Hope for Patients with Fibromyalgia Part 2: a Multi-Faceted Treatment Approach

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Jill Murphy, DPT, LAT, CSCS

Last month in Part 1 of this series on fibromyalgia we reviewed what fibromyalgia is and highlighted the common symptoms of this phenomenon. To review just a bit, fibromyalgia is essentially a heightened nervous system (sympathetic portion of the autonomic nervous system to be exact), which causes the nerves to send too much information to the muscles all around the body at rest. This excess resting muscle tone is draining to the muscles fibers and to the body itself, contributing to the overall feeling of fatigue and malaise similar to feeling like you have the flu, except this feeling is much or all of the day, and does not go away. This also can affect sleep patterns, also governed in large part by the autonomic nervous system. This month we build on this information by offering a broad, multi-faceted treatment approach that is necessary for such a syndrome with a broad area of impact on the body.

First, it is important to note, that people with fibromyalgia did not get these symptoms overnight. It is rare for someone to very quickly gain these symptoms throughout their body, although not unheard of, with a sudden break down of the immune system generally related to a high level of stress combined with an overwhelmed immune system. Most patients with fibro however, have had a long, slow road that may have begun as an isolated area of pain that may or may not have been fully treated, and then progresses to more widespread areas of pain and tenderness. This is important to note, because just as the symptoms generally did not just appear overnight, they also do not go away overnight. There is no quick fix or one simple solution. There is no medication or surgery that can solve all of the problems that fibro brings. Instead, the best approach is one that incorporates multiple ways to impact the nervous system in a positive way to bring the body’s out of whack balance between the sympathetic and parasympathetic nervous systems’ back into balance.

The nervous system consists of the central nervous system, which is the brain and the spinal cord, and the peripheral nervous system, which is made up of all of the nerves that run from the spinal cord to the muscles and tells them to either fire or relax. We need to impact both parts of the nervous system to assist the system in returning to normal or what the body sees as homeostasis.

To impact the central nervous system (the brain and the spinal cord), patients should consider the following:

Relax1) Relax. Find ways to simply enjoy yourself and relax fully in mind, body, and spirit. For some patients, this is a bubble bath with candles and music. For others it may be a scenic walk or hike next to water or up a hill or mountain. It may mean reflecting, meditating, praying, doing Bible study, worshipping, swinging, singing, reading, or any other way you may find relaxes both the mind and body. Ways that are not helpful (although patients have tried to convince me that these can work) are anything with loud, stimulating music with heavy and fast beats, noise, light, artificial light (i.e. computers, cell phone, reading devices), playing video games, gambling, etc. Anything loud and obnoxious, although enjoyable to some, feeds into a heightened nervous system, and will not be helpful. If you are not able to relax fully, or if you have issues you are unable to process on your own, seeing a counselor to discuss these issues will greatly improve your ability to allow your mind and body to relax. Your nervous system is so inter-connected with all of your body systems, that if your mind is constantly stressed, it is only a matter of time before your body reflects this stress as well.

2) Find work-life balance. God rested on the 7th day of creation. I don’t think it’s a mistake that at the very beginning of the Bible God gave an incredible example that even the most powerful Being in the atmosphere needs rest to re-charge after a week of serious work. Unfortunately, in this world of technology addiction, we are encouraged by our employers, friends, and family to be in constant contact (i.e., constant stimulation) every second of the day and night. And when not in communication mode, we are sitting back, enjoying a movie, searching the internet, or reading on an electronic device. While this may be a convenience at times, this does not give the body a chance to rest, and the mind a chance to reflect and process all of the information we have gathered in a reduced stimulation environment, all healthy endeavors that off-load the body and allow the necessary re-charging for the immune system to be ready for whatever comes its way. Find one full day per week, or several evenings/mornings, whatever, but at least 8 hours per week of set aside time for you to spend in a restful, re-charging way, uninterrupted by technology, phone calls, and work/family stressors.

3) Be selective in your diet. Now, I am not a proponent of extreme diet cleanses, or other dietary restrictions. There is no research supporting the ability of any regimented diet t cure patients with fibro. However, we do need to have a balanced and healthy diet to give our immune system the best chance to work. Limiting artificial dyes, fake sugars, diet sodas, and foods laden with preservatives, whenever possible, can only help our body by reducing the number of stressors our immune and digestive system need to combat. Also limiting large spikes in blood sugar can have beneficial effects on our overall health. Most importantly, limiting dietary choices that directly impact the nervous system, whether stimulants like caffeine, or downers like alcohol, can also help our nervous system stay balanced by not artificially manipulating it into a specific state. Aim for no more than one of these beverages per day is an excellent goal. Repeatedly living on spikes of caffeine followed by sleeping pills to counter-act the caffeine to sleep is a sure-fire way to create issues with autonomic nervous system balance over time.

4) Improve your sleep hygiene. We all need at least 2 bouts of REM (rapid eye movement) sleep per night for our body and nervous system to feel well rested. Check out this article for specific ideas on improving your sleep.

5) Breathe deep.  Using your diaphragm to breathe deeply directly impacts the nervous system, putting the sympathetic nervous system to bed.  See this article for details on where the diaphragm is located and how to perform diaphragmatic breathing.

6) Medications like lyrica, Cymbalta, gabapentins, anti-depressants, and anxiety meds all work to affect the central nervous system by attempting to reduce the expression of the sympathetic nervous system, allowing the parasympathetic nervous system to increase its influence to create a more relaxed body state. These medications can be a very helpful adjunct to treating fibromyalgia; however, patients are sometimes frustrated by some of the common side effects like weight gain linked to some of these medications.

Exercise7) Exercise!!! “You’ll feel better if you Mousercise!” It’s not just a cute saying on the Mickey Mouse Club. Exercise is as effective if not more effective as the medications listed above in relaxing the overall body state without the unwanted side effects (like weight gain)! Exercise only has helpful side effects such as weight maintenance or weight loss, increased muscle tone, decreased stress, improved metabolism, immune system boost, and many others. Exercise is the best and number one way to influence the central nervous system, and in research is proven equally effective as lyrica, Cymbalta, gabapentin, and Topamax as a treatment for fibromyalgia, chronic pain, and headaches.

These are just some of the ways we work with our patients as a coach and guide to assist them in instituting the healthy changes in lifestyle that they need to combat fibromyalgia. An overall acceptance of barriers to life, setting reasonable goals/to do lists, and pacing activities (no longer cleaning the house all in one day) are also very important ways for people with fibro to improve their symptoms. Putting an emphasis on caring for oneself instead of putting others needs first on a consistent basis is an important change for the better. Most of the patients I treat with fibromyalgia are Type A personalities. These folks are great at getting stuff done and done in the most perfect way, but many times their body pays the price. Their brain is far stronger than their body, and eventually the body becomes exhausted for long periods of time, leading to fibromyalgia.

Next month, we will discuss the ways we can treat fibromyalgia through the peripheral nervous system. Until then, challenge yourself to figure out what little changes you can make in your daily, weekly, and monthly schedule at home and at work to give your body the love and rest that it needs.