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Back Clinic Fibromyalgia Team. Fibromyalgia syndrome (FMS) is a disorder and syndrome that causes widespread musculoskeletal pain in the joints, muscles, tendons, and other soft tissues throughout the body. It is often combined with other symptoms like temporomandibular joint disorders (TMJ/TMD), irritable bowel syndrome, fatigue, depression, anxiety, cognitive issues, and sleep interruption. This painful and mysterious condition affects around three to five percent of the American population, predominantly women.

Diagnosis of FMS can be difficult, as there is no specific lab test to determine if the patient has the disorder. Current guidelines state that a diagnosis can be made if a person has widespread pain for more than three months, with no underlying medical condition. Dr. Jimenez discusses advances in the treatment and management of this painful disorder.

Fibromyalgia Could Cause Something More In The Body

Fibromyalgia Could Cause Something More In The Body


Everyone has dealt with acute or chronic pain at some point in their lives. The body’s response tells many of us where the pain is located and can leave the body sore as the immune system begins to heal the affected area. When disorders like autoimmune diseases start to attack the body for no reason, then that is when chronic issues and disorders begin to overlap in risk profiles on other various problems that affect both the muscles and organs. Autoimmune diseases like fibromyalgia can affect a person’s body; however, they could be associated with different issues affecting the body. Today’s article looks at fibromyalgia, how it affects the musculoskeletal system, and how chiropractic care helps manage fibromyalgia in the body. We refer patients to certified providers specializing in musculoskeletal treatments to help those with fibromyalgia. We also guide our patients by referring to our associated medical providers based on their examination when it’s appropriate. We find that education is the solution to asking our providers insightful questions. Dr. Alex Jimenez DC provides this information as an educational service only. Disclaimer

05 - LaValle Metaflammation - 1 Slide-compressed

What Is Fibromyalgia?


Have you experienced excruciating pain that is spread all over your body? Do you have trouble sleeping and feel exhausted every day? Do you experience brain fog or other cognitive disturbances? Many of these issues are signs and conditions of fibromyalgia. Fibromyalgia is defined as a chronic condition that is characterized by widespread musculoskeletal pain. Symptoms like fatigue, cognitive disturbances, and multiple somatic symptoms often overlap and accompany this disorder. Around two to eight percent of the world population suffers from fibromyalgia, and it affects women more than men. Sadly though, fibromyalgia is a challenge to diagnose, and the pain can last several months to years. Some of the main symptoms that fibromyalgia does to the body include:

  • Muscle and joint stiffness
  • General sensitivity
  • Insomnia
  • Cognitive dysfunction
  • Mood disorders

Fibromyalgia could also potentially be associated with specific diseases like diabetes, lupus, rheumatic diseases, and musculoskeletal disorders.


How Does It Affect The Musculoskeletal System?

The musculoskeletal system in the body has three muscle groups: skeletal, cardiac, and smooth muscles that provide different functions correlating how the body moves. Individuals with fibromyalgia will experience amplified painful sensations affecting their brain and spinal cord to process pain and nonpainful signals potentially associated with musculoskeletal disorders. The neural structures from the brain become hyper-reactive to any soft tissues close to the spine, known as segmental facilitation. These changes that occur to the soft tissues are called trigger points, and if situated in the muscles, they are referred to as “myofascial” trigger points. Studies reveal that the pathophysiology of musculoskeletal dysfunction can be considered secondary to central abnormalities of pain modulation associated with fibromyalgia.

An Overview Of Fibromyalgia-Video

Have you been experiencing excruciating pain in different areas of your body? Have you been constantly tired throughout the entire day? Or has your mood been dampened all of a sudden? These are the signs that you have fibromyalgia, and the video above gives an overview of what fibromyalgia is. Fibromyalgia is defined as a chronic disorder that is difficult to diagnose. Studies reveal that fibromyalgia is possible to be described as a cognitive disorder that triggers painful amplifications and sensory nociceptors that become hypersensitive. So what does this mean, and how is the nervous system affected by fibromyalgia? The nervous system has the central and peripheral systems. The peripheral system has a component known as the autonomic nervous system that regulates involuntary bodily functions. The autonomic system consists of two subsystems: the sympathetic and parasympathetic systems. For individuals with fibromyalgia, the sympathetic nervous system, which provides the “fight or flight” response, is constantly active, causing the parasympathetic nervous system, which provides the “rest and digest” response, to be inactive in the body. The good news is that individuals with fibromyalgia and its associated symptoms can find relief through treatment.

Chiropractic Care & Fibromyalgia


Even though there hasn’t been a cure for fibromyalgia yet, treatments are available to manage and improve the symptoms associated with fibromyalgia with chiropractic care. Chiropractic care can help relieve fibromyalgia pain by carefully correcting spinal misalignments or subluxations through spinal adjustments and manual manipulations of the body. Studies reveal that the effectiveness of chiropractic care for fibromyalgia patients helps improve their range of motion to the cervical and lumbar areas of the spine. Chiropractic care can help improve their flexibility, decrease their pain levels, and have better sleep quality. People diagnosed with fibromyalgia need to understand that many options for pain management don’t rely on medicines. Chiropractic care is gentle and non-invasive. It can be helpful for individuals that want to take control of their circumstances and have chiropractic therapy as a vital part of managing their well-being.


Fibromyalgia is a chronic disorder that affects the musculoskeletal system by causing stiffness in the muscles and joints, general sensitivity, and other chronic issues associated with this disorder. Individuals with fibromyalgia will describe their pain as unbearable due to the nerves in the sympathetic system being hyperactive and tender to the touch. Fortunately, treatments like chiropractic care can help relieve fibromyalgia pain through spinal adjustments and manual manipulations. Chiropractic care for individuals with fibromyalgia can help improve their range of motion and flexibility and decrease their pain levels without using medicines. Incorporating chiropractic care as a treatment for fibromyalgia can be vital in managing a person’s well-being.



Bhargava, Juhi, and John A Hurley. “Fibromyalgia – Statpearls – NCBI Bookshelf.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 1 May 2022,

Blunt, K L, et al. “The Effectiveness of Chiropractic Management of Fibromyalgia Patients: A Pilot Study.” Journal of Manipulative and Physiological Therapeutics, U.S. National Library of Medicine, 1997,

Geel, S E. “The Fibromyalgia Syndrome: Musculoskeletal Pathophysiology.” Seminars in Arthritis and Rheumatism, U.S. National Library of Medicine, Apr. 1994,

Maugars, Yves, et al. “Fibromyalgia and Associated Disorders: From Pain to Chronic Suffering, from Subjective Hypersensitivity to Hypersensitivity Syndrome.” Frontiers, Frontiers, 1 July 2021,

Siracusa, Rosalba, et al. “Fibromyalgia: Pathogenesis, Mechanisms, Diagnosis and Treatment Options Update.” International Journal of Molecular Sciences, MDPI, 9 Apr. 2021,


Fibromyalgia Altered Pain Perception Processing

Fibromyalgia Altered Pain Perception Processing

Fibromyalgia is a condition that causes pain throughout the whole body. It causes sleep problems, fatigue, and mental/emotional distress. It affects around four million adults in the United States. Individuals with Fibromyalgia tend to be more sensitive to pain. This is referred to as abnormal/altered pain perception processing. Research currently leans towards a hyperactive nervous system as one of the most plausible causes.

Fibromyalgia Altered Pain Perception Processing

Symptoms and Related Conditions

Individuals with fibromyalgia/fibromyalgia syndrome/FMS may have:

  • Fatigue
  • Sleep issues
  • Headaches
  • Concentration, Memory issues, or Fibro Fog
  • Stiffness
  • Tender points
  • Pain
  • Numbness and tingling in hands, arms, legs, and feet
  • Anxiety
  • Depression
  • Irritable bowel syndrome
  • Urinating issues
  • Abnormal menstrual cramps

Altered Central Pain Processing

Central sensitization means that the central nervous system, made up of the brain and spinal cord, processes pain differently and more sensitively. For example, individuals with Fibromyalgia could interpret physiological stimuli, like heat, coldness, pressure, as pain sensations. Mechanisms that cause altered pain processing include:

  • Pain signal dysfunction
  • Modified opioid receptors
  • Substance P increase
  • Increased activity in the brain where pain signals are interpreted.

Pain Signal Dysfunction

When a painful stimulus is felt, the brain signals the release of endorphins, the body’s natural painkillers that block the transmission of pain signals. Individuals with Fibromyalgia could have a pain-blocking system that is altered and/or not functioning correctly. There is also the inability to block repetitive stimuli. This means that the individual keeps feeling and experiencing the stimuli even as they try to block them out, suggesting a failure in the brain to filter out irrelevant sensory information.

Modified Opioid Receptors

Research has found that individuals with fibromyalgia have a reduced number of opioid receptors in the brain. Opioid receptors are where endorphins bind so the body can use them when necessary. With fewer available receptors, the brain is less sensitive to endorphins, as well as opioid pain medication like:

  • Hydrocodone
  • Acetaminophen
  • Oxycodone
  • Acetaminophen

Substance P Increase

Individuals with fibromyalgia have been found to have elevated levels of substance P in their cerebrospinal fluid. This chemical is released when a painful stimulus is detected by the nerve cells. Substance P is involved with the body’s pain threshold, or the point when a sensation turns into pain. High levels of substance P could explain why the pain threshold is low in individuals with fibromyalgia.

Increased Activity in the Brain

Brain imaging tests, like magnetic resonance imaging or MRI, have shown that fibromyalgia is associated with greater than regular activity in areas of the brain that interpret pain signals. This can suggest that pain signals are overwhelming those areas or that the pain signals are being processed dysfunctionally.


Certain factors can trigger a flare-up. These include:

  • Diet
  • Hormones
  • Physical stress
  • Too much exercise
  • Not enough exercise
  • Psychological stress
  • Stressful events
  • Sleep Patterns changed
  • Treatment changes
  • Temperature changes
  • Weather changes
  • Surgery


Chiropractic focuses on whole-body wellness. 90% of the central nervous system goes through the spinal cord. A misaligned vertebral bone can create interference and irritation on the nerves. Fibromyalgia is a condition related to the hyperactivity of the nerves; therefore, any vertebral subluxations will complicate and aggravate fibromyalgia symptoms. By realigning the misaligned vertebrae releases the stress off of the spinal cord and spinal nerve root. That is why individuals with fibromyalgia are recommended to add a chiropractor to their healthcare team.

Body Composition

Dietary Supplement Quality Guide


Clauw, Daniel J et al. “The science of fibromyalgia.” Mayo Clinic proceedings vol. 86,9 (2011): 907-11. doi:10.4065/mcp.2011.0206

Cohen H. Controversies and challenges in fibromyalgia: a review and a proposal. Ther Adv Musculoskelet Dis. 2017 May;9(5):115-27.

Garland, Eric L. “Pain processing in the human nervous system: a selective review of nociceptive and biobehavioral pathways.” Primary care vol. 39,3 (2012): 561-71. doi:10.1016/j.pop.2012.06.013

Goldenberg DL. (2017). Pathogenesis of fibromyalgia. Schur PH, (Ed). UpToDate. Waltham, MA: UpToDate Inc.

Kamping S, Bomba IC, Kanske P, Diesch E, Flor H. Deficient modulation of pain by a positive emotional context in fibromyalgia patients. Pain. 2013 Sep;154(9):1846-55.

Chiropractic Examination Fibromyalgia Diagnosis

Chiropractic Examination Fibromyalgia Diagnosis

A fibromyalgia diagnosis involves the process of eliminating other disorders and conditions with similar symptoms. It can be difficult to diagnose fibromyalgia. There is no common exam or test that a doctor can use to definitively diagnose fibromyalgia. The elimination process is utilized because of several other conditions with similar symptoms. These include:
  • Rheumatoid arthritis
  • Chronic fatigue syndrome
  • Lupus
11860 Vista Del Sol, Ste. 128 Chiropractic Examination Fibromyalgia Diagnosis
It can take some time when an individual first notices symptoms and actually being diagnosed with fibromyalgia, which can be frustrating. Doctors have to become detectives, working hard to find the right cause of pain and other symptoms. Developing the right diagnosis is necessary to create an optimal treatment plan.  

Fibromyalgia Diagnosis Criteria

  • Pain and symptoms based on the total number of painful areas
  • Fatigue
  • Poor sleep
  • Thinking problems
  • Memory problems
In 2010, a study was published that updated fibromyalgia diagnosis criteria for fibromyalgia. The new criteria remove the emphasis on tender point examination. The 2010 criteria’s focus is more on the widespread pain index or WPI. There is an item checklist about where and when an individual experiences pain. This index is combined with a symptom severity scale, and the end result is a new way to classify and develop a fibromyalgia diagnosis.  

Diagnostic Process

Medical History

A doctor will look at an individual’s complete medical history, asking about any other conditions present and family condition/disease history.

Symptoms Discussion

The most common questions asked by a doctor are where it hurts, how it hurts, how long it hurts, etc. However, an individual should offer as much or added details of their symptoms. Diagnosing fibromyalgia is very dependent on the report of the symptoms, so it is important to be as specific and accurate as possible. A pain diary, which is a record of all symptoms that present will make it easier to remember and share information with the doctor. An example is giving information on trouble sleeping, with a feeling of tiredness a majority of the time, and headache presentation.

Physical Examination

A doctor will palpate or apply light pressure with the hands around the tender points.  
11860 Vista Del Sol, Ste. 128 Chiropractic Examination Fibromyalgia Diagnosis

Other Tests

As previously stated symptoms can be very similar to other conditions like: A doctor wants to rule out any other conditions, so they will order various tests. These tests are not to diagnose fibromyalgia but to eliminate other possible conditions. A doctor could order:

Anti-nuclear antibody – ANA test

Anti-nuclear antibodies are abnormal proteins that can present in the blood if an individual has lupus. The doctor will want to see if the blood has these proteins to rule out lupus.

Blood count

By looking at an individual’s blood count, a doctor will be able to develop other possible causes for extreme fatigue like anemia.

Erythrocyte sedimentation rate – ESR

An erythrocyte sedimentation rate test measures how quickly red blood cells fall to the bottom of a test tube. In individuals with a rheumatic disease like rheumatoid arthritis, the sedimentation rate is higher. The red blood cells fall quickly to the bottom. This suggests that there is inflammation in the body.  

Rheumatoid factor – RF test

For individuals with an inflammatory condition like rheumatoid arthritis, a higher level of the rheumatoid factor can be identified in the blood. A higher level of RF does not guarantee that the pain is caused by rheumatoid arthritis, but doing an RF test will help the doctor explore a possible RA diagnosis.

Thyroid tests

Thyroid tests will help a doctor rule out thyroid problems.

Final Note Fibromyalgia Diagnosis

Again, diagnosing fibromyalgia can take awhile. A patient’s job is to be proactive in the diagnostic process. Be sure you understand what the results will tell and how that specific test will help figure out the cause of the pain. If you don’t understand the results, keep asking questions until it makes sense.



