Fibromyalgia is Real, and Medications are Not the Only Answer, Part 2
By Martin Rutherford, D.C., C.C.S.T., C.F.M.P., and Randall Gates, D.C., D.A.C.N.B.
In part one of this series we discussed the evolution of fibromyalgia as a disease condition, the name itself and what it means, the 1990 and 2010 American College of Rheumatology guidelines for its diagnosis, the concepts of central sensitization and concepts of past emotional traumas and their role in the development of pain in the fibromyalgia patient. In this article, we will cover the contribution of Hashimoto’s thyroiditis, digestive bowel issues and peripheral neuropathy to complete the clinical picture of what fibromyalgia is for the reader.
Hashimoto’s: A huge proportion of the patients coming to us with a diagnosis of fibromyalgia test positive for Hashimoto’s disease. There are numerous comprehensive presentations on our website: www.PowerHealthTalk.com. But, in short, this is a condition in which the immune system kills the thyroid. Due to the fatigue aspect of fibromyalgia, the patient is often tested for thyroid function and may be told that the thyroid test is normal, or told that they have a hypothyroid and are put on thyroid hormone replacement medication. Uncommonly tested for are the antibodies that attacked the thyroid and, when present in a certain number, indicate that the patient instead has Hashimoto’s thyroiditis. Hashimoto’s thyroiditis accounts for about 95 percent of low thyroid cases in the United States. It is mostly not tested for in the medical model because establishing its diagnosis does not change treatment to anything different than a hypothyroid. Your doctor in both cases will give you thyroid medication and monitor your TSH. This is not sufficient treatment for Hashimoto’s. Here’s why:
The immune inflammation from the immune attack on the thyroid we are finding can be very damaging to the pain nerves throughout the entire body – not unlike the excess adrenaline mentioned in part one. Imagine you get a viral infection and your immune system is trying to kill the virus. This process creates a lot of inflammation. As a result, you experience joint pain, achiness, tiredness, poor energy and a touch of depression. This same inflammatory process occurs with Hashimoto’s thyroiditis. The immune system should never kill ”us” but, in the U.S., this process of autoimmunity to the thyroid is becoming an epidemic, as one out of four women in the U.S. have Hashimoto’s thyroiditis. And it’s inflammatory response, along with the previously mentioned adrenaline hormones, are what sensitize the fibromyalgia patient nociceptors (pain fiber endings) throughout the body and cause the pain that comes with this condition.
A huge number of fibromyalgia patients also su er from irritable bowel syndrome. This condition is what causes cramping and bloating after you eat. IBS is also de ned by diarrhea, constipation, alternating constipation and diarrhea, any of which could last for 3 months (and at least for 3 days out of each of those 3 months). IBS can involve gluten sensitivities. It can include bacterial issues in which our population of good bacteria and bad bacteria are functionally out of balance: the bad bacteria overtake the landscape in a fibromyalgia patient. The fibromyalgia patient can also get too many bacteria, good or bad, and that can be an issue. Whatever it is in that patient, the abdominal inflammation from whatever is causing the IBS create an immune inflammation throughout the body that can then cause the fibromyalgia patient to have pain again by, for example, setting o immune inflammation against the thyroid and perpetuating that whole pain cycle.
As a subset of the IBS contributing factors, we must mention gluten. Relative to gluten sensitivity, it is significant to fibromyalgia patients even if they don’t have celiac, as it actually damages both central (brain) and peripheral (arms and legs) nerve tissue resulting in brain fog, depression and peripheral neuropathy in about 50-60 percent of the fibromyalgia patient population.
Peripheral neuropathy is the newest and hopefully last spoke in the wheel of positive contributors to fibromyalgia. About 50 percent of all fibromyalgia patients have peripheral neuropathy (see our presentation on www.PowerHealthTalk.com on small fiber neuropathy for a more comprehensive discussion of this topic). Peripheral neuropathy is numbness, tingling, burning, sharp shooting pain felt by the small fiber nerves in the feet and hands… and now we understand, also, the torso. In fact, recent studies show that there is 10 times more damage to the peripheral nerves in these areas in people who have fibromyalgia and peripheral neuropathy versus those who only have peripheral neuropathy. The long and short of this finding is that peripheral neuropathy in the fibromyalgia patient must be addressed in that patient’s clinical protocols inasmuch as it may be the causative generator for their overall pain (along with stress hormones, cortisol, and adrenaline and Hashimoto’s immune inflammation) as well as the direct cause of their IBS, small intestinal bacterial overgrowth, leaky gut and restless leg syndrome – if they are experiencing any of the latter three conditions as part of their overall clinical picture.
So, fibromyalgia is complex. But, the causes are known. And in the properly selected patient they can be addressed and managed. There are no quick fixes, no one-size- fits-all diets. Bags of supplements aren’t the answer. So, what is? Next month we will outline our paradigm for the treatment of fibromyalgia and how individualized the approach to fibromyalgia must be for treatment to be effective.
For more information, call Power Health at 775-329-4402 or visit www.PowerHealthNV.com.