The vitamin fibromyalgia patients are missing

Fibromyalgia patients are at risk of vitamin D deficiency according to a new study from Ireland. In the study, 36% of fibromyalgia patients had deficient levels of vitamin D and 62% had insufficient levels. That meant only 15% of patients were getting adequate levels of the vitamin.

The patients were mostly middle-aged women. Researchers pointed out that the women’s vitamin D levels may have been affected by the fact they lived in seldom-sunny Ireland. When it is sunny, patients may still choose to stay indoors because of their disability and pain.

Low vitamin D levels can increase the risk of cognitive impairment in older adults, severe asthma in children, cancer, and more. Vitamin D helps the body maintain normal blood levels of calcium and phosphorus. It also allows the body to absorb calcium to strengthen the bones.

Previous research has investigated the relationship between vitamin D deficiency and musculoskeletal pain with conflicting results. In some studies, fibromyalgia patients had low levels of the vitamin but in others their levels were no different than control participants.  In one study vitamin D supplementation appeared to have no specific clinical benefits for fibromyalgia patients.

Still, there does appear to be link between vitamin D deficiency and muscle pain. While more research is needed to understand this link, vitamin D supplements could benefit the overall health of fibromyalgia patients.

Consult with your chiropractor or health practitioner to learn which vitamins are right for you.

 

References

Jan A, et al. “Serum 25-hydroxy vitamin D levels in patients with fibromyalgia”BSR 2012; Abstract 231.

Walsh, Nancy. Medpage Today. Vitamin D May be Help in Fibromyalgia. May 3, 2012. Accessed May 10, 2012. //www.medpagetoday.com/MeetingCoverage/BSR/32497.

Fibromyalgia and Sleep

Sleep problems can potentially lead to fibromyalgia pain.

Millions of Americans lay awake in their beds at night tossing and turning, unable to sleep. Insomnia can disrupt your life, making the simplest tasks seem insurmountable and even damage your personal relationships.

But did you also know that insomnia can lead to debilitating conditions like fibromyalgia and chronic pain?

Fibromyalgia is a complex chronic pain syndrome that primarily affects women. The syndrome includes widespread pain in muscles, ligaments, and joints as well as fatigue and trouble sleeping.

New research from Norway shows that women with sleep disturbances were THREE time more likely to develop fibromyalgia. The study included data from over 12,000 women over the course of ten years. While the link between fibromyalgia and sleep still needs further research to be fully understood, the researchers recommended that early intervention into sleep disorders could prevent future chronic pain.

For people that already have fibromyalgia, exercise and chiropractic are two natural options for minimizing pain without the adverse effects of drugs.

New research has shown that gentle stretching, yoga, and tai chi can benefit fibromyalgia in a number of ways. In 2010, two different medical studies indicated that when compared to conventional treatment methods, patients who participated in yoga and tai chi experienced enhanced sleep quality, better physical symptoms, and improvements in mood, depression, and anxiety.

Chiropractic is another powerful, natural method to relieve the pain of fibromyalgia for many patients. One study looked at patients who were suffering with chronic fibromyalgia. After receiving chiropractic treatments, the majority of patients improved significantly, experiencing decreased pain intensity and fatigue as well as better sleep quality. Yet another study found that chiropractic and exercises were an effective way to reduce pain and disability.

Don’t let the pain of fibromyalgia determine your quality of life. Call our office today to see how we can help you relieve your pain.

Predicting Fibromyalgia Outcome

This study reports the factors that determined outcome from fibromyalgia in 44 patients. Researchers investigated pressure tenderness, work capacity, subjective improvement, pain reports, disturbed sleep, lack of energy reports, disability, depression measures, and number of negative life events.

The study found that “adequate physical exercise and increasing age predicted a positive outcome, while receiving a permanent disability pension or having an excess of major negative life events predicted a negative outcome.” Interestingly, the study found that symptom duration did not affect outcome pain and disability levels.

In concluding, the author states, “…one may do FS patients a disservice by granting them lifelong disability pensions.”