Body composition and Diabetes Connection

The body needs a balance of lean body mass and fat mass to function properly/optimally and maintain overall health. The balance can be disrupted in overweight and obese individuals because of excess fat. Individuals that are overweight should focus on improving body composition by reducing fat mass while maintaining or increasing lean body mass. Balanced body composition can reduce the risk of diabetes, other obesity-related disorders, and a positive effect on metabolism. Metabolism is the breaking down of foods for energy, the maintenance, and repair of body structures. The body breaks down the food nutrients/minerals into elemental components and directs them to where they need to go. Diabetes is a metabolic disorder meaning it changes the way the body makes use of the nutrients, in such a way that the cells are unable to utilize digested glucose for energy. Without insulin, the glucose cannot get into the cells, so it ends up lingering in the blood. When the glucose can�t make its way out of the blood, it builds up. All the excess blood sugar can potentially be converted to triglycerides and stored as fat. With an increase in fat mass, hormone imbalances or systemic inflammation can happen or progress. This increases the risk for other diseases or conditions. A buildup of fat and diabetes are associated with increased risk for:
  • Heart attacks
  • Nerve damage
  • Eye problems
  • Kidney disease
  • Skin infections
  • Stroke
Diabetes can even cause the immune system to become impaired. When combined with poor circulation to the extremities, the risk of wounds, infections, can lead to amputation of the toes, foot/feet, or leg/s.  

Dr. Alex Jimenez�s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*  
American College of Rheumatology. Fibromyalgia. 2013.� Accessed December 5, 2014. Living with Fibromyalgia:�Mayo Clinic Proceedings.�(June 2006) �Improvement in Fibromyalgia Symptoms With Acupuncture: Results of a Randomized Controlled Trial�� What Are Common Fibromyalgia Symptoms and How Does It Cause Back Pain?:�Clinical Biomechanics.�(July 2012) �Functional capacity, muscle strength and falls in women with fibromyalgia��
Fatigue And Fibromyalgia Chiropractic Therapeutics

Fatigue And Fibromyalgia Chiropractic Therapeutics

Fibromyalgia is a musculoskeletal condition that consists of pain symptoms and fatigue that can make diagnosis a challenge. Through chiropractic therapeutics, individuals can find relief from pain, fatigue, inflammation, and improve their quality of life. Individuals dealing with fibromyalgia and searching for answers should consider consulting a chiropractor to determine what treatment options will provide the most benefits. Treatment can be as much of a challenge without clear underlying issues. This often leads to frustration when trying to develop a treatment plan that works. �


Fibromyalgia is characterized by:

  • Body aches and pain
  • Tender points in muscles
  • General fatigue

Accompanied issues include:

  • Headaches
  • Anxiety
  • Depression
  • Sleep issues
  • Poor concentration
11860 Vista Del Sol, Ste. 128 Fatigue And Fibromyalgia Chiropractic Therapeutics

It is believed that fibromyalgia causes the brain and spinal cord to transmit amplified/overresponsive signals. The exaggerated response of the neural pathways in the spine and body generate chronic pain. This is where specific diagnostic tools for assessing symptoms, underlying cause/s, and treatment development are necessary. Risk factors include:

  • Smoking
  • Genetics
  • Previous infections
  • Autoimmune disorders
  • Trauma
  • Mental disorders
  • Sedentary lifestyle


Fibromyalgia treatment that is most effective consists of lifestyle adjustments. These usually include:

Treatment for chronic pain, swelling, and low energy includes:

  • Massage therapy
  • Physical therapy
  • Medication
  • Acupuncture
  • Chiropractic therapeutics

Chiropractors have a significant advantage for addressing these symptoms.

11860 Vista Del Sol, Ste. 128 Fatigue And Fibromyalgia Chiropractic Therapeutics

Chiropractic Therapeutics

Chiropractic therapeutics is a safe, gentle, non-invasive treatment option that can help alleviate body pain and swelling. Options include:

  • Spinal re-alignment
  • Physical therapy/massage for improved nerve circulation
  • Manual manipulation
  • Soft tissue therapy
  • Health coaching

When the body is rebalanced it can better manage symptoms because of the improved nerve circulation. Home treatments can include:

  • Exercise
  • Stretching
  • Heat therapy
  • Ice therapy

A full medical team consisting of the doctor, physical therapist, massage therapist, and chiropractor could be utilized to maximize results and ensure the highest quality of life.

Body Composition


Muscles and The Immune System

Increasing muscle mass is a great way to improve body composition and boost the immune system. Research shows that senior adults with greater skeletal muscle mass have an increased number of immune cells in the blood. This indicates that muscles and the immune system are interrelated.

When the muscles are worked out, myokines are released. These are hormone-type proteins that strengthen the immune system that helps protect against diseases. A study revealed that regular exercise increases the release of T lymphocytes/T cells. Regular exercise also helps reduce the risk of developing chronic diseases like type 2 diabetes, obesity, various cancers, and cardiovascular diseases.

Dr. Alex Jimenez�s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*

Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*


Schneider, Michael et al. �Chiropractic management of fibromyalgia syndrome: a systematic review of the literature.��Journal of manipulative and physiological therapeutics�vol. 32,1 (2009): 25-40. doi:10.1016/j.jmpt.2008.08.012

Mental Health Professionals Can Help with Fibromyalgia

Mental Health Professionals Can Help with Fibromyalgia

Fibromyalgia pain is not just physical. Around 30% of individuals experience depression, anxiety, or some form of mood disturbance/swing. Fibromyalgia is still being researched if it causes these conditions or vice versa, but what is clear is that when the mental state gives in to the physical pain, your pain gets worse and worse.

A doctor may recommend a:

  • Counselor
  • Psychologist
  • Psychiatrist


11860 Vista Del Sol, Ste. 128 Mental Health Professionals Can Help with Fibromyalgia El Paso, Texas

Symptoms are varied and impact an individual’s life in ways that go beyond physical pain. Fatigue alone can be enough to alter lifestyle in a negative way, which affects mood.

Taking control of symptoms usually means taking a multi-disciplinary approach that includes:

  • Medications
  • Physical therapy
  • Psychology

Mental and emotional therapy could be a part of a treatment plan.


Depression and Anxiety Difference

Depression and anxiety are sometimes put in the same category. Symptoms can include depression and anxiety occur at the same time but they are not synonymous disorders. Depression is characterized by chronic sadness. Individuals handle depression, their own way. Some cry or lash out in anger/frustration. Some days are spent in bed, other days/nights are spent eating excessively, as a response to the pain. The most important thing is recognizing the change in behavior. Talk to your doctor or a therapist.

Anxiety is known for feelings of panic, fear, and excessive worry. Individuals feel their heart is racing that can get confused with a heart problem.


Fibromyalgia Depression Connection

To understand how fibromyalgia relates to depression and anxiety, and see the difference between depression and anxiety, here are some symptoms.


11860 Vista Del Sol, Ste. 128 Mental Health Professionals Can Help with Fibromyalgia El Paso, Texas


The symbols show symptoms most associated with the disorder. However, it’s possible to experience less sleep than normal if you have depression, but the more common symptom is sleeping more than usual.



Finding a Mental Health Professional

Professionals include:

  • Licensed professional counselors (PCs)
  • Psychologists
  • Psychiatrists

These professionals are trained to diagnose and treat mental/emotional issues. Your doctor can help in figuring out which is best for you.

  • Licensed professional counselors require a master’s degree in counseling and are approved to diagnose and treat mental and emotional disorders.
  • Psychologists are considered as a separate group of non-physician mental health professionals. They have a doctorate and are approved to treat emotional problems using therapies like cognitive-behavioral therapy.
  • Psychiatrists are medical doctors that are licensed to prescribe medications to help depression and anxiety, along with several mental disorders.

Adding the impact this disorder has on a person’s mental and emotional state can seriously damage their quality of life. Recognizing when the pain is not just physical is difficult. Therefore setting up a telemedicine/video conference with a mental health professional could help in dealing with the mental stresses that come with fibromyalgia. Even for those that don’t require medication seeing a mental health professional can be highly beneficial.

You can openly talk about experiences having to do with fibromyalgia, how it affects your family, etc,� which is therapeutic in itself. Do not hesitate to seek the help of a mental health professional. The focus is to help you feel better, become educated on ways to help yourself and improved quality of life.


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Fibromyalgia and Chiropractic Medicine El Paso

Fibromyalgia and Chiropractic Medicine El Paso

Fibromyalgia is a chronic pain disorder affecting millions and mostly women. It is physically and emotionally distressing. Those with the condition experience widespread chronic muscle pain. Research has shown that individuals with fibromyalgia could have a lower threshold for pain. This can come from injury, emotional distress, or abnormal levels of substances/chemicals in the brain and spine linked to pain sensitivity. One of the most common treatments is chiropractic medicine.


11860 Vista Del Sol, Ste. 128 Fibromyalgia and Chiropractic Medicine El Paso, Texas

Common symptoms/conditions individuals report:

  • Chronic fatigue syndrome
  • Irritable bladder
  • Irritable bowel syndrome
  • Migraines
  • Sleep disorders
  • Restless legs syndrome
  • TMJ or Temporomandibular joint disorder
  • Raynaud’s Syndrome�-�a�rare blood vessel disorder causing the toes and hands to feel cold or numb.

Doctors are still trying to figure out the relationship between these conditions and fibromyalgia.



Doctors have yet to determine the exact cause, however, research is ongoing and beginning to shed light on the condition. Some possible causes include:

  • Abnormalities in the endocrine system
  • Abnormalities in the autonomic nervous system
  • Genetics
  • Muscle tissue abnormalities
  • Abnormal blood flow


Fibromyalgia Diagram 3 | El Paso, TX Chiropractor


As research has discovered many conditions/disorders do not have one cause but rather, several factors that impact the probability of developing the condition.



It has become one of the most common chronic pain conditions. 1 in 50 Americans are dealing with fibromyalgia. The condition can be difficult to diagnose, and, because of its chronic nature, it can linger for months and even years. Typically it causes pain throughout the body and creates areas that become tender to the slightest touch. There are both traditional and alternative treatments available.

Traditional approaches to manage the pain:

  • Anti-inflammatory’s
  • Over-the-counter pain relievers
  • Sleep medications
  • Muscle relaxants

Fibromyalgia medications include:

  • Lyrica – pregabalin, which is a nerve pain medication
  • Cymbalta – duloxetine hydrochloride, which is an antidepressant that can also help manage pain
  • Savella – milnacipran HCI, which is an antidepressant and nerve pain medicine

The type of treatment depends on the symptoms. For example, a doctor could prescribe an antidepressant to reduce pain and depression. If stress, anxiety, and trouble sleeping are presenting,�a therapeutic exercise program could be the answer. Individuals prefer natural remedies/therapies instead of more medications like vitamin therapy, acupuncture, and meditation.


11860 Vista Del Sol, Ste. 128 Fibromyalgia and Chiropractic Medicine El Paso, Texas


Other treatment options include alternative treatments like:

A doctor will usually recommend you see a physical therapist, chiropractor, and possibly psychologist to work on the mental and emotional toll.

Chiropractic medicine benefits

Pain is reduced

The most common issue is constant and consistent pain, which can affect the entire body for weeks and even months. Individuals realize that chiropractic helps restore overall health and aids the body to heal itself. Adjustments to the spine bring alignment and balance back to the body. Also incorporated is soft tissue work that can relieve and reduce painful pressure/trigger points and decrease pain in tender spots.


Range of motion is increased

Chiropractic medicine also adjusts the body’s joints and helps loosen them up. This increases the range of motion and allows the individual to move more freely and easily. Depending on how long the individual has been dealing with the condition, it can take a few treatments to achieve optimal results, so it does take a commitment from the individual patient. However, in the long run, it is well worth the time.


Sleep is improved

The pain associated with fibromyalgia often affects an individual’s ability to sleep well. Being unable to sleep normally will leave you exhausted, foggy, unable to accomplish things and irritable to downright angry. A chiropractor’s ability to loosen the body’s joints, massage tender points, and kickstart the body’s self-healing mechanisms means individuals with this condition can enjoy deep sleep, and stay asleep.

Complements other therapies

Medicines/treatments/therapies can counteract with each other, or get mixed up and cause side effects. Chiropractic medicine can be utilized in combination with medications/treatments, either traditional or natural. Individuals diagnosed with this condition should speak to their chiropractor about the different treatments available. Customized treatment programs are created case-by-case and are tailored to the specific needs of that individual. Remember there is not a one-stop solution.


Empowers the individual

Individuals that have to deal with painful, chronic conditions can exhaust themselves with the varying treatment options and can feel as if they have no control over the situation. This causes stress, anxiety, and depression, which works against achieving overall wellness. With chiropractic, individuals are more in charge of their treatment plan, which leads to an optimistic outlook in their recovery.�

Chiropractic medicine treats not only the symptoms of fibromyalgia but attempts to get to the root cause to alleviate the condition or to activate the body’s self-healing response. Patients that commit will see the benefits along with reduced pain, better mobility, and sound sleep.

The best benefit is being able to take control of the circumstances and playing a vital role in the managing of an individual’s well-being. Understand that there are options available for fibromyalgia pain management. If you or a loved one has been diagnosed with fibromyalgia, don�t go it alone. Dr. Alex Jimenez is passionate about helping those who are injured or struggling with a condition get relief. Contact us today to schedule an appointment.


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An Overview of Fibromyalgia

An Overview of Fibromyalgia

Do you feel:

  • Afternoon fatigue?
  • Headaches with exertion or stress?
  • Can you not stay asleep?
  • Slow starter in the morning?
  • Afternoon headaches?

If you are experiencing any of these situations, then you might be experiencing fibromyalgia.

Fibromyalgia is a common and chronic syndrome that causes pain and mental distress in the body. It causes widespread musculoskeletal pain, and it is accompanied by fatigue, sleep memory, and mood issues to the body.�The symptoms may be similar to arthritis; however, fibromyalgia is a rheumatic condition and causes soft tissue pain or myofascial pain.


The NIAMS (National Institute of Arthritis and Musculoskeletal and Skin Diseases) stated that around 5 million adults, ages 18 years and over in the United States had experienced fibromyalgia. Around 80 to 90 percent of fibromyalgia patients are mostly found in women who have this chronic disease, and men can have it as well.

Symptoms of Fibromyalgia


There are three symptoms that fibromyalgia causes a person to have discomfort in their daily lives. They are:

  • Widespread pain: This pain is associated with fibromyalgia, and it is described as a constant dull ache that can last for at least three months. For it to be considered as widespread pain, it must occur both sides of the body, as well as above and below the waist.
  • Fatigue: Individuals with fibromyalgia often awaken tired, even though they have been sleeping for long periods. The pain that fibromyalgia causes can disrupt the person’s sleep patterns, causing them to have sleep disorders such as restless legs syndrome and sleep apnea.
  • Cognitive difficulties: This symptom is commonly known as �fibro fog.� It impairs the person�s ability to focus, pay attention, and concentrate on mental tasks.

