Home: Related Disorders: FMS: The Brainstem and Fibromyalgia

The Brainstem and Fibromyalgia

Dr. Jason T. Pierce Pierce Specific Chiropractic Cape Girardeau, Missouri (334) 621-9500 email: c1c2@bellsouth.net

Dr. Bruce White Kessinger Clinic email: bjspecific@hotmail.com

Fibromyalgia (FM) is a chronic musculoskeletal condition first documented in 1904. An estimated 6 million Americans suffer from this condition. Fibromyalgia is perceived as a condition primarily involving young women between the ages of 20 and 40, however, may also affect men, the elderly, as well a 1.2% of all children (1,2,4).

Fibromyalgia, sometimes referred to as fibrositis disease, is characterized by widespread aching, stiffness, tender points and fatigue (1,2,5). Symptoms are due to painful muscles, joints and ligaments. The symptoms may be constant with periods of exacerbation or may even disappear for a short period of time and return later. Unfortunately, the symptoms cover a broad spectrum and often overlap with related disorders including: chronic fatigue syndrome (CFS), lupus (SLE), Rheumatoid Arthritis (RA), infections and others. There are no blood or x-ray tests that are abnormal. The intermingling of symptoms and vague nature of (FM) has contributed to the confusion on behalf of the medical profession concerning the cause and treatment. In 1990 the American College of Rheumatology (ACR), developed a concise protocol for the diagnosis of fibromyalgia. The definition includes a history of widespread pain for greater than 3 months and pain in at least 11 of 18 tender points upon palpation (1,5) .

Fibromyalgia is commonly accompanied by a wide variety of conditions including: irritable bowel syndrome (IBS), fatigue, headaches, numbness and tingling of extremities, restless leg and sleep disturbances. For several decades researchers have observed a connection between (FM) and sleep related disorders. In 1966 a study featured in the Journal of Rheumatology noted, '...when Fibromyalgia is the primary diagnosis, sleep apnea seems to be common; being found in up to 44% of men in one study. Restless legs are even more frequent (5). In a 1996 study published in the British Medical Journal, researchers found approximately 30-40% of female fibromyalgia patients also experience leg cramps or restless legs. Other researchers have observed a high prevalence of gastrointestinal abnormalities associated with fibromyalgia (6). Some scientists suggest as many as 70% of people who have (FM) experience symptoms of irritable bowel syndrome (7).

Many theories, attempting to explain the cause, have been advanced since its discovery in 1904. Soon researchers began to note a significant number of (FM) patients also commonly contracted infections. Hepatitis C is among the common infections seen with fibromyalgia. This observation soon lead to the common belief that it may be caused by a previous infection of an unknown agent. This idea was promoted heavily until the late 1970's.

Today this idea has been discarded by most researchers. The infectious model was abandoned primarily because a higher rate of fibromyalgia would be observed in immediate family members if due to infectious agents. There is no difference in the rate of (FM) in family members than in the general population. It is now believed the cause of fibromyalgia may also contribute to a lowered immune system strength, explaining common infections.

Although drug therapy continues to be the primary medical treatment for (FM), many researchers report, "Medication by itself is of little value in treating fibromyalgia" (9,18). Drugs used in treatment of (FM) are prescribed in an attempt to temporarily reduce symptoms. Many of these drugs produce their effect by artificially altering the activity of the brainstem (28). Steroids and non steroidal anti-inflamatories (NSAIDS) have proven to be no more beneficial that a placebo in reducing (FM) symptoms, while at the same time may induce insomnia and therefore should be avoided (9). Narcotics and benzodiazepines have similar effects and also should be avoided. Most drugs commonly prescribed for fibromyalgia have not been properly tested or have counter productive and dangerous side effects (9). The following is a partial list of drugs commonly used to treat (FM) and their side effects.

DRUG	SIDE EFFECT
(#)Amitriptyline	Cognitive impairment, weight gain, dry mouth
(#)Cyclobenzaprine	Fatigue, blurred vision, seizures, irregular heart beat
(*)Diphenhydramine	Dizziness, excitation
(*)Trazodone	Fainting, vomiting, irregular heart beat
Carisoprodol	Difficulty breathing, vomiting blood, dizziness
Alprazolam	Weakness, headache, clumsiness, dizziness
(#) most common prescribed
(*)still untested in controlled studies)

