Guides for patients:


Lower Body Stretching Guide PDF


Bruggers Micro-Break PDF


McKenzie Exercies PDF


Cold and Heat PDF

Use your best judgement when reading the following information. If you have any questions feel free to email us at drsdowell@yahoo.com
 

Fibromyalgia, by Dr. Cindie Dowell 

      Fibromyalgia is a rheumatic disease consisting of unrelenting musculoskeletal pain over the entire body with focal tender points. The prevalence (which is more than rheumatoid arthritis) is 2%, representing 10-20% of new rheumatology patients and 2-6% of the new patients in a primary care facility (Wilke, 1996).

Pathophysiology: 

      Fibromyalgia has no known cause at this time. There are many thoughts as to the cause of this entity and its predilection. Some of the current theories include decreased levels of serotonin, impaired hypothalamic-pituitary-adrenal activation, stress manifestations (Wilke, 1996), autonomic nervous system dysfunction with sympathetic hyperactivity (Martinez-Lavin, 2000), lack of stage 4 non-REM (rapid eye movement) sleep patterns, chronic fatigue syndrome complications, and whiplash-related trauma (White, 2000). Differential diagnosis must include endocrine disorders such as hypothyroidism, multiple sclerosis, systemic lupus erythematosus, siliconiosis (Wilke, 1996), poor calcium metabolism, tumor, hypokalemia, polymyalgia rheumatica, and inflammatory myopathy. 
      Some researchers do not believe fibromyalgia is a true entity. They suspect the patient is suffering from chronic fatigue complications, psychosocial issues, or is simply a malingerer (White, 1999). While all are possibilities, the two later can be ruled out in a meticulous history taking. Chronic fatigue syndrome differs from fibromyalgia in the primary patient complaint being fatigue instead of pain, though they can both co-exist (White, 1999).

Patient presentation: 

      ACR guidelines require 11 of 18 tender points to cause the patient to verbally state that palpation was painful when said spot is palpated with 4kg of force (Wolfe, 1990). Pain must be bilateral and above and below the mid-transverse line of the body(Wolfe, 1990). Patient must have widespread pain for greater than 3 months duration. The patient is usually female with insidious onset of symptoms in early adulthood (Simms, 1994). A patient most commonly suffers from morning stiffness, sleep disturbances, and fatigue (Wolfe, 1990). Less commonly are occurrences of pain all over, paresthesia, headache, anxiety, irritable bowel, Raynauds phenomenon and/or sicca symptoms (dryness) (Wolfe, 1990). Most patients symptoms remit within a one-year period. Men have been diagnosed with fibromyalgia, though their pain thresholds and overall symptoms were found to be less than that of their female counterparts (Yunus, 2000).

Evaluation: 

      There are no lab tests to confirm the diagnosis of fibromyalgia. A general chemistry panel, CBC, and thyroid-stimulating hormone tests are typically done to rule out other diagnosis (Wilke, 1996)(Huff, 1999). Substance P may be elevated along with low serotonin levels, low IGF-1, and low tryptophan. Muscle testing may be weak due to the inability of fibromyalgic tissue to discontinue contracting (Wilke, 1996). It does not cause any long-term organ damage, but does significantly decrease the quality of life for the individual. There are no x-ray findings (Huff, 1999). Validity/reliability The diagnosis of fibromyalgia can be identified with a sensitivity of 88.4% and a specificity of 81.1% from other rheumatic diseases (Wolfe, 1990). Widespread pain has a sensitivity of 97.6% when combined with the presence of >10 tender points (Wolfe, 1990).

Treatment guidelines: 

      Many clinical trials have been performed on fibromyalgia patients. Treatments that worked in some studies did not have the same successful outcomes in other trials, perhaps due to the wide range of possible causes for the condition. The following treatments warrant a 2-3 week trial for a presenting patient (Simms, 1994). Nutritional supplements: Each is in daily dosage: Coenzyme Q-10 75mg; Magnesium 600mg; Malic acid 1200mg; Manganese 20mg; Vitamin B complex, specifically Vitamin B6 and B1 200mg each (Balch, 1997). Nutritional considerations: It is recommended that the patient eat only whole foods (vegetables, fruits and whole grains)(Huff L, 1999). Stay away from canned food, processed meats, coffee, alcohol, sugars, saturated fats and dairy (Balch, 1997). Medications: Amitriptyline 10-50mg for up to 9 weeks; Cyclobenzaprine 30mg up to 12 weeks (extreme drowsiness); Temazepam 15-30mg 12 weeks; S-Adenosylmethionine (SAM-e) 200mg 3 weeks; Carisoprodol 1200mg 8 weeks (Simms, 1994). Exercise: Cardiovascular fitness training 20 minutes 3x/week (extreme post-exercise pain experienced) (Simms, 1994). Manipulation: Has been shown to increase ranges of motion in the spine. May relieve some distress of patient and help relieve the patient of some stress. Other: Biofeedback 20min 2x/week 15 tx total; Electroacupuncture 6 sessions; Hypnotherapy 12 weeks tx (Simms, 1994).