Other symptoms can include:

  • IBS (irritable bowel syndrome)
  • Stiff joints and muscles in the morning
  • Headaches
  • Problems with vision
  • Nausea
  • Pelvic and urinary problems
  • Depression and anxiety

In the past, studies have shown that patients diagnosed with fibromyalgia had 11 out of 18 specific trigger points all around their bodies. Healthcare providers would check their patients and document how many of these points were painful to their patients by firmly, but gently, pressing their bodies to get a diagnosis.

The typical trigger points include:

  • The back of the head
  • The tops of the shoulders
  • The upper chest
  • The hips
  • The knees
  • The outer elbows

Nowadays, in a 2016 revised diagnostic criteria, healthcare providers can diagnose patients with fibromyalgia if the patient has pain in 4 out of 5 areas of the body that is causing them pain. The protocol when diagnosing patients is referred to as �multisite pain.�

Fibromyalgia Affecting the Endocrine System

When it comes to fibromyalgia, the symptoms are associated with the endocrine system. Research shows that fibromyalgia-like symptoms such as muscle pain and tenderness, exhaustion, reduced exercise capacity, and cold intolerance can resemble symptoms that are associated with the endocrine dysfunction like hypothyroidism and adrenal or growth hormone insufficiency.

More research has stated that fibromyalgia causes a person to develop chronic fatigue syndrome. Chronic fatigue syndrome causes the body to have a deficiency of serotonergic activity and the hypofunction of sympathetic nervous system function that could contribute to the abnormalities of the central components of the HPA axis. It can distort the body’s hormonal pattern that is being attributed to the hyperactivity of the CRH neurons. The hyperactivity caused by the CRH neurons can be driven and sustained by stress being exerted by chronic pain that has originated in the musculoskeletal system or the alternation of the central nervous system mechanism of nociception.


Researchers believe that repeated nerve stimulation causes the brains of patients with fibromyalgia to change. The change causes an abnormal increase level of certain chemicals (neurotransmitters) in the brain that signals pain. In addition, the brain�s pain receptors will develop a sort of memory of the pain that is causing problems to the patient�s body and causing them to be more sensitive since the signals are overreacting.

Treating Fibromyalgia


Even though fibromyalgia pain can be uncomfortable and consistent enough to interfere with a person�s daily routine. There are ways to relieve the pain and inflammation that fibromyalgia causes the body. Pain medication can bring down the inflammation and help a person sleep a little better. Other safe treatments that can help manage fibromyalgia pain are:

  • Acupuncture: Acupuncture is a Chinese medical system that uses needles to cause changes in the blood flow and the levels of neurotransmitters in the brain and spinal cord.
  • Therapy: A variety of different therapies can help a person reduce the effects that fibromyalgia has caused.
  • Yoga and tai chi: These practices combine meditation, slow movements, deep breathing, and relaxation � both help control fibromyalgia symptoms.
  • Reducing stress: Developing a plan to avoid or limit overexertion and emotional stress is useful when dealing with fibromyalgia. Learning to meditate and trying stress management techniques can help a person feel calm and recharged for the rest of the day.
  • Getting enough sleep: Since fatigue is one of the main characteristics of fibromyalgia, getting enough sleep is essential. Practicing good sleep habits and going to bed and getting up at the same time each day can lessen the effects of fatigue.
  • Exercising regularly: At first, exercising may increase the pain, but doing it gradually and regularly over time can decrease the symptoms. This can be walking, swimming, biking, and water aerobics can be beneficial to the body.
  • Pacing yourself: Keeping track of activities is beneficial for people with fibromyalgia. Moderation of daily activities on the good days can help a person overcome the symptoms when they flare-up.
  • Maintaining a healthy lifestyle: Eating healthy food that has anti-inflammatory properties can be useful for the body, and finding enjoyable hobbies can be beneficial as well.


Fibromyalgia is a chronic illness that causes pain and inflammation that affects the soft tissue in the body. The symptoms can resemble joint inflammation and causes people to have fatigue and discomfort all over their body. When these symptoms flare up, it can cause body damage. Treatments can help a person reduce the effects of fibromyalgia and be beneficial. Some products are formulated to counter the effects of temporary stress and offer support in the gastrointestinal system and the body�s metabolism.

The scope of our information is limited to chiropractic, musculoskeletal, and nervous health issues as well as functional medicine articles, topics, and discussions. We use functional health protocols to treat injuries or chronic disorders of the musculoskeletal system. To further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at�915-850-0900�.


Felman, Adam. �Fibromyalgia: Symptoms, Causes, and Treatment.� Medical News Today, MediLexicon International, 5 Jan. 2018,

Geenen, Rinie, et al. �Evaluation and Management of Endocrine Dysfunction in Fibromyalgia.� Rheumatic Diseases Clinics of North America, U.S. National Library of Medicine, May 2002,

Neeck, G, and L J Crofford. �Neuroendocrine Perturbations in Fibromyalgia and Chronic Fatigue Syndrome.� Rheumatic Diseases Clinics of North America, U.S. National Library of Medicine, Nov. 2000,

Staff, Mayo Clinic. �Fibromyalgia.� Mayo Clinic, Mayo Foundation for Medical Education and Research, 11 Aug. 2017,

Staff, Mayo Clinic. �Fibromyalgia.� Mayo Clinic, Mayo Foundation for Medical Education and Research, 11 Aug. 2017,

Unknown, Unknown. �Fibromyalgia.� National Institute of Arthritis and Musculoskeletal and Skin Diseases, U.S. Department of Health and Human Services, 30 Sept. 2019,

Wolfe, Frederick, et al. �2016 Revisions to the 2010/2011 Fibromyalgia Diagnostic Criteria.� Seminars in Arthritis and Rheumatism, W.B. Saunders, 30 Aug. 2016,



Gluteus Tendinopathy, Sciatica and Fibromyalgia

Gluteus Tendinopathy, Sciatica and Fibromyalgia

Gluteus Tendinopathy and Sciatica Symptoms in Fibromyalgia


Gluteus medius tendinopathy (GMT), also known as dead butt syndrome (DBS), is a painful health issue caused by the inflammation of the tendons in the gluteus medius muscle. The gluteus medius (GM) is one of the smallest, less-known muscles of the buttocks which ultimately functions by providing stability and support to the structures of the hip and pelvis, especially throughout weight-bearing physical activities. Although GMT most commonly affects athletes, it can also affect people starting a new exercise program, during an intense workout routine or due to an underlying health issue. �


Healthcare professionals have reported an increased number of GMT cases over the past several years. While many doctors and functional medicine practitioners believe that this may perhaps be due to how many people participate and engage in exercise or physical activities after sitting down for extended periods of time, many GMT cases may actually be due to a well-known health issue called fibromyalgia. In the following article, we will discuss gluteus medius tendinopathy (GMT), or dead butt syndrome (DBS), fibromyalgia and how these two conditions can also be associated with sciatica symptoms. �


Gluteal Muscles Diagram 1 | El Paso, TX ChiropractorGluteal Medius Tendinopathy Diagram 2 | El Paso, TX Chiropractor


Sciatica and Gluteus Medius Tendinopathy Causes in Fibromyalgia


The common symptoms associated with gluteus medius tendinopathy, or GMT, include pain and discomfort, stiffness, and weakness in the hip or buttocks region. The painful symptoms can generally worsen throughout weight-bearing exercises, such as walking, running, and/or climbing. For many people, the pain and discomfort associated with dead butt syndrome, or DBS, can radiate down the hips, buttocks, and legs or thighs, similar to sciatica and hamstring tendinopathy. Sciatica is a collection of symptoms characterized by pain and discomfort, tingling sensations, and numbness along the sciatic nerve. �


Many patients diagnosed with GMT also report experiencing painful symptoms when lying in bed on the affected hip or buttocks region as well as pain, discomfort, stiffness, and weakness throughout the night and upon rising in the morning. Moreover, if DBS progresses past the initial stage, the hip bursa may become inflamed, another health issue known as trochanteric bursitis, which may also cause swelling, tenderness, redness or warmth in the hip. In people with fibromyalgia, the widespread pain and discomfort caused by the inflammation of the condition may also ultimately cause GMT symptoms. �


The role of the gluteus medius muscle is to contract the weight-bearing hip throughout walking and running. When this small, lesser-known muscle triggers, the hip flexors release and vice versa. However, when the tendon becomes inflamed due to an injury or an aggravated underlying condition, such as fibromyalgia, the gluteus medius can fail to trigger appropriately, hence why the “dead butt” term is utilized as an alternate name for this health issue. People sitting down for extended periods of time may cause their hip flexors to become tight and failure to stretch before physical activities can cause DBS. �


Furthermore, poor gluteal or buttocks and hip muscle control cause excess stress on the gluteal medius tendon and/or muscle. Several athletes, especially runners, generally avoid utilizing cross-training and weight-lifting in order to help strengthen the larger muscles which support the pelvis when running, however, the hip’s and buttock’s smaller tendons and muscles may take on the excess pressure. If left untreated, gluteus medius tendinopathy (GMT), or dead butt syndrome (DBS) may lead to complications,�including trochanteric bursitis, IT band syndrome, and plantar fasciitis, among other health issues.


Differential Diagnosis of Hip Pain and Discomfort

Fibromyalgia is widespread pain and discomfort throughout the human body. People with this painful condition can experience a variety of symptoms, including sciatica or sciatic nerve pain. Doctors and functional medicine practitioners believe that fibromyalgia can aggravate how the human body feels painful sensations by affecting how the human brain processes pain signals. Fibromyalgia and sciatica are two well-known conditions which can commonly coexist together. However, many fibromyalgia sufferers have also reported experiencing gluteal medius tendinopathy (GMT), or dead butt syndrome (DBS), a painful health issue caused by the inflammation of the tendons in the gluteus medius muscle. Because fibromyalgia is often associated with increased inflammation and painful symptoms, GMT or DBS and sciatica can commonly develop together. – Dr. Alex Jimenez D.C., C.C.S.T. Insight


Fibromyalgia Magazine


Fibromyalgia Magazine April 2019



People with fibromyalgia experience widespread pain and discomfort as a result of their medical condition, however, healthcare professionals have demonstrated that fibromyalgia may also cause other symptoms and health issues to manifest, such as sciatica, or sciatic nerve pain, and gluteal tendinopathy. The purpose of the article above was to demonstrate and compare fibromyalgia, sciatica and gluteal tendinopathy symptoms. The scope of our information is limited to chiropractic, musculoskeletal and nervous health issues as well as functional medicine articles, topics, and discussions. To further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900�. �


Curated by Dr. Alex Jimenez �



Additional Topic Discussion: Severe Sciatica


Back pain�is one of the most prevalent causes of disability and missed days at work worldwide. Back pain attributes to the second most common reason for doctor office visits, outnumbered only by upper-respiratory infections. Approximately 80 percent of the population will experience back pain at least once throughout their life. Your spine is a complex structure made up of bones, joints, ligaments, and muscles, among other soft tissues. Injuries and/or aggravated conditions, such as�herniated discs, can eventually lead to symptoms of sciatica, or sciatic nerve pain. Sports injuries or automobile accident injuries are often the most frequent cause of painful symptoms, however, sometimes the simplest of movements can have these results. Fortunately, alternative treatment options, such as chiropractic care, can help ease sciatic nerve pain, or sciatica, through the utilization of spinal adjustments and manual manipulations, ultimately improving pain relief. �



Formulas for Methylation Support


Xymogen Formulas - El Paso, TX


XYMOGEN�s Exclusive Professional Formulas are available through select licensed health care professionals. The internet sale and discounting of XYMOGEN formulas are strictly prohibited.


Proudly,�Dr. Alexander Jimenez makes XYMOGEN formulas available only to patients under our care.


Please call our office in order for us to assign a doctor consultation for immediate access.


If you are a patient of Injury Medical & Chiropractic�Clinic, you may inquire about XYMOGEN by calling 915-850-0900.

xymogen el paso, tx


For your convenience and review of the XYMOGEN products please review the following link.*XYMOGEN-Catalog-Download


* All of the above XYMOGEN policies remain strictly in force.



� �

Fibromyalgia and Sciatica vs Piriformis Syndrome

Fibromyalgia and Sciatica vs Piriformis Syndrome

Fibromyalgia and sciatica are two well-known health issues which can commonly occur at seemingly the same time in people, however, these may also frequently require different treatment approaches to help manage their painful symptoms. Fibromyalgia is characterized by widespread pain throughout numerous regions of the human body. As complex as the diagnosis and treatment for fibromyalgia might be, it’s ultimately fundamental for patients to be aware of any other conditions which may subsequently develop due to the painful symptoms of these well-known health issues. �


Sciatica, also known as sciatic nerve pain, is a collection of symptoms rather than a single condition and it is one of the most common health issues to coexist together with fibromyalgia. In this instance, one condition doesn’t necessarily cause the other, however, they can basically be present together. Fibromyalgia�patients should understand how sciatica and its characteristic symptoms can affect their overall health and wellness. Many people with fibromyalgia may subsequently develop other health issues when these painful symptoms overlap with other conditions, such as piriformis syndrome. �


Piriformis Syndrome vs Sciatica and Fibromyalgia


People with sciatic nerve pain, or sciatica, will often report experiencing pain and discomfort, tingling sensations, and numbness anywhere along the length of the sciatic nerve. The sciatic nerve is the longest and largest nerve in the human body, which travels from the lower back into the hip and buttocks, down into the thighs, knees, legs, and feet. Healthcare professionals may perform a variety of evaluations and tests to determine the source of a patient’s symptoms. People with fibromyalgia and sciatica may also experience another common health issue known as piriformis syndrome. �


Piriformis Syndrome Diagram 2 | El Paso, TX Chiropractor


Sciatica is caused by the compression or impingement of the sciatic nerve, frequently due to a herniated disc. Piriformis syndrome can cause sciatica when a piriformis muscle spasm irritates the sciatic nerve. The piriformis is a muscle which extends from the front of the sacrum, or the triangle-shaped bone between the two hipbones in the pelvis, across the sciatic nerve and into the top of the femur, or the large bone in the upper leg.� The piriformis muscle is fundamental because it allows the thighs to move from side to side. When an injury or underlying condition causes the piriformis muscle to compress or impinge the sciatic nerve due to irritation and/or inflammation, the end result is typically piriformis syndrome. �


Sciatica Diagram 1 | El Paso, TX Chiropractor


Sciatica is the most common symptom associated with piriformis syndrome. Other common symptoms associated with piriformis syndrome include tingling sensations and numbness, muscle tenderness, pain and discomfort while sitting or engaging in physical activities, and difficulty sitting comfortably. Because fibromyalgia causes widespread pain and inflammation, it’s also fundamental for people with fibromyalgia to seek immediate medical attention to diagnose all of their symptoms and rule out the possibility of their sciatica symptoms being due to piriformis syndrome or any other health issue. �


Fibromyalgia Diagram 3 | El Paso, TX Chiropractor



As previously mentioned above, sciatica, or sciatic nerve pain, is a medical condition or rather a collection of symptoms which causes pain and discomfort anywhere along the entire length of the sciatic nerve. For both fibromyalgia sufferers and people with the health issue alone, the pain and discomfort will generally manifest on one or both sides of the hips, buttocks, and thighs, where it will then radiate down the back of the leg, knees, and feet. In some instances, other common symptoms may manifest along the lower extremities, including tingling sensations, burning sensations, numbness, and weakness.


