Getting Rid of Fibromyalgia | Modern Manual Therapy Blog - Manual Therapy, Videos, Neurodynamics, Podcasts, Research Reviews

Getting Rid of Fibromyalgia

Any of you regular readers will know how much I appreciate Butler and Moseley's work on chronic pain. This post is not meant to be some secret formula or treatment recipe that I have stumbled upon to "cure" fibromyalgia. As an entity, we don't really know what causes it, most medical testing is negative, and the patient is supposed to have several standardized tender points. It can present as mechanical, but often is not.

I don't have the answer to those patients that everyone has difficulty with. What prompted me to write this is the incorrect diagnosis of fibromyalgia. Yesterday I did an initial evaluation on a patient referred to me with 3/10 cervical and facial pain. It was intermittent, and more on one side than the other. She had full cervical ROM, except OA forward bending, and some upper quarter fascial restrictions. Her posture of course was fair at best. She was not on soft food diet, and not wearing an orthotic like many of my TMD patients. After we finished with her brief history, I asked her my usual final question prior to starting the objective portion of the exam, "Is there anything else medically I should be aware of?" "Oh yes," she replied, "I have fibromyalgia." She said her a rheumatologist gave her the "diagnosis." This is in quotes because diagnosis is normally reserved for actual causes of symptoms, i.e. rotator cuff rupture, herniated disc with nerve compression. etc...  Fibromyalgia, like irritable bowel syndrome, or chronic fatigue syndrome, are clusters of symptoms, many times with no cause. A study even showed that patients with chronic "something" went to several specialists, the rheumatologist diagnosed them with fibromyalgia, the GI doc, with irritable bowel syndrome, GP with chronic fatigue syndrome. That gets them nowhere near any kind of solution!

She had
1) no tender points (on the standard chart)
2) cervical MRI was positive for such and such (I didn't look at it, but she told me about it; I don't base my treatments on them)
3) local pain
4) mechanically produced pain, with a directional preference of cervical retraction to make it better

I simply stated, "I am absolving you of that diagnosis, you don't have it, and I think you would feel a lot better if you don't think about it ever again." A simple google search showed 30 million results in .20 seconds. Most of those websites will do nothing but increase CNS sensitivity. As we want to move on and get the patient better, the first thing we can do after some postural reeducation is reassurance. What better reassurance is there than "curing" the incurable diagnosis? There are other things I take into account, many of which are intuitive. Suffice to say, I don't do this for every patient who drops the "f" bomb during the subjective, but for those who have been misdiagnosed, I never hesitate, and neither should you.

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