Fibromyalgia Syndrome (FMS) is muscle soreness and joint pains derived from abnormal brainstem processing of sensory information. The aetiology of which may lie in Adverse Childhood Events and or Attachment Disorder. Exacerbated by perceived threat, stress, internal metabolism (monoamines) and an environment where a real or perceived lack of control / lack of support is experienced (1). Some say it medicalises unexplained symptoms, but those who experience the continuous diffuse, deep, throbbing, aching in their muscles of FMS, probably wouldn’t agree!

FMS tends to affect more women than men and is generally thought of as a longer-term issue. Given enough time 25% of people will recover from FMS. The can’t think straight, wake unrefreshed and general fatigue are coupled with widespread persistent muscle pains. Affecting the back, neck, jaw, head and thorax. Those with FMS have normal blood tests yet about 25% of those with FMS have rheumatic disorders as well (2). Furthermore, in FMS there can be depression and disordered sleep.

What Can be Done?

A pain experience is made up of sensory information detected by your nervous system sent up to your brain along your spine. Sensory information is anything you can sense. Thus, contributory factors to pain in FMS are broad, even the American College of Rheumatology do not recommend using a series of tender spots during physical examination to diagnose FMS anymore, because FMS is seen as a sensory processing abnormality.

Pharmaceutical therapy has a limited impact on FMS. However, there is good news in the form of a natural supplement called S.A.M.e. or S-Adenosyl-L-Methionine (I prefer SAMe!). There have been several double-blind trials investigating the benefits of SAMe in those with FMS and they all have shown improvements (3). Reporting improved mood, reduced fatigue and less widespread pain.

Because Depression worsens back pain episodes in the future, helping with depression is a short-term strategy with long term results for those who have FMS. Studies have shown taking SAMe alongside anti-depressant medication provides an improved effect on mood, sleep, fatigue and depression (4). The sore muscles part of FMS are not improved by SAMe or anti-depressant medication and it is these that are the remit of your Chiropractor to help you with as you employ aerobic exercise.

What Can I do?

As a Chiropractor I am not saying I am treating Fibromyalgia (4), I am saying FMS requires management (5) within a biopsychosocial model (6). A strategy to help support you in the longer term with FMS could be to: Make use of your GP’s ability to prescribe you appropriate anti-depressant medication, take SAMe, aerobically exercise and see your chiropractor for the muscular aspect of Fibromyalgia ((To book an appointment click here). This strategy might just place you into the 25% who fully recover from Fibromyalgia…

References:

1. Mease P et al (2009) Fibromyalgia Syndrome (OMERACT9) Journal of Rheumatology 36(10) 2318
2. Kurohori Y et al (1995) Adhesion Molecule Expression on Peripheral Blood Mononuclear Cells in Rheumatoid Arthritis. Journal of Clinical Rheumatology 14 335
3. Jacobsen S et al (1997) Oral S-adenosylmethionine in Primary Fibromyalgia. Scand J Rheu 20 (4) 294, Tavoni A et al (1987) Evaluation of S-adenosylmethionine in Primary Fibromyalgia Am J Med 83 (5a) 107, Tavoni A et al (1998) Evaluation of S-adenosylmethionine in Secondary Fibromyalgia. Clin Exp Rheu 16 (1) 106 and Volkmann H et al (1997) I.V. S-adenyl-L-Methionine in Patients with Fibromyalgia. Scand J Rheu 26 (3) 206
4. E Ernst (2009) Chiropractic Treatment for Fibromyalgia Clin Rheu 28 1175
5. Schneider M et al (2009) Chiropractic Management of Fibromyalgia Syndrome JMPT 32(1) 25
6. Alpert JE et al (2004) SAMe as an adjunct for resistant (to venlafaxine or SSRIs) major Depressive Disorder J Clin Psychopharma 24 (6) 661 and Rosenbaum JF et al (1990) The Anti-Depressant Potential of SAMe. Acta Psychiatry Scand 81 (5) 432
7. EULAR Recommendations (2017) Ann Rheum Disease 76 (2) 318