Sciatic nerve pain is most frequently caused by a slipped disc, a bulging disc, a herniated disc, or any other health issue which ultimately causes nerve pain and discomfort, such as fibromyalgia. When sciatica due to piriformis syndrome and/or another medical condition is experienced by fibromyalgia sufferers, it may be difficult for healthcare professionals to find the true source of their painful symptoms. Also, the symptoms associated with sciatic nerve pain and piriformis syndrome are generally the same for fibromyalgia sufferers, however, the most common causes may not be responsible for the symptoms.


Differential Diagnosis in Hip Pain


Differential Diagnosis Proximal Hip Pain


Fibromyalgia is characterized as widespread pain and discomfort throughout the human body. People with this painful health issue can experience a variety of symptoms, including sciatic nerve pain, or sciatica. Healthcare professionals believe that fibromyalgia can increase the way the human body experiences painful sensations by affecting the way the brain processes pain signals. Fibromyalgia and sciatica are two well-known conditions which can commonly coexist together. However, many fibromyalgia sufferers have reported piriformis syndrome, a condition caused when the piriformis muscle irritates the sciatic nerve. Because fibromyalgia can often be associated with increased pain and inflammation, these painful symptoms and health issues can ultimately occur. – Dr. Alex Jimenez D.C., C.C.S.T. Insight

Fibromyalgia Magazine


Fibromyalgia Magazine April 2019



People with fibromyalgia experience widespread pain and discomfort as a result of their medical condition, however, healthcare professionals have demonstrated that fibromyalgia may also cause other symptoms and health issues to manifest, such as sciatica, or sciatic nerve pain, and piriformis syndrome. The purpose of the article above was to demonstrate and compare fibromyalgia and sciatica symptoms versus piriformis syndrome. The scope of our information is limited to chiropractic, musculoskeletal and nervous health issues as well as functional medicine articles, topics, and discussions. To further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900�. �


Curated by Dr. Alex Jimenez �



Additional Topic Discussion: Severe Sciatica


Back pain�is one of the most prevalent causes of disability and missed days at work worldwide. Back pain attributes to the second most common reason for doctor office visits, outnumbered only by upper-respiratory infections. Approximately 80 percent of the population will experience back pain at least once throughout their life. Your spine is a complex structure made up of bones, joints, ligaments, and muscles, among other soft tissues. Injuries and/or aggravated conditions, such as�herniated discs, can eventually lead to symptoms of sciatica, or sciatic nerve pain. Sports injuries or automobile accident injuries are often the most frequent cause of painful symptoms, however, sometimes the simplest of movements can have these results. Fortunately, alternative treatment options, such as chiropractic care, can help ease sciatic nerve pain, or sciatica, through the utilization of spinal adjustments and manual manipulations, ultimately improving pain relief. �



Formulas for Methylation Support

Xymogen Formulas - El Paso, TX


XYMOGEN�s Exclusive Professional Formulas are available through select licensed health care professionals. The internet sale and discounting of XYMOGEN formulas are strictly prohibited.

Proudly,�Dr. Alexander Jimenez makes XYMOGEN formulas available only to patients under our care.


Please call our office in order for us to assign a doctor consultation for immediate access.

If you are a patient of Injury Medical & Chiropractic�Clinic, you may inquire about XYMOGEN by calling 915-850-0900.

xymogen el paso, tx


For your convenience and review of the XYMOGEN products please review the following link.*XYMOGEN-Catalog-Download

*All of the above XYMOGEN policies remain strictly in force.



Symptoms Associated with Fibromyalgia

Symptoms Associated with Fibromyalgia

Sciatica and Fibromyalgia

Fibromyalgia is a disorder characterized by widespread musculoskeletal pain which is also generally accompanied by fatigue, sleep, memory, and mood health issues. The most common symptoms associated with fibromyalgia include muscle pain and tenderness, however, many people with this painful condition also experience sciatica, a collection of symptoms characterized by pain, discomfort, tingling sensations, and numbness along the length of the sciatic nerve in the lower back. �


Because fibromyalgia can cause painful symptoms throughout several regions of the human body, many people with fibromyalgia may also be diagnosed with other health issues which may overlap with their present symptoms, such as sciatica. It’s essential for patients to seek immediate medical attention from a healthcare professional to receive a proper diagnosis of all of their symptoms as these other health issues may generally require different treatment approaches. �


Sciatica is one of the most common health issues to coexist with fibromyalgia. Fibromyalgia doesn’t necessarily cause sciatica or sciatic nerve pain, however, these can ultimately exist together. It’s also essential for people with fibromyalgia to understand what sciatica is and how these painful symptoms can affect their health and wellness. Healthcare professionals believe that fibromyalgia amplifies painful sensations by affecting the way the human brain processes pain signals. Moreover, fibromyalgia can affect a variety of other structures and functions in the human body, such as the gastrointestinal tract. �


Fibromyalgia and Digestion Problems


Along with muscle pain and tenderness, patients with this painful disorder also experience digestive health issues. About 70 percent of people with fibromyalgia suffer from irritable bowel syndrome symptoms, including gas, bloating, constipation, and diarrhea. Although the causes of digestion health issues and fibromyalgia are unknown, healthcare professionals have demonstrated that there is an undeniable connection between fibromyalgia and digestive health issues. �


The gastrointestinal, or GI, system consists of several fundamental parts including, the esophagus, the stomach, the small intestine, and the bowel. When digestion slows down or a food intolerance, described in further detail below, disrupts the natural process of digestion, a chain of events can cause pain and discomfort, among other symptoms, throughout the entire gastrointestinal, or GI, tract. Patients with fibromyalgia commonly report frustrating digestive problems, such as: �


  • Acid reflux. When the gastric juices are not being utilized in the stomach, they can often travel back up through the esophagus, causing heartburn or a painful sensation in the chest, known as acid reflux.
  • Cramping and constipation. When the process of peristalsis, or the smooth muscle contractions which move food through the gastrointestinal tract, becomes affected due to the irritation of the intestines, it can begin to cramp and prevent the movement of waste through the bowel, causing cramping and constipation.
  • Diarrhea. When the digestive process slows down or stops, undigested food can move from the stomach and into the intestine, where it can irritate the lining of the colon and produce IBS symptoms, such as diarrhea.
  • Gas. The longer food stays in your stomach and intestines, the longer the natural GI bacteria has to break down the compounds and the more methane gas is produced from bacteria metabolism, resulting in gas.


Research studies have utilized brain scans to demonstrate the physiological responses of patients with irritable bowel syndrome, or IBS, and patients with fibromyalgia. According to the research studies, both groups of patients demonstrated higher neurological responses to pain. Patients with IBS and fibromyalgia also demonstrated higher pain awareness. Due to the similar brain activity to pain stimulus, researchers suspect that the two health issues may share underlying causes. �


Many people with fibromyalgia frequently report that certain types of foods irritate their stomach or exacerbate their fibromyalgia symptoms. Dairy and gluten, among other foods, can worsen fibromyalgia. Many people have food intolerances which can be challenging to diagnose. Another common explanation for the digestion problems of patients with fibromyalgia involves the autonomic nervous system, which is in charge of regulating the structure and function of internal organs. �


This autonomic nervous system is made up of two subsystems: the sympathetic nervous system and the parasympathetic nervous system, which rarely work together simultaneously. In patients with fibromyalgia, the sympathetic nervous system, which is largely responsible for increasing blood pressure, heart rate and adrenaline, is almost always active, causes the parasympathetic system, which is largely responsible for relaxation and digestion, to become inactive. Fortunately, patients with fibromyalgia and its associated symptoms like sciatica and digestive problems, can find relief through treatment.

Patients with fibromyalgia commonly experience widespread pain and discomfort, however, research studies have demonstrated a connection between other symptoms and health issues, such as sciatica and digestive problems. The purpose of the following article is to educate as well as discuss how fibromyalgia may be connected to other symptoms like sciatica and irritable bowel syndrome, among other digestive problems. By understanding how these symptoms and health issues are associated with fibromyalgia, patients and doctors can safely and effectively treat this painful condition and its symptoms. – Dr. Alex Jimenez D.C., C.C.S.T. Insight



Non-Invasive Treatments for Chronic Low Back Pain




Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by a variety of symptoms. Many people with this painful condition also experience sciatica and digestive problems. The scope of our information is limited to chiropractic, musculoskeletal and nervous health issues as well as functional medicine articles, topics, and discussions. To further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900�. �


Curated by Dr. Alex Jimenez �



Additional Topic Discussion: Severe Sciatica


Back pain�is one of the most prevalent causes of disability and missed days at work worldwide. Back pain attributes to the second most common reason for doctor office visits, outnumbered only by upper-respiratory infections. Approximately 80 percent of the population will experience back pain at least once throughout their life. Your spine is a complex structure made up of bones, joints, ligaments, and muscles, among other soft tissues. Injuries and/or aggravated conditions, such as�herniated discs, can eventually lead to symptoms of sciatica, or sciatic nerve pain. Sports injuries or automobile accident injuries are often the most frequent cause of painful symptoms, however, sometimes the simplest of movements can have these results. Fortunately, alternative treatment options, such as chiropractic care, can help ease sciatic nerve pain, or sciatica, through the utilization of spinal adjustments and manual manipulations, ultimately improving pain relief. �



Formulas for Methylation Support


Xymogen Formulas - El Paso, TX


XYMOGEN�s Exclusive Professional Formulas are available through select licensed health care professionals. The internet sale and discounting of XYMOGEN formulas are strictly prohibited.


Proudly,�Dr. Alexander Jimenez makes XYMOGEN formulas available only to patients under our care.


Please call our office in order for us to assign a doctor consultation for immediate access.


If you are a patient of Injury Medical & Chiropractic�Clinic, you may inquire about XYMOGEN by calling 915-850-0900.


xymogen el paso, tx


� For your convenience and review of the XYMOGEN products please review the following link.*XYMOGEN-Catalog-Download


* All of the above XYMOGEN policies remain strictly in force.



Benefits of Self-Care Techniques for TMD and Fibromyalgia

Benefits of Self-Care Techniques for TMD and Fibromyalgia

Although oral devices, such as splints and bite guards, are the most prevalent treatments for facial pain associated with temporomandibular disorders, or TMD, patients have found that these remedies are frequently less effective than self-care techniques, such as jaw exercises or warm compresses, according to a new research study published by researchers at the New York University (NYU) College of Dentistry in New York City.

The research study, published in the journal Clinical Oral Investigations, demonstrates that self-care techniques should primarily be utilized to help treat muscle-related temporomandibular disorders or TMD.

TMD, occasionally known as TMJ after the temporomandibular joint, is a collection of prevalent painful conditions which develop in the jaw joint and its surrounding muscles. Myofascial temporomandibular disorder, or mTMD, is a muscular condition which affects over 10 percent of women. Individuals with TMD often suffer from other chronic pain conditions. Research studies found that 7 to 18 percent of people with TMD also experience fibromyalgia, a condition characterized by widespread pain.

Treatments for TMD and Fibromyalgia

Dentists and patients utilize an assortment of treatments to help manage facial pain, such as oral devices like splints and bite guards, pain medicines, including nonsteroidal anti-inflammatory drugs, and self-care methods like jaw exercises and hot compresses.

Oral devices are a prevalent first-line treatment for TMD, regardless of research study outcome measures regarding their advantages, stated Vivian Santiago, Ph.D., MPH, research study scientist at the Department of Oral and Maxillofacial Pathology, Radiology, and Medicine at NYU College of Dentistry, and the research study’s leading author.

“While oral splints have been discovered to have some benefits, they have yet to be found to be as successful for patients who have widespread pain when treating mTMD,” she explained.

In this research study, the researchers evaluated what non-medication remedies women with mTMD utilized to handle their pain as well as how successful patients perceived these remedies. The researchers interviewed a total of 125 women including 26 women who had fibromyalgia and mTMD, so as to find out whether treatment differed for patients.

The most frequent treatments reported were oral devices (utilized by 59 percent of participants), physical therapy (utilized by 54 percent of participants), and at-home jaw exercises (utilized by 34 percent of participants). The least frequent treatments reported were acupuncture (utilized by 20 percent), chiropractic care (utilized by 18 percent), trigger point injections (utilized by 14 percent), yoga (utilized by 7 percent), and meditation (utilized by 6 percent). Participants frequently used more than one treatment.

Participants reported the most improvement in their pain from well-known self-care techniques, such as jaw exercises, yoga, meditation, massage, and warm compresses, with over 84 percent reporting that these techniques helped reduce painful symptoms. Only 64 percent of participants who used the oral devices reported that they helped improve their pain. About 11 percent of women who used oral devices stated that these made their pain worse, an area which warrants further research studies.

Oral devices failed to outperform self-care techniques in improving facial pain, according to Karen Raphael, Ph.D., professor at the Department of Oral and Maxillofacial Pathology, Radiology, and Medicine at NYU College of Dentistry, and the research study’s co-author.

“Our outcome measures encourage utilizing self-care techniques as the first line of treatment for mTMD before contemplating more costly interventions,” stated Raphael.

The researchers didn’t find substantial differences between the amount of remedies reported by women with and without fibromyalgia. While the use of alternative treatment options for mTMD was reported among women with fibromyalgia, further research studies are still required. Pain relief tended to be greater through the use of self-care techniques in women with and without fibromyalgia.

“While fibromyalgia is diagnosed by a healthcare professional, such as a rheumatologist, TMD is typically diagnosed and treated by a dentist,” said Santiago. “Our research study demonstrates that dentists must ask patients with facial pain if they also have widespread chronic pain because this might provide more information to help plan their treatment.”

Dr Jimenez White Coat

Fibromyalgia is a health issue characterized by widespread chronic pain accompanied by fatigue, sleep, memory and mood problems. Fibromyalgia has been associated with a variety of other health issues, such as TMD and/or TMJ. Individuals with this painful disorder may often struggle to engage in their everyday physical activities. As a qualified and experienced chiropractor, I’ve helped treat numerous patients with fibromyalgia. It’s important for patients to know that they are not alone when it comes to treating their painful symptoms. Chiropractic care is an alternative treatment option which can help treat a variety of health issues, including fibromyalgia.

Dr. Alex Jimenez D.C., C.C.S.T. Insight

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The scope of our information is limited to chiropractic, spinal health issues, and functional medicine articles, topics, and discussions. To further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900 .

Curated by Dr. Alex Jimenez

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Additional Topic Discussion: Acute Back Pain

Back pain is one of the most prevalent causes of disability and missed days at work worldwide. Back pain attributes to the second most common reason for doctor office visits, outnumbered only by upper-respiratory infections. Approximately 80 percent of the population will experience back pain at least once throughout their life. Your spine is a complex structure made up of bones, joints, ligaments, and muscles, among other soft tissues. Injuries and/or aggravated conditions, such as herniated discs, can eventually lead to symptoms of back pain. Sports injuries or automobile accident injuries are often the most frequent cause of back pain, however, sometimes the simplest of movements can have painful results. Fortunately, alternative treatment options, such as chiropractic care, can help ease back pain through the use of spinal adjustments and manual manipulations, ultimately improving pain relief.

