Dr Frances Pitsilis - Body Pain And Fibromyalgia

Pain is the number one reason people go to the doctor.  If you survey yourself and your friends, particularly your female friends, you will recall the sorts of pains that they complain of.  These can include migraine and headache that can be related to hormones and stress, but also tend to include diffuse or generalised vague body pains and even stiffness.  These sorts of problems can be so vague and difficult to treat that doctors may be at a loss as to how to approach the problem. 

Polymyalgia rheumatica

Polymyalgia rheumatica tends to become more common in women more than men, after the age of 50.  It is as common as between 1.3 and 11.3 per 10,000 people aged over 50 and it is twice as common in men than women.

Polymyalgia rheumatica affects the shoulder and/or hip area, with aching and morning stiffness, and sometimes pain down the upper arms and into the elbows, and also down the thighs and into the knees.  People with this problem find it difficult to get out of bed or stand up from the seated position.  However, this is a common symptom and can be related to other rheumatic conditions.  Polymyalgia symptoms can start quite suddenly and symmetrically over the parts of the body mentioned and can even involve the neck and low back as well.  The doctor will confirm the diagnosis by doing a blood test called CRP and sometimes ESR – when both of these are quite high along with the symptoms, the diagnosis can be made.  At this time, the doctor will wish to be careful that the large arteries of the head and relating to the eye are not involved (this is called giant cell arteritis) so that there is not a risk of blindness.  If this is the case (in about 10% of sufferers), the doctor will refer the patient to an eye specialist if necessary.

What is really important about PMR is that there are many other conditions that can mimic it.  It is important to check these out so that the person does not end up on large doses of steroids (this is the treatment of PMR) for something that they have not got.  Some of the conditions that can mimic PMR include:

• Cancer
• Viral or bacterial infection
• Giant cell arteritis.
• Rheumatic conditions including lupus, fibromyalgia, rheumatoid arthritis and other rheumatic conditions.
• Underactive thyroid.
• Drugs including statin drugs for cholesterol.
• Arthritis.
• A local shoulder or hip problem.

In my own experience, there have been patients who have not had polymyalgia rheumatica, and in one case the condition was really an underactive thyroid.

Case – David, aged 73:

David came along and told me that he had a stiffness and pain in his shoulders that seemed to go down his arms.  The stiffness also went down his thighs.  I happen to know that he had had an underactive thyroid and we had had trouble getting good control of his medication for it.  His blood tests were not helpful because his CRP and ESR were not really raised.  I referred him to a rheumatologist who did not think the condition was polymyalgia rheumatica but could not say what else it was.  I worked hard with David to get his underactive thyroid under much better control and his pain went away.

Fibromyalgia

Fibromyalgia is a syndrome of unknown cause.  In fact, doctors call conditions syndromes when they don’t actually know what the cause is.  A syndrome in my own mind, seems to be a collection of symptoms that seem to run together in patients and have been given a name, like fibromyalgia syndrome or chronic fatigue syndrome. 

Very often in these conditions, there is a description of all the symptoms that run in that syndrome with no real underlying cause.  As in both the syndromes mentioned, there has been lots of research with many suggested causes being hypothesised by researchers.  However, what they are trying to do is find one specific cause of the syndrome which I believe is never the case. 

Fibromyalgia is defined by the American College of Rheumatology as being “diffuse soft tissue pain lasting at least three months”.  In addition the person has to have particular pain in at least 11out of 18 specific points around the body.  The symptoms are worsened by exertion, stress, lack of sleep and weather changes.

Fibromyalgia used to be called “fibrositis” by the previous generation.  It can affect up to 6% of people seen by your family doctor.  The age group seems to be between the age of 20-50 but it gets even higher by the age of 80.  It is between 9 and 20 times more common in women.  Half of the patients seem to get the symptoms after a flu-like illness or after some sort of physical or emotional trauma.  Experts say that it should be a diagnosis of exclusion – this means that doctors have to do lots of tests and examinations to make sure that they cannot find anything wrong with the person.  At the end of all of this, when they have excluded depression, joint problems,a chronic pain condition, or an arthritic or rheumatic condition, then they can call the condition fibromyalgia. 