Wigers SH. Fibromyalgia outcome: the predictive values of symptom duration, physical activity, disability pension, and critical life events — a 4.5 year prospective study. Journal of Psychosomatic Research 1996;41(2):235-243.

Fibromyalgia and CNS Dysfunction

Research on fibromyalgia (FM) has recently focused on disturbances in the central nervous system (CNS). McDermid et al.1 reported generalized hypervigilance in FM patients, and Wachter et al.2 recently published a study that found evidence of overactivity of the sympathetic nervous system in patients with fibromyalgia and other pain syndromes.

A current study examined 168 fibromyalgia patients to determine if there indeed was evidence of CNS dysfunction. All patients underwent an auditory brainstem response test (ABR), used to test the function of the cochlear nerve and auditory pathway in the brainstem; an oculomotor test, which monitors the neurological systems responsible for eye motor function; and a electronystagmography test (ENG), which measures vestibular function.

Researchers found:

  • 78% of the FM patients complained of dizziness or vertigo. Most of these cases were mild, but 4% complained of constant, severe dizziness.
  • Sensorineural hearing loss was found in 15% of the FM patients.
  • 51 of the subjects (30%) had abnormal ABR test findings.
  • 58% of the FM subjects had abnormal eye movement tests, and 45% had abnormal findings on the ENG test.

Similar findings have been found in whiplash injuries (see Soft-Tissue Review, Volume 1, Nos. 4,9,10.) What has not been determined is the root cause of this disturbance. Some speculate that the vestibular dysfunction arises from injury to the brainstem; others believe that proprioceptive disturbance in the cervical spine is responsible.

The issue is complex. On one had, the authors report that the nature of the abnormal ABR tests “strongly indicate that dysfunction involving the pons is common in patients with fibromyalgia.” Then, in another paragraph, they state, “The interpretation of the findings of abnormal saccades and smooth pursuits as well as abnormal ENG registrations is that of CNS dysfunction, most likely in the posterior fossa. However, disturbances of smooth pursuits and also, to some extent, of saccades, can be seen in patients with tension headache without neurological signs and symptoms. The explanation of this observation is that proprioceptive dysfunction in the neck might cause erroneous signals which could disturb the oculomotor regulation.”

In short, fibromyalgia shows some similarities to whiplash. It is not know whether these objective findings are due to problems in the brainstem or to disturbance of neck proprioception. As more studies are conducted, hopefully we can discover the answer to this problem.

  1. McDermid AJ, Rollman GB, McCain GA. Generalized hypervigilance in fibromyalgia: evidence of perceptual amplification. Pain 1996;66:133-144.
  2. Wachter KC, Kaeser HE, Guhring H, et al. Muscle damping measured with a modified pendulum test with patients fibromyalgia, lumbago, and cervical syndrome. Spine 1996;21(18):2137-2142.
  3. Rosenhall U, Johansson G, Orndahl G. Otoneurologic and audiologic findings in fibromyalgia. Scandinavian Journal of Rehabilitation Medicine 1996;28:225-232.

Characteristics of Post-Traumatic Fibromyalgia

This study compared two groups of fibromyalgia syndrome (FS) patients: 46 with post-traumatic FS, and 46 with idiopathic FS. Each group was given a series of self-report inventories and a medical examination.

The study found that there were no significant differences between the groups in terms of physical findings. The traumatic-onset FS patients, however, reported more pain, distress, disability, and lower general activity than the idiopathic-onset FS patients. “The greater disability and psychological distress in the post-traumatic FS patients were present even when we controlled for compensation status, a potential mediator. Thus, the differences between the two types of FS onset cannot be attributed solely to a desire by these patients to receive some financial gain.”

Turk DC, Okifuji A, Starz TW, Sinclair JD. Effects of symptom onset on psychological distress and disability in fibromyalgia syndrome patients. Pain 1996;68:423-430.