Xymogen Formulas - El Paso, TX

XYMOGEN�s Exclusive Professional Formulas are available through select licensed health care professionals. The internet sale and discounting of XYMOGEN formulas are strictly prohibited.

Proudly, Dr. Alexander Jimenez makes XYMOGEN formulas available only to patients under our care.

Please call our office in order for us to assign a doctor consultation for immediate access.

If you are a patient of Injury Medical & Chiropractic Clinic, you may inquire about XYMOGEN by calling 915-850-0900.

xymogen el paso, tx

For your convenience and review of the XYMOGEN products please review the following link.*XYMOGEN-Catalog-Download

* All the above XYMOGEN policies remain strictly in force.


How Chiropractic Care Helps Relieve Fibromyalgia

How Chiropractic Care Helps Relieve Fibromyalgia

I actually feel pretty good right away, just because I know what I need and he knows how to take care of my particular injury. So, I’m usually good to go, next day, after I get re-aligned. Without a shadow of a doubt. I like the way he treats his patients, I like the way he treats me and he gets it done for me. I would recommend Dr. Jimenez to anyone. He is incredible. He is awesome. And I think he can pretty much pinpoint a lot of the issues that you may have. – Carlos Hermosillo


The vast majority of people are capable of dealing with a little bit of pain. Some people may often experience the occasional aggravation from overdoing their workout at the gym or perhaps some people have experienced that sudden twinge out of hitting their shins on the mattress, however, most of the time, these symptoms can be easily dismissed through the use of an over-the-counter anti-inflammatory drug and/or medication and they can go about their everyday life again as usual. But when pain is much more widespread throughout the whole body and it starts to be accompanied with fatigue, changes in mood and sleep patterns, these people may be dealing with a more serious health issue: fibromyalgia.


What is Fibromyalgia?


Fibromyalgia is a medical term utilized to describe a group of symptoms, rather than a single condition. Ordinarily, someone who is experiencing debilitating fatigue, tender areas around their the body, changes in mood or muscular pain, it may be characterized as common symptoms associated with this particular illness. Even though many healthcare professionals are still not sure about what causes fibromyalgia, most believe the pain is due to an overactive sympathetic nervous system, the part of the human body which activates the fight or flight response. A great deal of individuals experience symptoms after a physically or emotionally traumatic event. Other individuals begin having pain after spells of chronic depression or anxiety although others have symptoms that grow gradually over time. Fibromyalgia has been demonstrated to impact more women than men and in the event that they’ve got a relative with the disease, they are more likely to develop it also.


How is Fibromyalgia Treated?


Because fibromyalgia is not considered to be a single illness but rather a collection of symptoms and since it’s cause is unknown, there is currently no known cure for fibromyalgia. Instead, healthcare professionals generally focus on improving as well as managing the symptoms, typically by prescribing pain drugs and/or medications. Frequently, in case the sympathetic nervous system does respond to drugs/medications, the pain will subside. Healthcare professionals usually prescribe a combination of pain drugs and/or medications, antidepressants or anti-seizure medication to achieve this sort of regulation and alleviate symptoms. However, this treatment approach only temporarily relieves the symptoms associated with fibromyalgia instead of treating the health issue at its source. Chiropractic care is a safe and effective, alternative treatment option which focuses on the diagnosis, treatment and prevention of a variety of injuries and conditions associated with the musculoskeletal and nervous system.



Dr. Alex Jimenez’s Insight

Many patients with fibromyalgia seek chiropractic care to help ease neck pain, back pain and leg cramps which are often common symptoms associated with this syndrome. Research studies have also demonstrated that spinal adjustments and manual manipulations can help relieve chronic pain. One research study evaluated the effectiveness of chiropractic care on relieving symptoms related to fibromyalgia. The outcome measures demonstrated a decrease in pain and fatigue as well as an increase in the quality of sleep of the patients. A chiropractor who specializes in patients with fibromyalgia can carefully correct the alignment of the spine, alleviating the chronic pain associated with fibromyalgia.


Chiropractic Care for Fibromyalgia


Although fibromyalgia cannot be cured, one of the most well-known ways of managing and improving your symptoms is with chiropractic care. Chiropractic care can help relieve fibromyalgia pain by�carefully correct any spinal misalignments, or subluxations, through the use of spinal adjustments and manual manipulations. A variety of research studies have also demonstrated that other treatment techniques, such as aerobic exercise together with postural strengthening activities, which not only alleviate widespread pain, but also increase energy levels, improve sleep and elevate mood. Through an appropriate treatment plan, a chiropractor can help balance your own body’s capability to control nerve impulses, thus relieving your fibromyalgia symptoms. Normally, chiropractic care can include the following treatment techniques, besides spinal adjustments and manual manipulations.


Cardiovascular Exercise


One of the best methods to alleviate widespread pain would be by means of low-impact movement. This may include exercises and physical activities, such as walking on a treadmill, water aerobics or other exercises aimed towards improving blood flow, reducing strain and increasing cardiovascular fitness. A doctor of chiropractic, or chiropractic, can prescribe an exercise and physical activities program designed to your abilities, in order to help relieve fibromyalgia pain and symptoms.


Muscle Strengthening and Range of Motion


If you are in pain, the human body’s natural tendency is to protect the area, or limit its motion from fear of causing aggravation. This limited mobility can weaken substantial muscle structures and functions which further limit your range of motion and lift your stress� levels. This vicious cycle can only be improved by working to strengthen weakened muscles and reunite range of motion to the area you have been guarding. But how can you do this if you are in pain? A chiropractor will combine special exercises and physical activities together with other treatment approaches in order to help promote a faster recovery as well as decrease the symptoms of pain. A chiropractor will also closely assess the patient to make sure they are performing the right treatments.


Pain Relieving Modalities


A doctor of chiropractic, or chiropractor, comprises a large number of tools aimed toward relieving pain without the need for drugs and/or medications. These may consist�of ice, heat, trigger point therapy, stretching, massage, electrical stimulation, or other therapeutic tools that can help limit your pain and retrain your body. With concentrated exercise together with a cardiovascular exercise program, it is very likely to retrain your body without triggering widespread pain. Whether you have a disease which cannot be cured, such as fibromyalgia, it is very likely to get relief in the worst indications throughout alternative treatment options. Contact a healthcare professional to schedule your evaluation and find out how we can get you on the road to recovery. The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at�915-850-0900�.


Curated by Dr. Alex Jimenez




Additional Topics: Acute Back Pain

Back pain is one of the most prevalent causes for disability and missed days at work worldwide. As a matter of fact, back pain has been attributed as the second most common reason for doctor office visits, outnumbered only by upper-respiratory infections. Approximately 80 percent of the population will experience some type of back pain at least once throughout their life. The spine is a complex structure made up of bones, joints, ligaments and muscles, among other soft tissues. Because of this, injuries and/or aggravated conditions, such as herniated discs, can eventually lead to symptoms of back pain. Sports injuries or automobile accident injuries are often the most frequent cause of back pain, however, sometimes the simplest of movements can have painful results. Fortunately, alternative treatment options, such as chiropractic care, can help ease back pain through the use of spinal adjustments and manual manipulations, ultimately improving pain relief.




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EXTRA IMPORTANT TOPIC: Low Back Pain Management


Fibromyalgia, 4 Ways Chiropractic Helps | El Paso, TX.

Fibromyalgia, 4 Ways Chiropractic Helps | El Paso, TX.

Fibromyalgia is one of the most common chronic pain conditions in the United States. It is believed to affect one in fifty people in the U.S. alone, according to the American College of Rheumatology.

This condition is very problematic because it is extremely difficult to diagnose. It is also difficult to treat because it tends to be a chronic condition. Many doctors use pain medication that treats the symptoms, but there is evidence that shows chiropractic treatment as a very effective way to treat fibromyalgia, minimize the pain, and even control.

What Is Fibromyalgia?

fibromyalgia el paso tx.Doctors don�t really know what fibromyalgia is or what causes it, but researchers believe that that the condition affects the way that the brain processes pain, causing it to be amplified and spread throughout the body. Symptoms of fibromyalgia include pain, excessive sleeping, mood swings, fatigue, memory loss, fuzziness, and depression. It seems to be more prevalent in women than in men.

The condition may develop suddenly after severe psychological stress or physical trauma such as infection or surgery. However, it may also develop gradually with no known triggers. Often people who suffer from fibromyalgia also have irritable bowel syndrome, tension headaches, anxiety, temporomandibular joint (TMJ), and depression.

4 Ways That Chiropractors Can Help Fibromyalgia Patients

fibromyalgia el paso tx.There are four primary ways that a chiropractor can help patients with fibromyalgia. Chiropractic focuses on whole body wellness and has been shown to be very effective in treating the condition.

Chiropractic Adjustments

This chiropractic technique helps to realign your body and re-establish the connection between the nervous system and nerves throughout the body. It essentially resets the nervous system so that the brain can process pain more accurately. In fibromyalgia the pain is believed to be caused by the central nervous system receiving faulty or inaccurate pain signals and the result is pain felt throughout the body.

Physical Therapy

This is an important part of treatment that your chiropractor will recommend. Fibromyalgia can cause severe muscular pain and patient stop moving or exercising because it simply hurts too much. When the patient stops moving they lose muscle tone which actually exacerbates the effects of the condition.

Lifestyle Adjustment Recommendations

The chiropractor may also make recommendations regarding lifestyle adjustments. This can include incorporating exercise into the patient�s daily routine or finding ways to control the pain without medication. A patient who spends most of their day sitting behind a desk may be advised to take periodic walks. The recommendations will depend on the patient�s everyday activities and lifestyle.

Nutritional Recommendations

Nutrition plays a large part in every aspect of the body. It can cure conditions and help alleviate symptoms. The chiropractor will often make recommendations regarding changes to the diet and supplements. It helps both the psychological aspects of the condition as well as they psychological ones. This type of treatment is often recommended in conjunction with chiropractic treatments as part of a whole body wellness approach.

Chiropractic treatments have been shown to be very successful in treating fibromyalgia patients, particularly in alleviating pain. Patients report a significant decrease in neck, back, and leg pain after just one visit. Because it provides immediate relief without medication, chiropractic is regarded as one of the best treatments for the condition. When the spine is properly aligned the entire body functions more efficiently and effectively.

One of the most attractive benefits of chiropractic treatments is that it treats pain and mobility issues without the use of medications. In the case of fibromyalgia, because so little is actually known about it, chiropractic is an optimal treatment method because it does work but it does not put an additional burden on the body by introducing medications.

Chiropractic Clinic Extra: Fibromyalgia Care & Treatment

Fibromyalgia History And Definition

Fibromyalgia History And Definition

Fibromyalgia History

Fibromyalgia History: Historically, fibromyalgia � or conditions very like it � have been reported for hundreds of years, under many names, including the most unsatisfactory term �fibrositis�. The fascinating history of what we now call fibromyalgia syndrome (FMS) and myofascial pain syndrome (MPS) has been catalogued by several modern clinicians working in the sphere of chronic muscle pain, from whose work the material summarized in Box 1.1 has been compiled. Thanks are due to these individuals (Peter Baldry, David Simons and Richard van Why in particular) for revealing so much about past studies into the phenomenon of chronic muscle pain. What we can learn from this information is just how long ago (well over 150 years) particular features were recognized, for example pain referral patterns and characteristics such as taut bands and �nodules�, as well as insights from many astute researchers and clinicians into the pathophysiology of these conditions.

American College Of Rheumatology Definition

Simply defined, fibromyalgia syndrome (FMS) can be said to be a debilitating illness, characterized primarily by musculoskeletal pain, fatigue, sleep disturbances, depression and stiffness (Yunus & Inanici 2002). It was not until the 1980s that a redefining took place of what was by then a confused � and confusing � picture of a common condition. In 1987, the American Medical Association recognized fibromyalgia as a distinct syndrome (Starlanyl & Copeland 1996), although at that time detailed knowledge of what the syndrome comprised was not as clear as the current, generally accepted American College of Rheumatology (ACR) definition, which was produced in 1990 (see Box 1.2 and Fig. 1.1). Russell (in Mense & Simons 2001) notes that defining the condition had profound effects on the scientific and medical communities:

fibromyalgia historyfibromyalgia historyfibromyalgia historyfibromyalgia history

fibromyalgia history

In the wake of successful classification criteria, a surge of investigative energy in the early 1990s led to a number of important new observations. FMS was found to be universally common. It was present in approximately 2% of the adult population of the USA and exhibited a similar distribution in most other countries where valid epidemiological studies had been conducted. Adult women were affected five to seven times more commonly than were men. In children the gender distribution was about equal for boys or girls.

When psychosocial and physical/functional factors of people with FMS were compared with those six different, predominantly chronic pain syndromes (upper extremity pain, cervical pain, thoracic pain, lumbar pain, lower extremity pain and headache), it was found that the fibromyalgia group experienced the most difficulties, by a significant margin. In regard to gender distribution of these seven chronic pain conditions, it was noted that fibromyalgia (and headache) are experienced by more females than males (Porter-Mofitt et al 2006).

fibromyalgia history


What can be said with certainty about fibromyalgia syndrome is that:

� It is a non-deforming rheumatic condition, and, indeed, one of the commonest such conditions.

� It is an ancient condition, newly defined (controversially � see below) as a disease complex or syndrome.

� There is no single cause, or cure, for its widespread and persistent symptoms (however, as will become clear, there do seem to exist distinct subsets of individuals with different aetiologies to their conditions, such as thyroid imbalance and whiplash injuries).

� Its complex causation often seems to require more than one essential aetiological factor to be operating, and there are numerous theories as to what these might be (see Ch. 4).

� There has been an explosion of research into the subject over the past decade (one data search on the internet revealed over 20 000 papers which mention fibromyalgia as a key word).

Despite its earlier medical meaning, which suggested involvement of both articular and non-articular structures, the word rheumatic has, through common usage, come to mean �a painful but nondeforming soft tissue musculoskeletal condition�, as distinct from the word arthritic which suggests articular and/or deforming features (Block 1993).

The Fibromyalgia Controversy

For the purposes of practicality this book accepts that the current widely used ACR definition is a hypothesis that is evolving, but that it may be flawed (see below). The definition as presented in Box 1.2 allows for the categorization of individuals with chronic pain and associated symptoms into subgroups, and offers clinicians a chance to begin to decipher the confusing patterns of symptoms displayed and reported by people who have been so labelled. However, not all experts, including many of the contributors to this text, accept the ACR definition. Nevertheless, since it forms the foundation for much of the research reported on in the book, the current definition needs to be given due consideration.

What Are The Arguments Against The ACR Definition?

Schneider et al (2006) sum up one major alternative view:

Recent data tend to support the notion that FMS is a disorder of the central nervous system pain processing pathways, and not some type of primary auto-immune disorder of the peripheral tissues. It is quite possible that the term FMS is a poor choice of words, for it implies that patients with a variable symptom complex all have the same singular disease or disorder.