Very often, fibromyalgia seems to run along with chronic fatigue syndrome – in fact there appears to be a clinical spectrum that seems to involve both fibromyalgia and chronic fatigue.  There are many chronic fatigue patients that have diffuse body pain and many fibromyalgia patients that have fatigue.

Fibromyalgia is often found in people with other chronic pain conditions – these can include migraine, jaw joint problems (called temporomandibular joint syndrome), rheumatoid arthritis and lupus.  Some of the patients can have undiagnosed hypothyroid that can be mistaken for fibromyalgia because some of the pain symptoms around the shoulder and arms can be extremely similar.

Case – Suzie, age 23

Her mother had told me that she had fibromyalgia when we met her socially.  I mentioned to her mother that some of the fibromyalgia patients could indeed have an underactive thyroid.  Months later, Suzie’s mother brought her to me because she was under a lot of stress with her university exams and I had the opportunity to be able to blood test her and examine her.  There were several nutritional imbalances.  However, when I examined Suzie, she had very obvious examination signs that she was burnt out and that she had an underactive thyroid.  The burnt out symptoms and clinical examination findings included clammy hands, dark circles and she was rather anxious and tired. The hypothyroid signs were extremely yellow hands and feet, and very puffy fluid around her eyes and she had the textbook sign which was delayed ankle reflexes.  I decided to treat Suzie’s thyroid even though her blood tests looked normal (see my article on hypothyroid), and I was very pleased to hear that within six weeks she was starting to feel a lot better.  Her fatigue was improving and her body pains had completely gone.

Researchers think that what is really going on in fibromyalgia are a number of different things.  The primitive part of the brain and gets stimulated a lot when someone has been under chronic stress, whether it has been physical or mental, and researchers have found that the primitive brain (called the limbic system) is involved and stimulates the adrenal glands over a long period of time, and as a result the adrenals respond a lot less to stress.  Often these people do not sleep very well, get ‘ wired and tired” and the whole thing just keeps getting worse.  There have been a lot of other imbalances found in fibromyalgia patients including that they respond more to minor stimuli and pain and so that researchers think that there is something wrong with their pain system.

What is really important about fibromyalgia is to help that person sleep better to start the process of restoring their body.  Another part of treatment must be exercise because it oxygenates the body and improves circulation.  Exercise can also have psychologically beneficial effects.  However, it is really important that these people do not overdo it or they end up becoming overly fatigued.  Conventional medicine also includes using tricyclic antidepressant medicines which are usually very helpful.

The natural approach to fibromyalgia is to include the conventional medical approach and add in the correction of any imbalances in terms of diet, vitamins and hormones, and correct these.

Truncal and body pain

Case – Rita, aged 63

Rita, who has mixed Samoan and Chinese blood, worked at an indoor job and came to me for fatigue and her diffuse body pain – this consisted of back, neck, shoulders and generally vague pains around her body that she could not specifically identify.  The pain was bad enough that she could not turn over in bed without waking.  She was found to have the lowest vitamin D level that I had ever found and within a week of starting her on a loading dose of vitamin D, she emailed me and told me that she could go to the shopping mall now because she used to have to hold onto a wall so that she did not fall over.  (Vitamin D stops people from swaying and falling over).  She also told me that she was now able to sleep through the night because before, rolling over would cause pain and wake her up.  

One of the medical syndromes that I have come across in my practice is the vague pain of the trunk.  By this I mean around the back but not down into the hips or up into the shoulders specifically.  Sometimes it may go into the thighs.  On a number of occasions I have found these people to be low in vitamin D and their pain symptoms have been corrected by restoring their vitamin D levels. The vague body pain related to low vitamin D is more common in women.