Fibromyalgia and CNS Dysfunction

Research on fibromyalgia (FM) has recently focused on disturbances in the central nervous system (CNS). McDermid et al.1 reported generalized hypervigilance in FM patients, and Wachter et al.2 recently published a study that found evidence of overactivity of the sympathetic nervous system in patients with fibromyalgia and other pain syndromes.

A current study examined 168 fibromyalgia patients to determine if there indeed was evidence of CNS dysfunction. All patients underwent an auditory brainstem response test (ABR), used to test the function of the cochlear nerve and auditory pathway in the brainstem; an oculomotor test, which monitors the neurological systems responsible for eye motor function; and a electronystagmography test (ENG), which measures vestibular function.

Researchers found:

  • 78% of the FM patients complained of dizziness or vertigo. Most of these cases were mild, but 4% complained of constant, severe dizziness.
  • Sensorineural hearing loss was found in 15% of the FM patients.
  • 51 of the subjects (30%) had abnormal ABR test findings.
  • 58% of the FM subjects had abnormal eye movement tests, and 45% had abnormal findings on the ENG test.

Similar findings have been found in whiplash injuries (see Soft-Tissue Review, Volume 1, Nos. 4,9,10.) What has not been determined is the root cause of this disturbance. Some speculate that the vestibular dysfunction arises from injury to the brainstem; others believe that proprioceptive disturbance in the cervical spine is responsible.

The issue is complex. On one had, the authors report that the nature of the abnormal ABR tests “strongly indicate that dysfunction involving the pons is common in patients with fibromyalgia.” Then, in another paragraph, they state, “The interpretation of the findings of abnormal saccades and smooth pursuits as well as abnormal ENG registrations is that of CNS dysfunction, most likely in the posterior fossa. However, disturbances of smooth pursuits and also, to some extent, of saccades, can be seen in patients with tension headache without neurological signs and symptoms. The explanation of this observation is that proprioceptive dysfunction in the neck might cause erroneous signals which could disturb the oculomotor regulation.”

In short, fibromyalgia shows some similarities to whiplash. It is not know whether these objective findings are due to problems in the brainstem or to disturbance of neck proprioception. As more studies are conducted, hopefully we can discover the answer to this problem.

  1. McDermid AJ, Rollman GB, McCain GA. Generalized hypervigilance in fibromyalgia: evidence of perceptual amplification. Pain 1996;66:133-144.
  2. Wachter KC, Kaeser HE, Guhring H, et al. Muscle damping measured with a modified pendulum test with patients fibromyalgia, lumbago, and cervical syndrome. Spine 1996;21(18):2137-2142.
  3. Rosenhall U, Johansson G, Orndahl G. Otoneurologic and audiologic findings in fibromyalgia. Scandinavian Journal of Rehabilitation Medicine 1996;28:225-232.

Tender Points, Distress, and Fibromyalgia

Fibromyalgia involves multiple and dispersed tender points that induce pain. In conjunction with the pain are the psychological symptoms of depression, anxiety, and fatigue. This study examined associations between tender point counts, and components of somatization, including childhood events, illness and self-care behavior, and fatigue.

The authors began with 289 subjects that displayed psychological distress assessed by the General Health Questionnaire, Somatic Symptom checklist, and Illness Attitude Scales. Of these, 99 (34%) had a high tender point count. When evaluating these 99 subjects (and comparing them to low-count participants) the authors found the following psychological and somatic trends among high tender point patients:

  • Higher levels of fatigue.
  • Lower levels of self-care.
  • Scored in the top third of the Illness Behavior scales.
  • Had physical symptoms of an unknown origin.
  • Sought more medical consultations.
  • Were more likely to be female and older.
  • Had more somatic and psychological symptoms.
  • Reported child abuse nearly five times as much as those with the lowest number of tender points.
  • Did not report a lack of maternal care or overprotection, but did perceive their father as uncaring.

These findings indicate, “It is possible that these characteristics of somatization and illness behavior, and their childhood antecedents, contribute to the development of the syndrome of fibromyalgia.”

McBeth J, Macfarlane G, Benjamin S, et al. The association between tender points, psychological distress, and adverse childhood experiences. Arthritis & Rheumatism 1999;42(7):1397-1404.