Reference:

1. Wilke WS. Recognizing and addressing the multiple interrelated factors. Postgraduate medicine 1996;100(1):153-69.
2. Yunus MB. Fibromyalgia in men: comparison of clinical features with women. J Rheumatol 2000;27(2):485-90.
3. Martinez-Lavin M. Autonomic nervous system dysfunction may explain the multisystem features of fibromyalgia. Semin Arthritis Rheum 2000;29(4):197-9.
4. White KP. Trauma and fibromyalgia: Is there an association and what does it mean? Semin Arthritis Rheum 2000;29(4):200-16.
5. Simms RW. Controlled trials of therapy in fibromyalgia syndrome. BaillieresClinical Rheumatology 1994;8(4):917-32.
6. Wolfe F. et al., The American college of rheumatology 1990 criteria for the classification of fibromyalgia. Arhtritis and Rheumatism 1990;33(2):160-72.
7. White KP. Co-existence of chronic fatigue syndrome with fibromyalgia syndrome in the general population. Scand J Rheumatol 2000;(29):44-51.
8. Huff L, Brady D. Instant access to chiropractic guidelines and protocols. Mosby1999 pgs. 340-47.
9. Balch JF. Prescription for nutritional healing. Avery Publishing Group 1997 second edition pgs.274-76.

Fibromyalgia Nutritional Protocols:
written/edited by Dr. Steven M. Dowell

The following are three separate information packs in regards to supplementation for Fibromyalgia. The first is based upon recommendations from Dr. John Donofrio, president of the Chiropractic Neurology Board. The second is based upon feedback from patients who have successfully found relief and/or treatment from adding some supplements to their diet. The third is my personal recommendations from research and clinical experience.


Please remember two important things:

A. Vitamins and supplements are not a substitute for healthy eating and a healthy lifestyle.
B. Exercise is crucial to overcoming Fibromyalgia. I highly recommend starting in a hot tub or swimming pool with something basic such as leg kicks.



1. FIBROMYALGIA: Toxic lactic acid accumulation - Oxygen needs to be added to the body to help remove the acid

      *Exercise 
      *CoQ10


Most people are depressed, bi-polar, and/or have sleep disorders
      CoQ10 - 400 mg per day
      Exercise – at least walking
      Supplement with DHA – get fats into the brain – 750 mg per day 
      Vitamin B complex - helps with energy
      5-htp – to increase serotonin levels
      Melatonin to improve sleep patterns 
      SAMe – works well for mood elevation as well
      St. Johns Wart – be careful because it has a tendency to interfere with a lot of other medications/drugs.


IMPORTANT: You should never take 5-htp, Melatonin, SAMe, or St. Johns Wort if you are taking prescription anti-depressants.



2. What my patients have tried and found success with:

*Magnesium (glycerinate) 2 x per day = 300 - 500 mg each pill
*Malic Acid 2 x per day = 600 - 1200 mg each pill
*Manganese 2 x per day = 10 mg each pill

*Vitamins B6 and B1
*B complex

*Look on the internet for a company called "METAGENICS, INC." and look for a pill called FIBROPLEX for Fibromyalgia.

*CoQ10: 200-400 mg per day.



3. My personal recommendations:

CoQ10 is a must. It will help increase your energy levels and research shows tremendous cardiovascular benefits. Take CoQ10 with oil or fat to help absorption. Taking it with fat soluble vitamins A and E will also help absorption. Your body only produces 1/4 of what you needs after about the age of 25. It may take up to 2 months before you notice a difference with energy and your thought processes. It is great for the heart. CoQ10 helps the body utilize more oxygen at the cellular level via the Mitochondria. I recommend this for everyone, even if they dont have Fibromyalgia.

B complex vitamins will also give you an energy boost. CoQ10 combined with B complex vitamins will help provide relief from the chronic fatigue of Fibromyalgia.

5-htp is the precursor to amino acid Tryptophan. Your body will convert this supplement into Tryptophan. It typically helps restore normal sleep cycles, gently elevates mood, and provides a more restful sleep. 5-htp is usually found in 50 - 100 mg capsules. Take either early in the morning or right before bed. Taking 5-htp more than a half hour before bed may cause insomnia.





IMPORTANT: Always consult with a medical professional before beginning any new regime of supplements or vitamins. The information provided here are just guidelines to help educate the consumer about their choices. We aren't guaranteeing that the above advice will help nor are we trying to diagnose your condition. Be advised that the protocols aren't necessarily scientific in nature but are based heavily upon clinical experience. The above vitamins and supplements may not mix well with your current medications or condition so always start with the lowest dose available. Once again, please consult with a medical professional first.