As will be clear in subsequent chapters, this is precisely the message that this book will promote � that there are numerous aetiological influences relating to the symptom cluster represented by people with a diagnosis of FMS, and that within that population subgroups can be identified that demand quite distinctive therapeutic handling, compared with other subgroup cohorts. A logical extension of this multicausal scenario is a model that offers a variety of potential therapeutic interventions, none of which would have universal applicability, and most of which would be most usefully employed in treatment of specific subgroups within the overall diagnosis of FMS. The chapters in this book that reflect a variety of therapeutic approaches include those that evaluate and explain the use of acupuncture, endocrine issues, psychological influences, myofascial trigger points/ dry needling, use of microcurrent, hydrotherapy, therapeutic touch, manipulation, massage, exercise, nutrition and various other clinical methods. The issues surrounding FMS subsets, and of possible over(or mis-)diagnosis of FMS, are explored more fully in Chapters 3, 4 and 5.

Problems Arising From The ACR Definition

Useful as the defining of this condition has been, there are distinct and obvious problems with a definition as precise as that offered by the ACR:

� If pressure varies only slightly, so that on a �good day� a patient may report sensitivity and tenderness rather than �pain� when tender points are being tested, the patient may therefore not �qualify�; this could have very real insurance benefit implications, as well as leaving distressed individuals still seeking a diagnosis which might help them understand their suffering.

� If all other criteria are present, and fewer than 11 of the 18 possible sites are reported as �painful� (say only 9 or 10), what diagnosis is appropriate?

� If there are 11 painful sites but the �widespread� nature of the pain is missing (as per the definition in Box 1.2), what diagnosis is appropriate? Clearly, what is being observed in people with widespread pain and who also demonstrate at least 11 of the 18 test points as being painful is a situation which represents the distant end of a spectrum of dysfunction. Others who do not quite meet the required (for a diagnosis of FMS) number of tender points may well be progressing towards that unhappy state.

As reported earlier, approximately 2% of the population meet all the ACR criteria (Wolfe et al 1993). A great many more people, however, are advancing in that direction, according to both British and American research, which shows that about 20% of the population suffer �widespread� pain that matches the ACR definition, with almost the same number, but not necessarily the same people, demonstrating 11 of the specified 18 tender points as being painful on appropriate testing, also in accordance with the ACR definition. Some people have the widespread pain and not enough painful points, while others have the points but their generalized pain distribution is not sufficiently widespread.

What Condition Do They Have If It Is Not FMS (Croft et al 1992)?

If all the criteria are not fully met, and people with, say, 9 or 10 points (rather than the 11 needed) are offered a diagnosis of FMS (and therefore become eligible for insurance reimbursement or disability benefits, or suitable for inclusion in research projects), what of the person with only 8 painful points who meets all the other criteria?

In human terms this is all far from an academic exercise, for pain of this degree is distressing and possibly disabling, whether or not 11 (or more) points are painful. Clinically, such patients should receive the same attention, wherever they happen to be in the spectrum of disability, and whatever the tender point score, if their pain is sufficient to require professional attention.

As will become clear as examination of FMS unfolds in this and subsequent chapters, the frustration of the patient is matched in large degree by that of health care providers attempting to understand and offer treatment for the patient with FMS. This is largely because no single aetiological pattern has emerged from research efforts to date. Russell (in Mense & Simons 2001) sums it up as follows:

The cause of FMS is unknown, but growing evidence indicates that its pathogenesis involves aberrant neurochemical processing of sensory�signals in the CNS. The symptomatic result is lowering of the pain thresholds and an amplification of normal sensory signals until the patient experiences near constant pain.

As will also become clear, the components of the pathogenesis of the condition commonly include biochemical, psychological and biomechanical features. Somewhere in the combination of causal elements and unique characteristics of the individual may lie opportunities for functional improvement and the easing of the often intractable pain and other symptoms associated with FMS.

Symptoms Other Than Pain

In 1992, at the Second World Congress on Myofascial Pain and Fibromyalgia in Copenhagen, a consensus document on fibromyalgia was produced and later published in The Lancet (Copenhagen Declaration 1992). This declaration accepted the ACR fibromyalgia definition as the basis for a diagnosis, and added a number of symptoms to that definition (apart from widespread pain and multiple tender points), including persistent fatigue, generalized morning stiffness and non-refreshing sleep.

The Copenhagen document recognized that people with FMS may indeed at times present with fewer than 11 painful points � which is clearly important if most of the other criteria for the diagnosis are met. In such a case, a diagnosis of �possible FMS� is thought appropriate, with a follow-up examination suggested to reassess the condition.

There are practical implications for a cut-off point (of symptoms or tender point numbers, for example) in making such a diagnosis: these relate directly to insurance reimbursement and/or disability benefits, as well as, possibly, to differential diagnosis.

The Copenhagen document adds that FMS is seen to be a part of a larger complex which includes symptoms such as headache, irritable bladder, dysmenorrhoea, extreme sensitivity to cold, restless legs, odd patterns of numbness and tingling, intolerance to exercise, and other symptoms.

Mind Issues

The Copenhagen Declaration (1992) of the symptoms associated with FMS (over and above pain, which is clearly the defining feature) also addresses the psychological patterns often related to FMS, namely anxiety and/or depression.

The possible psychological component in FMS is an area of study fraught with entrenched beliefs and defensive responses. A large body of medical opinion assigns the entire FMS phenomenon � as well as chronic fatigue syndrome (CFS) � to the arena of psychosomatic/psychosocial illness. An equally well-defined position, occupied by many health care professionals as well as most patients, holds that anxiety and depression symptoms are more commonly a result, rather than a cause, of the pain and disability being experienced in FMS (McIntyre 1993a).

A 1994 review paper analysed all British medical publications on the topic of CFS from 1980 onwards and found that 49% favoured a non-organic cause while only 31% favoured an organic cause. When the popular press was examined in the same way, between 70% (newspapers) and 80% (women�s magazines) favoured an organic explanation (McClean & Wesseley 1994).

Typical of the perspective which holds to a largely �psychological� aetiology is a multicentre study by Epstein and colleagues, which was published in 1999. It concluded: �In this multicenter study, the persons with FMS exhibited marked functional impairment, high levels of some lifetime and current psychiatric disorders, and significant current psychological distress.� The most common disorders noted were major depression, dysthymia, panic disorder and simple phobia.

Many leading researchers into FMS who hold to an organic � biochemical � neurological explanation for the main symptoms are, however, dismissive of psychological explanations for the condition. Dr Jay Goldstein, whose detailed and important research and clinical insights into the care of patients with CFS and FMS will be outlined later in this book, uses the term �neurosomatic� to describe what he sees as a disorder of central information processing. He makes clear his position regarding the non-organic, psychosocial school of thought (Goldstein 1996):

Many of the illnesses [CFS, FMS] treated using this model [neurosomatic] are still termed �psychosomatic� by the medical community and are treated psychodynamically by psychiatrists, neurologists and general physicians. Social anthropologists also have their theories describing CFS as the �neurasthenia� of the 1990s, and a �culture bound syndrome� that�displaces the repressed conflicts of patients unable to express their emotions (�alexithymics�) into a culturally acceptable viral illness or immune dysfunction. Cognitive�behavioural therapy is perhaps more appropriate, since coping with the vicissitudes of their illnesses, which wax and wane unpredictably, is a major problem for most of those afflicted. Few investigators in psychosomatic illness (except those researching panic disorders) have concerned themselves about the pathophysiology of the patients they study, seeming content to define this population in psychosocial phenomenological terms. This position becomes increasingly untenable as the mind�body duality disappears.

Goldstein says that he only refers patients for psychotherapy if they are suicidally depressed. He emphasizes the normalization (using a variety of medications) of the biochemical basis for neural network dysfunction, which he has satisfied himself is the underlying cause of these (and many other) conditions.

When Is A Cause Not A Cause?

Goldstein�s methods will be examined in later chapters; however, it might prove useful at this stage to make a slight diversion in order to clarify the importance of looking beyond apparent causes to attempt to uncover their origins.

As we progress through the saga which is FMS (and CFS) we will come across a number of welldefined positions which maintain that the dominant cause is X or Y � or more usually a combination of X and Y (and possibly others). The truth is that in some important instances these �causes� themselves have underlying causes, which might usefully be therapeutically addressed.

An example � which will emerge in more detail later � is the suggestion that many of the problems associated with FMS (and CFS) are allergy related (Tuncer 1997). This may well be so in the sense that particular foods or substances can be shown, in given cases, to provoke or exacerbate symptoms of pain and fatigue. But what produces this increased reactivity/sensitivity? Are there identifiable causes of the (usually food) intolerances (Ventura et al 2006)?

In some cases this can be shown to result from malabsorption of large molecules through the intestinal wall, possibly due to damage to the mucosal surfaces of the gut (Tagesson 1983, Zar 2005). In some cases the mucosal damage itself can be shown to have resulted from abnormal yeast or bacterial overgrowth, resulting from prior (possibly inappropriate) use of antibiotics and consequent disturbance of the normal flora, and their control over opportunistic organisms (Crissinger 1990). Or the disturbed gut mucosa may be associated with endotoxaemia involving disturbed beneficial bacteria status (McNaught et al 2005).

The layers of the onion can be peeled away one by one, revealing causes which lie ever further from the obvious. The pain is aggravated by allergy, which results from bowel mucosa damage, which results from yeast overgrowth, which results from excessive or inappropriate use of antibiotics… and so on. The allergy in this example is not a cause per se but an exacerbating factor, a link in a chain, and while treating it might satisfactorily reduce symptoms, it would not necessarily deal with causes. Neither would treating the bacterial or yeast overgrowth, although this too might well assist in reducing overall symptom distress.

Where does the cause lie in this particular individual�s FMS? Probably in a complex array of interlocking (often historical) features, which may be impossible to untangle. Therefore, approaches such as those which direct themselves at the allergy or at the increased permeability, while possibly (in this instance) valid and helpful, are not necessarily dealing with fundamental causes.

Does this matter? In Goldstein�s model of FMS and CFS aetiology we are faced with a neural network which is dysfunctional. He acknowledges that the evolution of such a state requires several interacting elements:

� a basic susceptibility which is probably genetically induced

� some developmental factors in childhood (physical, chemical or psychological abuse/ trauma, for example)

� probably a degree of viral encephalopathy (influenced by �situational perturbations of the immune response�)

� increased susceptibility to environmental stressors resulting from reduction in neural plasticity.

The possibility that early developmental trauma or abuse is a feature is supported by research. For example, Weissbecker et al (2006) report that:

Adults with fibromyalgia syndrome report high rates of childhood trauma. Neuroendocrine abnormalities have also been noted in this population. Findings suggest that severe traumatic experiences in childhood may be a factor of adult neuroendocrine dysregulation among fibromyalgia sufferers. Trauma history should be evaluated and psychosocial intervention may be indicated as a component of treatment for fibromyalgia.

The �causes� within this model can be seen to be widely spread. Goldstein�s (apparently successful) interventions deal with what is happening at the end of this complex sweep of events when the neural network has, as a result, become dysfunctional. By manipulating the biochemistry of that end-state, many (Goldstein says most) of his patients� symptoms apparently improve dramatically and rapidly.

Such improvement does not necessarily indicate that underlying causes have been addressed; if these are still operating, future health problems may be expected to eventually emerge. The schematic representation of a �stairway to ill-health� (Fig. 1.2) indicates some of the possible features ongoing in complicated dysfunctional patterns such as FMS, where adaptive resources have been stretched to their limits, and the �stage of exhaustion� in Selye�s general adaptation syndrome has been reached (Selye 1952). See also the discussion of allostasis in Chapter 3, particularly Table 3.2.

Dysfunctional patterns such as CFS and FMS seem to have three overlapping aetiological features interacting with the unique inborn and subsequently acquired characteristics of individuals to determine their particular degree of vulnerability and susceptibility (Fig. 1.3):

1. Biochemical factors. These can include toxicity, deficiency, infectious, endocrine, allergic and other characteristics (Wood 2006).

2. Biomechanical factors. These might include:

a. structural (congenital � i.e. short leg or hypermobility features � postural or traumatically induced characteristics) (Gedalia et al 1993, Goldman 1991)

b. functional (overuse patterns, hyperventilation stresses on respiratory mechanisms, etc.)

c. neurological (sensitization, hypersensitivity � �wind-up�) (Staud et al 2005).

3. Psychosocial factors. These might include depression and/or anxiety traits, poor stress coping abilities, post-traumatic stress disorders, etc. (Arguellesa et al 2006).

Let us briefly consider Dr Goldstein�s model of dysfunction, which suggests neural network dysfunction as the �cause� of FMS, itself being a result of a combination of features as outlined above (Goldstein 1996). If we utilize the clinical options suggested in Figure 1.2, we can see that it is possible to attempt to:

1. reduce the biochemical, biomechanical or psychogenic �stress� burden to which the person is responding

2. enhance the defense, repair, immune functions of the person so that they can handle these stressors more effectively

3. palliate the symptoms, hopefully without producing any increase in adaptive demands on an already overloaded system.

Which of these tactics are being employed in Goldstein�s treatment approach in which drug-induced biochemical manipulation is being carried out, and does this address causes or symptoms, and does this matter, as long as there is overall improvement?

The particular philosophical perspective adopted by the practitioner/therapist will determine his judgement on this question. Some may see the rapid symptom relief claimed for the majority of these patients as justifying Goldstein�s particular therapeutic approach. Others might see this as offering short term benefits, not addressing underlying causes, and leaving the likelihood of a return of the original symptoms, or of others evolving, a probability. These issues will be explored in relation to this and other approaches to treatment of FMS in later chapters.

Associated Conditions

A number of other complex conditions exist which have symptom patterns which mimic many of those observed in FMS, in particular:

� chronic myofascial pain syndrome (MPS) involving multiple active myofascial trigger points and their painful repercussions

� chronic fatigue syndrome (CFS) which has among its assortment of symptoms almost all those ascribed to FMS, with greater emphasis on the fatigue elements, rather than the pain ones

� multiple chemical sensitivity (MCS)

� post-traumatic stress disorder (PTSD). MPS, FMS, MCS (for example, in relation to what has become known as Gulf War syndrome) and CFS � their similarities, and the sometimes great degree of overlap in their symptom presentation, as well as their differences � will be examined in later chapters. One feature of all of these conditions which has been highlighted is based on a toxic/biochemical hypothesis, involving �elevated levels of nitric oxide and its potent oxidant product, peroxynitrite� (Pall 2001).


fibromyalgia history

fibromyalgia history


Other Theories Of Causation

A variety of theories as to the causation of FMS have emerged, with many of these overlapping and some being essentially the same as others, with only slight differences in emphasis as to aetiology, cause and effect. FMS is variously thought to involve any of a combination of the following (as well as other) causative features, each of which raises questions as well as suggesting answers and therapeutic possibilities:

� FMS could be a neuroendocrine disturbance, particularly involving thyroid hormone imbalances (see Ch. 10) (Garrison & Breeding 2003, Honeyman 1997, Lowe 1997, Lowe & Honeyman-Lowe 2006) and/or hypophyseal growth hormone imbalances (possibly as a direct result of sleep disturbance � a key feature of FMS, and/or lack of physical exercise) (Moldofsky 1993). The question which then needs to be asked is, what produces the endocrine disturbance? Is it genetically determined as some believe, or is it the result of deficiency, toxicity, allergy, an autoimmune condition or infection?