Fibromyalgia Five Years Later

This study investigated the significance and course of pain in a female population over a period of 5.5 years. 2,038 women from the general population were evaluated for their self-reported pain, history, and associated symptoms (fatigue, swelling, sleep disturbance, waking achy). 1,168 reported chronic pain, and 214 had an extensive interview and examination. 16 pain sites, and 18 tender points were examined by applying pressure with fingers. The authors also measured the intensity of fatigue, pain, and stiffness via a scale questionnaire.

In performing this study the authors established four categories for pain and patients:

  • Non Chronic Pain (NCP)
  • Chronic Regional Pain (CRP)
  • Chronic Multifocal Pain (CMP)
  • Chronic Widespread Pain (CWP)

 At the baseline, 46 had NCP, 69 CRP, 42 CMP, and 57 CWP. Of the 57 CWP, 39 patients met the diagnostic criteria for fibromyalgia (FM).

5.5 years later only 7 patients had no pain. The regional pain group decreased by 11%, and the widespread pain group increased by 11%. The FM subgroup increased to include 71 patients—33% of the total sample. The following charts express the differences, and how the groups changed over the years.

Condition Percentage
Worsened 71 (33%)
Same 88 (41%)
Improved 55 (26%)

The authors conclude:

“These observations indicate that the extension of pain in musculoskeletal pain syndromes tends to increase with time, and that an evolution into widespread pain is not uncommon…These findings, together with the overall increase in CWP, indicate an unfavorable outcome of chronic pain, especially if the extension exceeds regional pain.”

Furthermore, the authors state that their “findings substantiate other reports…and indicate that FM is a clinical syndrome at the severe end of a continuum rather than a well-defined disease entity.”

Forseth KO, Foree O, Gran JT. A 5.5 year prospective study of self-reported musculoskeletal pain and of fibromyalgia in a female population: significance and natural history. Clinical Rheumatology 1999;18:114-121.

Myofascial Face Pain and Fibromyalgia

Previous studies have reported that patients suffering myofascial face pain (MFP) are likely to report high rates of widespread pain associated with fibromyalgia (FM). This recent study aimed to determine differences in clinical characteristics between patients with only MFP and patients suffering both MFP and FM.

Using the records of a clinician specializing in treatment of chronic facial pain, the researchers identified 162 female patients whose records showed they met diagnostic criteria for MFP. An average of 7 years had elapsed between the time of physical examination of the patients and the time of this study. Researchers conducted structured telephone interviews to determine the patients’ health and psychiatric histories.

Of the 162 patients, 38 (23.5%) reported a history of FM. At the time of physical examination, both the 38 that had reported a history of FM and those that did not report FM had exhibited similar signs and symptoms of MFP. Those with both MFP and FM were:

  • less likely to recover from MFP. Only 2.7% of patients with both FM and MFP were free of facial pain at the end of the study, as opposed to 25% of the non-FM patients.
  • reported more symptoms of MFP that were more severe and were more likely to interfere in social and occupational function.
  • more likely to have had a history of major depression and somatization of symptoms.

The authors conclude that those patients with both MFP and fibromyalgia are likely to suffer more persistent and debilitating MFP than those that do not have a history of FM. Those with both conditions are also likely to have higher rates of depression and somatization of symptoms.

This study was limited in that it could not address issues of similar or different pathogenesis of FM vs. MFP, nor could it explain the association between them. The study used patients self reports to assess presence of FM, which raises questions as to how the conclusion may have been affected. Nevertheless, the authors assert that their findings are,

“… clinically significant in that they show that the course of, outcome of and disability associated with MFP are influenced by whether MFP is accompanied by symptoms of FM. Thus it is recommended that symptoms of FM be assessed among patients seeking treatment of a regional myofascial problem such as MFP.”

Raphael K, Marbach J, Klausner J. Myofascial face pain clinical characteristics of those with regional vs. widespread pain. The Journal of the American Dental Association 2000;131:161-171.