Vitamin D is an important ingredient in helping people with chronic pain problems.  Not only has correcting vitamin D been important with diffuse body pain but in patients who thought that they had fibromyalgia with pain all over their body.  Even specific areas of pain have been helped by it.

Case – Todd, aged 26

Todd came to me because he had been feeling tired and thought he was a bit burnt out with his adult studies at the university.  He had also sprained his Achilles tendon and was having physiotherapy for that but was not proceeding very well with it.  I found him to have a few nutritional deficiencies and they included an extremely low vitamin D.  During the course of correcting his nutritional deficiencies, he found that when I corrected his vitamin D his Achilles pain significantly reduced.

Body pain stiffness and fibromyalgia like symptoms can be associated with many other conditions

Over the course of my work and research, I have found it interesting to see that there are many conditions that seem to overlap with each other and can be associated.  Different patients will come to me with some of these symptoms in different combinations.  These different conditions can include the following:

• Migraine.
• Tension headache.
• Irritable bowel syndrome.
• Chronic fatigue syndrome.
• Fibromyalgia syndrome.
• Myofacial pain syndrome.
• Temporomandibular dysfunction.
• Restless legs syndrome.
• Periodic limb movement disorder.
• Multiple chemical sensitivity.
• Post traumatic stress disorder.
• Depression.
• Painful periods.
• Burning mouth syndrome
• Disordered breathing and hyperventilation

Additional symptoms and complains that seem to go with these include:

• Problems sleeping
• Fatigue
• Problems with memory and concentration
• Brain fog
• Food cravings
• Depression
• Anxiety

When a patient comes with some of these symptoms in combination, I know that I must not treatment them by giving a pill for each condition.  Rather I need to find out what is underlying and common to many of these conditions.  This ends up being a vitamin D deficiency or a hormone deficiency, or some other dietary, hormone or vitamin deficiency.  As all of these are slowly corrected, the symptoms of the various conditions start to get better.

Hormones and pain and stiffness

Not surprisingly it seems that women seem to have more of the pain conditions than men, and also interestingly, they tend to have some of these in association with their menstrual cycle or around menopause. 

Some women get their headaches mostly during their period and this is likely because there is a drop in oestrogen at this time during their cycle.  Other women tend to get their headaches premenstrually which can suggest it is because there is a drop in natural progesterone in the second half of their cycle.  Progesterone in this situation has been found to help tension and migraine headaches.

Women have been found to develop rheumatoid arthritis around and after menopause.  Researchers have suggested that oestrogen levels may have a role in preventing pain in this situation.  However, researchers have also found that adequate levels of androgenic (male type) hormones like DHEA and testosterone, may also protect both women and men from pain.

Deficiencies of oestrogen, thyroid, testosterone and other hormones typically can cause morning stiffness and stiffness when getting out of a chair, so it is not just some of the other conditions that can cause this type of stiffness.  The doctor needs to be aware that it could be a wide variety of deficiencies, not just vitamin D, nutrition, polymyalgia, but it can be a deficiency or imbalance of hormones.  In the end, what is best for the body that eradicates pain and stiffness, is the harmony of the body’s biochemistry which will include diet, lifestyle, correcting nutritional and hormone imbalances. 

Drugs

We must also not forget that some of the medications people are taking for a variety of conditions could affect them.  In particular, statin drugs can cause pain and stiffness that can mimic polymyalgia and hypothyroid.  Indeed the pain that can be caused by statins tends to be worse when the person has an underactive thyroid as well.

So, in the end, any pain or stiffness can be investigated and hopefully treated when remembering to follow a plan that will help to identify the following:

1. Check that its not a drug causing it
2. Make sure something serious has not been missed.
3. Consider that what you think is wrong could be something else eg Hypothyroid.
4. Check for any nutritional deficiencies
5. Check and correct any hormone deficiencies. When it comes to hormones like estrogen and testosterone, they need to be harmonized.
6. Unless the patient has a specific rheumatic condition that really requires drugs, try to avoid them.