� Duna & Wilke (1993) propose that disordered sleep leads to reduced serotonin production, and consequent reduction in the pain-modulating effects of endorphins and increased �substance P� levels, combined with sympathetic nervous system changes resulting in muscle ischaemia and increased sensitivity to pain (Duna & Wilke 1993). This hypothesis starts with a symptom, sleep disturbance, and the logical question is, what produces this?

� Dysautonomia, autonomic imbalance or dysfunction, characterized by �relentless sympathetic hyperactivity�, more prominent at night (Martinez-Lavin & Hermosillo 2005), have been proposed as foundational causes in a subgroup of individuals with FMS (and CFS). Many such patients have also been labelled with Gulf War-related illness (Geisser et al 2006, Haley et al 2004, van der Borne 2004).

� Muscle microtrauma may be the cause, possibly due to genetic predisposition (and/or growth hormone dysfunction), leading to calcium leakage, and so increasing muscle contraction and reducing oxygen supply. An associated decrease in mitochondrial energy production would lead to local fatigue and an inability for excess calcium to be pumped out of the cells, resulting in local hypertonia and pain (Wolfe et al 1992). The question as to why muscle microtrauma occurs more in some people than in others, or why repair is slower, requires investigation.

� FMS may be a pain modulation disorder resulting at least in part from brain (limbic system) dysfunction and involving mistranslation of sensory signals and consequent misreporting (Goldstein 1996). Why and how the limbic system and neural networks become dysfunctional is the key to this hypothesis (promoted by Goldstein, as discussed above).

� It has been suggested that what are termed idiopathic pain disorders (IPD) � such as temporomandibular joint disorders (TMJD), fibromyalgia syndrome (FMS), irritable bowel syndrome (IBS), chronic headaches, interstitial cystitis, chronic pelvic pain, chronic tinnitus, whiplash-associated disorders and vulvar vestibulitis (VVS) � are mediated by an individual�s genetic variability, as well as by exposure to environmental events. The primary pathways of vulnerability that underlie the development of such conditions are seen to involve pain amplification and psychological distress, modified by gender and ethnicity (Diatchenko et al 2006) (Fig. 1.4).

� FMS may be a congenitally acquired disorder, possibly related to inadequate thyroid regulation of gene transcription, with an autosomal dominant feature (Lowe et al 1997, Pellegrino et al 1989). As will be outlined, some research studies have found evidence of a genetically linked predisposition towards FMS. Congenital structural abnormalities, such as extreme ligamentous laxity (i.e. hypermobility (Karaaslan et al 2000)), and Chiari malformations (see further discussion of this in Ch. 3 (Kesler & Mandizabal 1999, Thimineur et al 2002)), certainly seem to predispose toward FMS. The questions this raises include: which factors exacerbate these predispositions, and can anything be done about them?

� Hudson et al (2004) have proposed that fibromyalgia is one member of a group of 14 psychiatric and medical disorders (attentiondeficit/hyperactivity disorder, bulimia nervosa, dysthymic disorder, generalized anxiety disorder, major depressive disorder, obsessive-compulsive disorder, panic disorder, post-traumatic stress�disorder, premenstrual dysphoric disorder and social phobia � plus four medical conditions: fibromyalgia, irritable bowel syndrome, migraine, and cataplexy), collectively termed affective spectrum disorder (ASD), hypothesized to share possibly heritable pathophysiological features. Following detailed analysis of data from 800 individuals with and without fibromyalgia (and the additional conditions under assessment), Hudson et al concluded that the present information added to evidence that the psychiatric and medical disorders, grouped under the term ASD, run together in families, raising the possibility that these disorders might share a heritable physiological abnormality.

fibromyalgia history

� The underlying cause of FMS is seen by some to result from the (often combined) involvement of allergy, infection, toxicity and nutritional deficiency factors which themselves produce the major symptoms of FMS (and CFS), such as fatigue and pain, or which are associated with endocrine imbalances and the various consequences outlined above, such as thyroid hormone dysfunction and/or sleep disturbance (Abraham & Lubran 1981, Bland 1995, Cleveland et al 1992, Fibromyalgia Network Newsletters 1990�94, Pall 2001, Robinson 1981, Vorberg 1985). The list of possible interacting features such as these, which frequently seem to coexist in someone with FMS, offers the possibility of intervention strategies which seem to focus on causes rather than effects. For example, specific �excitotoxins� such as monosodium glutamate (MSG) have been identified as triggering FMS symptoms (Smith et al 2001). These and other examples will be examined in later chapters.

� A central sensitization hypothesis suggests that central mechanisms of FMS pain are dependent on abnormal peripheral input(s) for development�and maintenance of the condition (Vierck 2006). A substantial literature defines peripheral�CNS� peripheral interactions that seem integral to fibromyalgia pain. The generalized hypersensitivity associated with the condition has focused interest on central (CNS) mechanisms for the disorder. These include central sensitization, central disinhibition and a dysfunctional hypothalamic�pituitary�adrenal (HPA) axis. However, it is asserted that the central effects associated with fibromyalgia can be produced by peripheral sources of pain. In this model, chronic nociceptive input induces central sensitization, magnifying pain and activating the HPA axis and the sympathetic nervous system. Chronic sympathetic activation then indirectly sensitizes peripheral nociceptors, and sets up a vicious cycle. (See also notes on facilitation later in this chapter, as well as further discussion of central and peripheral sensitization in Ch. 4.)

� Use of MRI and other scanning/imaging technology suggests that the central sensitization concept has objective evidence to support it. This subject is discussed further in Chapter 3 (see �The polysymptomatic patient�) and Chapter 4 (see �Central sensitization hypothesis� and Fig. 3.1). Two examples of imaging evidence, relating to altered brain morphology and/or behaviour in relation to FMS, are summarized in Box 1.3.

� Within the framework of �allergy� and �intolerance� as triggers to FMS symptoms lies a hypothesis which remains controversial, but worthy of discussion. This relates to the concept of blood-type specific intolerances resulting from an interaction between food-derived lectins (protein molecules) and specific tissue markers related to the individual�s blood type. D�Adamo (2002), who has done most to promote this concept, states (in relation to FMS sufferers who happen to be type O):

It has become obvious that those who are type O and suffering from fibromyalgia can see quite dramatic responses if they can stick to the wheat-free component of the diet for a long enough duration. A recent study indicates that dietary lectins interacting with enterocytes (cells lining�the intestines) and lymphocytes may facilitate the transportation of both dietary and gutderived pathogenic antigens to peripheral tissues, which in turn causes persistent immune stimulation at the periphery of the body, such as the joints and muscles (Cordain et al 2000). This, despite the fact that many nutrition �authorities� still question whether lectins even get into the systemic circulation! In genetically susceptible individuals, this lectin stimulation may ultimately result in the expression of disorders like rheumatoid arthritis and fibromyalgia via molecular mimicry, a process whereby foreign peptides, similar in structure to endogenous peptides, may cause antibodies or T-lymphocytes to cross-react and thereby break immunological tolerance. Thus by removing the general and type O specific lectins from the diet, we allow for the immune system to redevelop tolerance, the inflammation begins to ebb, and healing can begin.

fibromyalgia history

� Many FMS patients demonstrate low carbon dioxide levels when resting � an indication of possible hyperventilation involvement. The symptoms of hyperventilation closely mirror those of FMS and CFS, and the pattern of upper chest breathing which it involves severely stresses the muscles of the upper body which are most affected in FMS, as well as producing major oxygen deficits in the brain and so influencing its processing of information such as messages received from pain receptors (Chaitow et al 2002, Janda 1988, King 1988, Lum 1981). When hyperventilation tendencies are present, they can be seen in some instances to be a response to elevated acid levels (because of organ dysfunction perhaps) or they can be the result of pure habit. Breathing retraining can, in some FMS patients, offer a means of modifying symptoms rapidly (Readhead 1984).

� Psychogenic (or psychosomatic) rheumatism is the name ascribed to FMS (and other nonspecific chronic muscle pain problems) by those who are reluctant to see an organic origin for the syndrome. Until the 1960s it was suggested that such conditions be treated as �psychoneurosis� (Warner 1964). In FMS, as in all chronic forms of ill-health, there are undoubtedly elements of emotional involvement, whether as a cause or as an effect. These impact directly on pain perception and immune function, and, whether causative or not, benefit from appropriate attention, assisting both in recovery and rehabilitation (Melzack & Wall 1988, Solomon 1981).

� FMS is seen by some to be an extreme of the myofascial pain syndrome (MPS), where numerous active myofascial triggers produce pain both locally and at a distance (Thompson 1990). Others see FMS and MPS as distinctive, but recognize that �it is not uncommon for a patient with myofascial pain syndrome to progress with time to a clinical picture identical to that of FMS� (Bennett 1986a). Among the most important practical pain-relieving approaches to FMS will be the need to identify and deactivate myofascial trigger points which may be influencing the overall pain burden. A number of different approaches, ranging from electroacupuncture to manual methods, will be detailed (see Chs 6, 8 and 9 in particular).

� Trauma (e.g. whiplash) seems to be a key feature of the onset in many cases of FMS, and especially cervical injuries, particularly those involving the suboccipital musculature (Bennett 1986b, Curatolo et al 2001, Hallgren et al 1993). Recognition of mechanical, structural factors allows for interventions which address their repercussions, as well as the psychological effects of trauma. In Chapter 9 Carolyn McMakin presents compelling evidence for the use of microcurrents in treatment of FMS of traumatic (especially of the cervical region) origin.

� There is an �immune dysfunction� model for myalgic encephalomyelitis (ME) � that uniquely British name for what appears to be an amalgam of chronic fatigue syndrome and fibromyalgia. This proposes a viral or other (vaccination, trauma, etc.) initial trigger which may lead to persistent overactivity of the immune system (overproduction of cytokines). Associated with this there may be chemical and/or food allergies, hypothalamic disturbance, hormonal imbalance and specific areas of the brain (e.g. limbic system) �malfunctioning�. The primary feature of this model is the overactive immune function, with many of the other features, such as endocrine imbalance and brain dysfunction, secondary to this (Macintyre 1993b). In recent research, the presence of systemic bacterial, mycoplasmal and viral coinfections in many�patients with CFS and FMS has been a feature (Nicolson et al 2002).

The Musculoskeletal Terrain Of FMS

Current research and clinical consensus seem to indicate that FMS is not primarily a musculoskeletal problem, although it is in the tissues of this system that its major symptoms manifest: �Fibromyalgia is a chronic, painful, musculo-skeletal condition characterised by widespread aching and points of tenderness associated with: 1) changed perception of pain, abnormal sleep patterns and reduced brain serotonin; and 2) abnormalities of microcirculation and energy metabolism in muscle� (Eisinger et al 1994).

These characteristics, involving abnormal microcirculation and energy deficits, are the prerequisites for the evolution of localized areas of myofascial distress and neural hyper-reactivity (i.e. trigger points). As indicated, one of the key questions to be answered in any given case is the degree to which the person�s pain is deriving from myofascial trigger points, or other musculoskeletal sources, since these may well be more easily modified than the complex underlying imbalances which are producing, contributing to, or maintaining the primary FMS condition.

Fibromyalgia History: Early Research

A great deal of research into FMS (under different names � see Box 1.1), and of the physiological mechanisms that increase our understanding of the FMS phenomenon, has been conducted over the past century (and earlier) and is worthy of review. Additional research in parallel with that focused on chronic muscular pain may clarify processes at work in this complex condition.

Korr�s Work On Facilitation

Among the most important researchers in the area of musculoskeletal dysfunction and pain over the past half century has been Professor Irwin Korr, whose work in explaining the facilitation phenomenon offers important insights into some of the events occurring in FMS and, more specifically, in myofascial pain settings. Needless to say, these often overlap. As suggested above, in a clinical context it is vital to know what degree of the pain being experienced in FMS is the result of myofascial pain, since this part of the pain package can relatively easily be modified or eliminated (see Chs 8 and 9).

Neural structures can become hyper-reactive in either spinal and paraspinal tissues or almost any other soft tissue. When they are found close to the spine the phenomenon is known as segmental facilitation. When such changes occur in ligaments, tendons or periosteal tissues, they are called trigger points; if situated in muscles or in fascia they are termed �myofascial� trigger points. In early studies by the most important researcher into facilitation, Irwin Korr (1970, 1976), he demonstrated that a feature of unilateral segmental facilitation was that one side would test as having normal skin resistance to electricity compared with the contralateral side, the facilitated area, where a marked reduction in resistance was present. When �stress� � in the form of needling or heat � was applied elsewhere in the body, and the two areas of the spine were monitored, the area of facilitation showed a dramatic rise in electrical (i.e. neurological) activity. In one experiment volunteers had pins inserted into a calf muscle in order to gauge the effect on the paraspinal muscles, which were monitored for electrical activity. While almost no increase occurred in the normal region, the facilitated area showed greatly increased neurological activity after 60 seconds (Korr 1977) (Fig. 1.5). This and numerous similar studies have confirmed that any form of stress impacting the individual � be it climatic, toxic, emotional, physical or anything else � will produce an increase in neurological output from facilitated areas.

In Chapter 9, Carolyn McMakin describes how some forms of trauma, particularly those affecting cervical structures, can lead to chronic local facilitation, resulting in FMS-like pain. She reports that treatment utilizing microcurrent, manual modalities and nutritional support can frequently ease, or even remove, such symptoms.

Professor Michael Patterson (1976) explains the concept of segmental (spinal) facilitation as follows:

The concept of the facilitated segment states that because of abnormal afferent or sensory inputs to a particular area of the spinal cord, that area is kept in a state of constant increased excitation. This facilitation allows normally ineffectual or subliminal stimuli to become effective in producing efferent output from the facilitated segment, causing both skeletal and visceral organs innervated by the affected segment to be maintained in a state of�overactivity. It is probable that the somatic dysfunction with which a facilitated segment is associated, is the direct result of the abnormal segmental activity as well as being partially responsible for the facilitation.

fibromyalgia history

Wind-Up And Facilitation

The process known as wind-up (Fig. 1.6) supports the concepts of facilitation, in different terms. Staud (2006) has described the relationship between peripheral pain impulses that lead to central sensitization as follows:

Increasing evidence points towards peripheral tissues as relevant contributors of painful impulse input that might either initiate or maintain central sensitization, or both. It is well known that persistent or intense nociception can lead to neuroplastic changes in the spinal cord and brain, resulting in central sensitization and pain. This mechanism represents a hallmark of FM and many other chronic pain syndromes, including irritable bowel syndrome, temporomandibular disorder, migraine, and low back pain. Importantly, after central sensitization has been established only minimal nociceptive input is required for the maintenance of the chronic pain state. Additional factors, including pain related negative affect and poor sleep have been shown to significantly contribute to clinical FM pain.

