part of TMD examination. This is part of the data that is collected for TMD diagnosis. It also serves as a metric of progress during active TMD treatment. After all a muscle that postures the jaw / head or neck would be tender if it is ‘hypertonic, over worked and tired. Palpation of the areas below the neck is not part of a dentist’s physical examination. However, evaluating overall postural compensations through a gait analysis is part of our TMD examination. Misaligned jaw, head and neck posture commonly results in postural compensations down the postural chain even to the feet. When the shoulders and hips are not level, the muscles of leg and back have to work non-stop to make up for that imbalance. So it is quite conceivable that at least one more of the “other 8” points are tender to palpation as well. THAT is all that would be needed for a FM diagnosis.

What is the goal of FM treatment? Again from NIH:

The goal of treatment is to help relieve pain and other symptoms, and to help a person cope with the symptoms.

The first type of treatment may involve: Physical therapy, Exercise and fitness program (and)Stress-relief methods, including light massage and relaxation techniques

If the cause of the postural imbalance is left uncorrected, then these steps either do not work or do not work for very long. It is like ignoring the source of the “check engine light” in the car analogy earlier.

If these treatments do not work, your doctor may prescribe an antidepressant or muscle relaxant. The goal of medication is to improve sleep and pain tolerance. Medicine should be used along with exercise and behavior therapy. Duloxetine (Cymbalta), pregabalin (Lyrica), and milnacipran (Savella) are medications that are approved specifically for treating fibromyalgia.

However, many other drugs are also used to treat the condition, including:
  • Anti-seizure drugs
  • Other antidepressants
  • Muscle relaxants
  • Pain relievers
  • Sleeping aids
This is the typical FM patient’s life -various drugs and combinations of drugs to manage the symptoms, with no end in sight. Again, from NIH:

Expectations (Prognosis)

Fibromyalgia is a long-term disorder. Sometimes, the symptoms improve. Other times, the pain may get worse and continue for months or years.

This approach is based on the theory that the nerves themselves are ‘over active’. But what if the nerves are that way for a reason? Is it then possible to correct it once and for all?

We treat a number of patients that came to us seeking relief from jaw related problems including headaches, jaw pain and other TMD symptoms. Some of them have been diagnosed with Fibromyalgia by rheumatologists or pain management specialists. Often they have been advised by their physicians to accept FM and manage it. But I have yet to see a single case where their FM either completely resolve or greatly diminish after their Neuromuscular TMD therapy allowing them to get off their medications and reclaim their lives. So I am convinced that Fibromyalgia is a group of symptoms resulting from a musculoskeletal system that exceeded its adaptive capacity due to the imbalances throughout the postural chain. As the ‘top block’ of this postural chain, the jaw and head mis-alignment often plays a primary role in the cascade of events that result in a FB diagnosis.


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