Fibromyalgia


Fibromyalgia is a chronic condition presented with two components, pain and mental disturbances. According to the American College of Rheumatology, fibromyalgia is the second most common rheumatic disorder in the United States. It is estimated 10 millions of Americans suffering from fibromyalgia and an estimated 3-6% of the world population.

Cause

The cause of this condition is not well known; researches do not explored a single cause that provokes this non-inflammatory multi involvement illness. Fibromyalgia affects predominately women between the ages of 35 and 55. It can occur independently, or can be associated with another disease. From the complex of appearance of this illness two things, multiple pain and stress, are the principle conditions. What is the relation between them or which is the cause and which is the result are issues to be discovered.

Symptoms

Symptoms of fibromyalgia included pain, stiffness, and tenderness of the muscles, tendons and joints. Fibromyalgia is also characterized by poor sleep, awakening, chronic fatigue, depression, anxiety and disturbance of bowel function. Although there are painful tissue involvement in fibromyalgia, but there are not accompanied by tissue inflammation. Therefore, fibromyalgia is different from many other rheumatic diseases by not developing body damage or deformity. Fatigue occurs in 90% of patients and sleep disorder is common in patients with fibromyalgia. Fibromyalgia symptoms can also be triggered or exacerbated by many factors (stressors), including physical trauma, pain due to damage or inflammation of peripheral tissues, autoimmune disorders, and emotional stress

Diagnosis 

The FM diagnostic criteria, established by the American College of Rheumatology (ACR) in 1990, includes a history of widespread pain in all four quadrants of the body for a minimum duration of three months, and pain in at least 11 of the 18 designated tender points when a specified amount of pressure is applied.

 

 

Treatment

Traditional treatment for fibromyalgia usually is a combination of education, stress reduction, exercise, and medications. Stretching exercises, heat application and gentle massage are treatments for fibromyalgia, but the therapeutic effects usually are of short duration. Long term usages of medications often carry unwanted side-effects.

Complementary and alternative therapies in the area of pain and stress management have been practiced for thousands of years. Such as acupuncture, chiropractic, yoga and meditation do appear to safely relieve pain and stress, and some are gaining acceptance in mainstream medicine.

Acupuncture for Fibromyalgia

According to the theory of Chinese Medicine, pain is caused by blockage of energy flow (in Chinese medicine called “Chi”) in the body. And once if the blockage were removed pain disappeared. There are energy flows (chi) floating in different systems or organs. They are very specific but related one to another. In applying this theory to the illness of fibromyalgia, evidently, all the symptoms of this illness are unitary related with diverse features. So far as we know Acupuncture is to use needles to agitate the energy flow of the body to move. With different points applying by needles, various specific flows of energy are promoted, sick areas returned to a normal balance status and “healed”.

Scientific researches demonstrated acupuncture initiates electric magnetic change of cells of the body, including muscle fibers, nerve endings, receptors, brain, thyroid and adrenal gland. The voluntary muscles were relaxed in the peripheral and the smooth muscles were relaxed in the internal of the body by the effect of acupuncture. Furthermore, acupuncture stimulate the secretion of regulating hormone, endorphins, on the same time, a stress relieving effect is thus gained as well.

What we do

Standard steps we approach to patient with fibromyalgia:

1. Record detail history of illness to find out the cause.

2. Review test data and imaging result (X-ray, CT scan, MRI).

3. Perform physical examination and movement test.

4. Reach a diagnosis and propose a treatment plan.

5. Common acupuncture points used include: Ear sympathetic, heart, subcortex and liver; Shu-points of upper and lower extremities; Energy points on Du and Ren channels; and distal analgesic points.

6. Electric stimulation or cupping added as need.

Demography of fibromyalgia patient and treatment results of our clinic

Study data draw from 2003 to 2007. Age: 45 to 80, average 63. Gender: F: M=3:1

Diagnosis % of total pain patients % of Improvement % of marked improvement Average treatment
Fibromyalgia 9.43 88.9 68.7 14

*1. The result of treatment is related closely with many factors include age, gender, length of sickness, severity of sickness, treatment that have used and current combined therapy.

  2. The patients included in this data were patient who did not combined use with any pain or mood Medications.

  3. Some studies had shown that combined use of medication with Acupuncture might increase the positive results.

Clinical trials

Itoh K. Effects of acupuncture to treat fibromyalgia: a preliminary randomized controlled trial. Chin Med. 2010 Mar 23;5:11. doi: 10.1186/1749-8546-5-11.

Sixteen patients (13 women and 3 men aged 25-63 years) suffering from fibromyalgia were randomized into two groups: group A (n=8) received five acupuncture treatments started from the fifth week, and group B received ten acupuncture treatments, started from the first week. VAS (Visual analogue scale) and FIQ (fibromyalgia impact questionnaire) were used as the measurement of effects. Electroacupuncture and traditional needling were applied to both groups. After the fifth week, pain intensity in group B decreased and Quality of Life (QoL) improved compared to group A. CONCLUSION: The present study suggests that acupuncture treatment is effective to relieve pain for fibromyalgia patients in terms of QoL and FIQ.

David P Martin. Improvement in Fibromyalgia Symptoms with Acupuncture: Results of a Randomized Controlled Trial. Mayo Clinic Proceedings, June 2006; vol 81: pp 749-757.

A prospective, partially blinded, controlled, randomized clinical trial. Fifty patients participated in the study; all patients met American College of Rheumatology criteria for fibromyalgia and had tried conservative symptomatic treatments other than acupuncture. 25 in the acupuncture group and 25 in the control group (sham acupuncture). Total fibromyalgia symptoms, as measured by the Fibromyalgia and Impact Questionnaire (FIQ), were significantly improved in the acupuncture group compared with the control group during the study period, immediately after treatment, 1 month and 7 months after treatment. The largest difference in mean FIQ total scores was observed at 1 month. Fatigue and anxiety were the most significantly improved symptoms during the follow-up period. However, activity and physical function levels did not change. Acupuncture was well tolerated, with minimal adverse effects. Conclusion: Acupuncture significantly improved symptoms of fibromyalgia. Symptomatic improvement was not restricted to pain relief and was most significant for fatigue and anxiety.

H. Sprott et al. Pain treatment of fibromyalgia by acupuncture. Rheumatol Int (1998) 18: 35–36.

The author performed acupuncture therapy in fibromyalgia patients and established a combination of methods to objectify pain measurement before and after therapy. 29 fibromyalgia patients (25 female, 4 male) with a mean age of 48 years and a mean disease duration of 6 years participated in the study. Pain levels and positive

tender points were assessed using the visual analogue scale and dolorimetry. Serotonin and substance P levels in serum and the serotonin concentration in platelets were measured concomitantly. During acupuncture therapy no analgesic medication was allowed. The VAS scores decreased from 64.0 mm before therapy to 34.5 mm after therapy. Dolorimetry revealed a decreased number of tender points after therapy from 16.0 to 1.8. Serotonin serum concentration increased from 134.0 ng/ml to 171.2 ng/ml. Substance P levels in serum increased from 43.4 pg/ml to 66.9 pg/ml. Acupuncture treatments of patients with fibromyalgia

was associated with decreased pain levels and fewer positive tender points. This was accompanied by decreased serotonin concentration in platelets and an increase of serotonin and substance P levels in serum. These results suggest that acupuncture therapy is associated with changes in the concentrations of pain-modulating substances in serum. The preliminary results are objective parameters for acupuncture efficacy in patients with fibromyalgia.