Although no drug breakthroughs are eminent, researchers have noted a strikingly high incidence of normal people who experience head/neck injury soon develop Fibromyalgia for the first time. This mechanism of cause indicates a strong connection to the onset of (FM) and the spine. New research demonstrates, both clinically and radiologically, (FM) is frequently derived from spinal malfunction. This study was headed by Dr. Muller of the Hochrhein-Institute for Rehabilitation Research in Sackingen, Germany. Dr. Muller reports, "It is likely that spinal disturbances are responsible for the first manifestations of fibromyalgia..."(27). The 1997 Scandinavian Journal of Rheumatology article reports the altered bio-mechanics of the spine during pregnancy, frequently worsened Fibromyalgia symptoms (31). In the August 1996 USA Fibromyalgia Association Newsletter, Dr. David Ryan, states; "It is puzzling to me how a 22 year old male weight lifter can develop (FM) after an auto accident. I feel that what happens is some trauma to the brain stem (the very area that houses the 'sleep center'). A concussion may occur here and result in the altered activity of the 'sleep center' resulting in abnormal sleep." Other researchers have observed this interesting connection between trauma and fibromyalgia. In the book "The Complete Guide to Whiplash" author Michael Melton states, "Fibromyalgia is a well recognized symptom of whiplash injury..." as well as "Fibromyalgia seems to be a condition closely related to injury of the neck" (11). Compression of the brainstem (CNS) is a common result of whiplash-type traumas. In many cases this appears the likely cause of (FM) and related conditions (13). In 1997 a controlled study of 161 cases of traumatic injury concluded that (FM) was 13 times more frequent following neck injury than leg injury (12). Research is beginning to support a strong connection between (FM) and brainstem (CNS) malfunction (15).

Until recently medical treatment consisted primarily of drug therapy, which by itself proves relatively ineffective. In September of 1997, the National Fibromyalgia Research Association held its annual symposium in Portland Oregon. Dr. Michael Rosner reported on the finding of spinal cord/brain stem compression in (FM) and Chronic Fatigue Syndrome. Rosner's research included 48 patients diagnosed with fibromyalgia and chronic fatigue syndrome who underwent decompressive craniovertebral surgery. Six months following surgery, 80% of the patients felt some improvement in a list of 18 symptoms. Two years following surgery, approximately 50% felt somewhat improved, while 50% felt no change or worse (16). After learning of this new information, Pam Scott (wife of the National Fibromyalgia Research Association founder and fibromyalgia sufferer), underwent this new surgery. Pam has since reported a dramatic improvement of symptoms including the following:

• Fatigue greatly reduced
• Overall body pain reduced
• Cognitive and memory increased
• Gastrointestinal symptoms improved
• Sight improved
• Warm hands and feet for the first time in years

This new information further demonstrates a very close relationship between (FM) and the function of the brain stem.

Frustrated with traditional treatment, (FM) sufferers have long sought help from various types of health care practioners. In a recent survey of FM patients, almost all were utilizing methods other than traditional medicine. Perhaps, indicating the ineffectiveness of medical therapies (17). The objective of Specific Chiropractic is to locate and correct brainstem compression. This is accomplished using laser aligned x-ray analysis, precision neurologic instrumentation and specific adjustments. A Specific Chiropractor uses the laser aligned x-ray analysis to determine the exact malposition of the vertebrae causing brainstem compression. A neurologic reading determines the amount of brainstem malfunction and when an adjustment is necessary. Another reading following the Specific Adjustment assesses correction of brainstem compression. The Specific Chiropractic procedure is a safe and effective way to promote normal function of the brainstem. Clinical experience has shown favorable results with patients suffering from fibromyalgia .

Exercise has always been an essential part of a healthy lifestyle. In recent years exercise has been shown to be helpful in the management and prevention of cardiovascular conditions. Researchers at the Department of Military and Emergency Medicine have noted an inverse relationship between physical activity and a variety of chronic diseases (25). Several experiments have also been conducted, in the past years, attempting to determine whether (FM) may be improved by exercise. A 1996 study reported in the Journal of Rheumatology concluded aerobic exercise is beneficial in the management of (FM), at least in the short term (23). Other information suggests that (FM) patients willing to make sustained lifestyle changes, regarding their exercising habits, will continue to experience long term results (24). Daily, gentle, low impact aerobic exercise appears to be most effective. Swimming, biking, walking or use of home exercise equipment should be considered. Patients should start out slow, gradually building up to 20 to 30 minutes per day.

Although fibromyalgia has been a documented condition for most of the twentieth century, modern medical practice has not determined the precise cause and proper treatment. Some fibromyalgia patients receive mild relief using drug therapy, but more must be done. In light of all information available, there is a strong indication that many if not most cases of (FM) are initiated by a physical trauma to the head/neck (10,11,12,13,14) causing brainstem (CNS) compression (15,16,19,20,21,22). The next logical step for future research is to explore procedures that remove brainstem compression with the least side effects. Although new surgical intervention may appear an option for some, most patients aren't willing to risk the dangerous side effects. We must search for safe, conservative, and effective care for fibromyalgia patients. Specific Chiropractic appears as a leading opportunity for (FM) sufferers seeking help (3,13,14,26). The objective of Specific Chiropractic is to locate and correct brainstem pressure (compression), allowing the central nervous system to function as intended. Specific Chiropractic accomplishes this goal in a safe, conservative, cost effective manner.

REFERENCES

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3. Harper A., Lui D. The effectiveness of chiropractic management of fibromyalgia patients: a pilot study. J Manipulative Physiol Ther 1998 Jul-Aug; 21 (6): 429.
4. Clark P., Burgos-Vargas R., Medina-Palma C., et al. Prevalence of fibromyalgia in children: a clinical study of Mexican children. Journal of Rheumatology 1998 Oct; 25 (10): 2009-14.
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Modified October 7, 2005