The similarities between modern neurological observations and Korr�s original work are clear.

Arousal And Facilitation

Emotional arousal is also able to affect the susceptibility of neural pathways to sensitization. The increase in descending influences from the emotionally aroused subject would result in an increase in toxic excitement in the pathways and allow additional inputs to produce sensitization at lower intensities. This implies that highly emotional people, or those in a highly emotional situation, would be expected to show a higher incidence of facilitation of spinal pathways or local areas of myofascial distress (Baldry 1993).

fibromyalgia history

This has a particular relevance to fibromyalgia, where heightened arousal (for a variety of possible�reasons, as will become clear), in addition to possible limbic system dysfunction, leads to major influences from the higher centers (Goldstein 1996). Since the higher brain centers do influence the tonic levels of the spinal paths, it might be expected that physical training and mental attitudes would also tend to alter the tonic excitability, reducing the person�s susceptibility to sensitization from everyday stress. Thus the athlete would be expected to withstand a comparatively high level of afferent input prior to experiencing the self-perpetuating results of sensitization. This, too, has a relevance to fibromyalgia, where there exists ample evidence of beneficial influences of aerobic training programs (McCain 1986, Richards & Scott 2002).

Selective Motor Unit Recruitment

Researchers have shown that a small number of motor units, located in particular muscles, may display almost constant or repeated activity when influenced psychogenically. Low amplitude activity (using surface EMG) was evident even when the muscle was not being employed, if there was any degree of emotional arousal. �A small pool of lowthreshold motor units may be under considerable load for prolonged periods of time … motor units with Type 1 [postural] fibers are predominant among these. If the subject repeatedly recruits the same motor units, the overload may result in a metabolic crisis.� (Waersted et al 1993). The implications of this research are profound for they link even low grade degrees of emotional distress with almost constant sensitization of specific myofascial structures, with the implications associated with facilitation and pain generation. This aetiology parallels the proposed evolution of myofascial trigger points, as suggested by Simons et al (1999).

Not Only Myelinated Fibres

Research by Ronald Kramis has shown that, in chronic pain settings, non-nociceptive neurons can become sensitized to carry pain impulses (Kramis 1996). Hypersensitization of spinal neurons may actually involve non-nociceptive neurons altering their phenotype so that they commence releasing substance P. This, it is thought, may play a significant part in FMS pain perception, as increased levels of substance P in�the cerebrospinal fluid maintain heightened amplification of what would normally be registered as benign impulses. The research suggests that impulses from associated conditions such as ongoing viral activity, �muscular distress� or irritable bowel may be adequate to maintain the central pain perception.

Local Facilitation

Apart from paraspinal tissues, where segmental facilitation, as described above, manifests, localized areas of neural facilitation can occur in almost all soft tissues: these are called myofascial trigger points.

Much of the basic research and clinical work into this aspect of facilitation has been undertaken by doctors Janet Travell and David Simons (Simons et al 1999; Travell 1957; Travell & Simons 1986, 1992; see also Chs 6 and 8). Travell and Simons are on record as stating that if a pain is severe enough to cause a patient to seek professional advice (in the absence of organic disease), it usually involves referred pain, and therefore a trigger area is probably a factor. They remind us that patterns of referred pain are constant in distribution in all people, and that only the intensity of referred symptoms/pain will vary.

The implication for the fibromyalgia patient is the possibility (according to Travell and Simons this is a veritable certainty) that their pain has as part of its make-up the involvement of myofascial trigger points, which are themselves areas of facilitation (see Ch. 8 by Dommerholt & Issa). This suggests that trigger points, and the pain (and tingling, numbness, etc.) which they produce, will be exaggerated by all forms of stress influencing that individual patient. Travell has confirmed that her research indicates that the following factors can all help to maintain and enhance myofascial trigger point activity:

� nutritional deficiencies (especially vitamins C and B complex, and iron)

� hormonal imbalances (low thyroid hormone production, menopausal or premenstrual dysfunction)

� infections (bacteria, viruses or yeasts)

� allergies (wheat and dairy in particular)

� low oxygenation of tissues (aggravated by tension, stress, inactivity, poor respiration) (Simons et al 1999, Travell & Simons 1986, 1992).

This list corresponds closely with factors that are key aggravating agents for many (most) people with fibromyalgia, suggesting that the connection between facilitation (trigger point activity) and FMS is close (Starlanyl & Copeland 1996). Myofascial trigger points are, however, not the cause of fibromyalgia, and myofascial pain syndrome is not FMS, although they may coexist in the same person at the same time. Myofascial trigger points do undoubtedly frequently contribute to the painful aspect of FMS, and as such are deserving of special attention.

As will be explained in later chapters, there are a number of ways in which deactivation or modulation of myofascial trigger points can be achieved. Some practitioners opt for approaches that deal with them manually, while others prefer microcurrents or electro-acupuncture methods or variations on these themes, with yet others suggesting that reduction in the number and intensity of stress factors � of whatever type � offers a safer approach to reducing the influence of facilitation on pain.

Following this introduction to the concept of hyper-reactive, sensitized (facilitated) neural structures, it would be justifiable to enquire as to whether or not what is happening in the brain and in the neural network, as described by Goldstein, is not simply facilitation on a grand scale. The outline of some of the leading current hypotheses as to the aetiology of FMA in Chapter 4 may shed light on this possibility.

Additional Early Research Into FMS

Early FMS research has been presented in summary form in Box 1.1. Aspects of that research, and how some of it correlates with more recent findings, are outlined below.

R. Gutstein, a Polish physician who emigrated to the UK prior to the Second World War, was a remarkable researcher who published papers under different names (M. G. Good, for example) before, during and following the war. In them he clearly described the myofascial trigger point phenomenon, as well as what is now known as fibromyalgia, along with a great many of its predisposing and maintaining features.

Gutstein (1956) showed that conditions such as ametropia (an error in the eye�s refractive power occurring in myopia, hypermetropia and astigmatism) may result from changes in the neuromuscular component of the craniocervical area, as well as more distant conditions involving the pelvis or shoulder girdle. He stated: �Myopia is the long-term effect of pressure of extra-ocular muscles in the convergence effort of accommodation involving spasm of the ciliary muscles, with resultant elongation of the eyeball. A sequential relationship has been shown between such a condition and muscular spasm of the neck.�

Gutstein termed reflex areas he identified �myodysneuria� and suggested that the reference phenomena of such spots or �triggers� would include pain, modifications of pain, itching, hypersensitivity to physiological stimuli, spasm, twitching, weakness and trembling of striated muscles, hyper- or hypotonus of smooth muscle of blood vessels and of internal organs, and/or hyper- or hyposecretion of visceral, sebaceous and sudatory glands. Somatic manifestations were also said to occur in response to visceral stimuli of corresponding spinal levels (Gutstein 1944). In all of these suggestions Gutstein seems to have been in parallel with the work of Korr.

Gutstein/Good�s method of treatment involved the injection of an anaesthetic solution into the trigger area. He indicated, however, that where accessible (e.g. muscular insertions in the cervical area) the chilling of these areas combined with pressure would yield good results.

In this and much of what he reported in the 1940s and 1950s Gutstein was largely in agreement with the research findings of John Mennell (1952) as well as with Travell & Simons, as expressed in their major texts on the subject (Travell & Simons 1986, 1992). He reported that obliteration of overt and latent triggers in the occipital, cervical, interscapular, sternal and epigastric regions was accompanied by years of alleviation of premenopausal, menopausal and late menopausal symptoms (Good 1951). He quotes a number of practitioners who had achieved success in treating gastrointestinal dysfunctions by deactivating trigger areas. Some of these were treated by procainization, others by pressure techniques and massage (Cornelius 1903). He also reported the wide range of classic fibromyalgia symptoms and features, suggesting the name myodysneuria for this syndrome, which he also termed �nonarticular rheumatism� (Gutstein 1955). In describing myodysneuria (FMS), Gutstein demonstrated localized functional sensory and/or motor abnormalities of musculoskeletal tissues and saw the causes of such changes as multiple (Gutstein 1955). Most of these findings have been validated subsequently, in particular by the work of Travell and Simons. They include:

� acute and chronic infections, which he postulated stimulated sympathetic nerve activity via their toxins

� excessive heat or cold, changes in atmospheric pressure and draughts

� mechanical injuries, both major and repeated minor microtraumas � now validated by the recent research of Professor Philip Greenman of Michigan State University (Hallgren et al 1993)

� postural strains, unaccustomed exercise, etc., which could predispose towards future changes by lowering the threshold for future stimuli (in this he was agreeing with facilitation mechanisms as described above)

� allergic and/or endocrine factors which could cause imbalances in the autonomic nervous system

� congenital factors which make adaptation to environmental stressors difficult

� arthritic changes which could impose particular demands on the musculoskeletal system�s adaptive capacity

� visceral diseases which could intensify and precipitate somatic symptoms in the distribution of their spinal and adjacent segments.

We can see from these examples of Gutstein�s thinking strong echoes of the facilitation hypothesis in osteopathic medicine.

Gutstein�s diagnosis of myodysneuria was made according to some of the following criteria:

� a varying degree of muscular tension and contraction is usually present, although sometimes adjacent, apparently unaffected tissue is more painful

� sensitivity to pressure or palpation of affected muscles and their adjuncts

� marked hypertonicity may require the application of deep pressure to demonstrate pain.

In 1947 Travell & Bigelow produced evidence supporting much of what Gutstein (1944) had reported. They indicated that high intensity stimuli from active trigger areas produce, by reflex, prolonged vasoconstriction with partial ischaemia in localized areas of the brain, spinal cord, or peripheral nerve structures.

A widespread pattern of dysfunction might then result, affecting almost any organ of the body. These�early research findings correlate well with modern fibromyalgia and chronic fatigue research and the hypothesis of �neural network disorders� as described by Goldstein (1996), and in British and American research utilizing SPECT scans, which show clearly that severe circulatory deficits occur in the brainstem and in other areas of the brain of most people with CFS and FMS (Costa 1992).

Gutstein�s Suggested Pathophysiology Of Fibromyalgia/ Fibrositis/Myodysneuria

The changes which occur in tissue involved in the onset of myodysneuria/fibromyalgia, according to Gutstein, are thought to be initiated by localized sympathetic predominance, associated with changes in the hydrogen ion concentration and calcium and sodium balance in the tissue fluids (Petersen 1934). This is associated with vasoconstriction and hypoxia/ischaemia. Pain resulted, he thought, by these alterations affecting the pain sensors and proprioceptors.

Muscle spasm and hard, nodular, localized tetanic contractions of muscle bundles, together with vasomotor and musculomotor stimulation, intensified each other, creating a vicious cycle of self-perpetuating impulses (Bayer 1950). Varied and complex patterns of referred symptoms might then result from such �trigger� areas, as well as local pain and minor disturbances. Sensations such as aching, soreness, tenderness, heaviness and tiredness may all be manifest, as may modification of muscular activity due to contraction, resulting in tightness, stiffness, swelling and so on.

It is clear from this summary of his work that Gutstein was describing fibromyalgia, and many of its possible causative features.

Chapter 2 examines what FMS is, as well as what it is not, with suggestions for differential diagnosis.


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Close Accordion

Fibromyalgia Sufferers Benefit From Chiropractic Care

Fibromyalgia Sufferers Benefit From Chiropractic Care

Fibromyalgia is one of today’s most common chronic pain conditions. According to the American College of Rheumatology, around 1 in 50 Americans currently suffer from fibromyalgia. Unfortunately, the condition is difficult to diagnose, and, being chronic in nature, can linger for several months or even years. Fibromyalgia typically causes pain throughout the body and creates areas so tender that the slightest pressure hurts.

Patients diagnosed with the condition have both traditional and alternative treatment options available to them. Traditional approaches to managing the pain and treating fibromyalgia are anti-inflammatory prescriptions, sleep medications, and muscle relaxers. Patients frequently choose natural remedies instead of or in addition to traditional medication, such as vitamin therapy, acupuncture, and meditation. One of the most common treatments is chiropractic care.

The main ways chiropractic care benefits those who suffer from fibromyalgia are:

Reduces Fibromyalgia Pain Levels

The most difficult issue to deal with for fibromyalgia sufferers is the constant pain, which often affects the entire body for weeks or months at a stretch. Although these patients initially seek care for the pain they�re experiencing, they soon realize that chiropractic also helps restore overall health and aids the body in self-healing.

By adjusting the spine to improve alignment, as well as incorporating some form of soft tissue work, chiropractors can assist fibromyalgia patients in minimizing their painful pressure points. Many who suffer with this condition look for relief with chiropractic treatment options, and experience a decrease in the tender spots.

Increases Range Of Motion

Chiropractors are also able to adjust the body’s joints and help loosen them. For fibromyalgia patients, this can sometimes increase their range of motion and allow them to move more easily.

Sometimes it takes several treatments to see significant results, so it’s important to note that chiropractic treatment of fibromyalgia takes a commitment from the patient. The effects, however, are well worth the time invested.

Boosts Sleep Quality

A common by-product of the pain associated from fibromyalgia is lack of sleep. As anyone knows, being unable to snag several hours sleep can leave you feeling tired, foggy, and irritable.

By working with a chiropractor to loosen their joints and manage their tender points, patients suffering from this condition can enjoy a deeper sleep, and stay asleep longer.

Complements Other Treatments

Sometimes medicines counteract with each other, or mix together and cause side effects. A big advantage of chiropractic care is it can be utilized in tandem with medications or other remedies, whether traditional or natural.

An individual who is diagnosed with this condition should speak to his or her chiropractor about the various ways to treat it, and remember that there is not a one-stop solution. A treatment regimen should be built on a case-by-case basis tailored to the specific needs of that patient.

Empowers The Patient

Individuals who must cope with painful, chronic illnesses can become exasperated with treatment options, and feel as if they have no control over their situations. Unfortunately, these feelings can bring on stress and depression, which only works against getting better. By working with a chiropractor, patients can feel more in charge of their pain management and more optimistic in their recovery.

People who are diagnosed with fibromyalgia need to understand that there are options available to them for pain management, and they may decide to try more than one at a time. Chiropractic care is a valuable tool to treat the symptoms of fibromyalgia, and patients who will commit will see the benefits of less pain, greater mobility, and better sleep. And, perhaps the best benefit of all, they can take control of their circumstances and be a vital part of managing their personal well-being.

Retired Brig. General Rebecca Halstead Shares How Chiropractic Care “Saved Her Life”

If you or a loved one are suffering from fibromyalgia, don�t do it alone. Our chiropractor has a passion for helping sick people get well. So contact us today to schedule an appointment.

This article is copyrighted by Blogging Chiros LLC for its Doctor of Chiropractic members and may not be copied or duplicated in any manner including printed or electronic media, regardless of whether for a fee or gratis without the prior written permission of Blogging Chiros, LLC.