Fibromyalgia Presentations-One Day Workshops

Upcoming One Day Fibromyalgia Workshop

Date: Saturday May 16th, 2009

Cost $ 175 IRMA Members $195 all other therapists

Sponsored by IRMA Institute of Registered Myotherapists
Fibromyalgia: Clinical Approaches for the Manual Therapist

Details: IRMA Office- 200 Alexander Parade, Fitzroy

Contact Persons to Register : Gabriela or Laura on  03 9418 3913

Fibromyalgia Article: Dr John Gillick

Ultimate Cumulative Overload Syndrome

Foundation article on the basis of understanding for manual therapists as to how to understand and approach a client with fibromyalgia. The article by Dr.John Gillick was one of the clearest available to contextually understand the syndrome.

Article: UNDERSTANDING FIBROMYALGIA

How to Tame Fibromyalgia © 2001, John S. Gillick
Jgillick@simple-ergonomics.com

FIVE CONCEPTS
To understand Fibromyalgia (FM), it is necessary to understand:

I. Vulnerability; II. Cushion & Overload; III. Trigger & Enabler; IV. Active Fibromyalgia; and, V. Ownership

I. VULNERABILITY

There is an apparent increased vulnerability among certain persons toward development of fibromyalgia. Others, exposed to the same triggers, show no signs of the condition.
Vulnerability (predisposition) appears to be familial with women more vulnerable than men. However, with enough trauma, virtually anyone can develop fibromyalgia. There are not significant cultural, ethnic, geographic, or generational predisposes or protectors.

II. COPING, CUSHION, OVERLOAD, OVERWHELM

People have varying capacities to cope with or cushion ongoing stress and trauma. An intact, healthy capacity allows multi-task coping without exhaustion. Each individual has a limited capacity for trauma with which can be overwhelmed. When the coping mechanism are strained or maladaptive — during illness, severe mental stress, marked sleep depravation –capability (buffering, cushioning) is decreased and an individual can become chronically overwhelmed. Uninjured individuals, with normally resilient and untaxed restorative powers, continue to readily cope with the ongoing large and small traumas of daily life.

While some people can endure prolonged torture without “breaking,” others are more easily overwhelmed. When the micro-traumas of daily tasks cumulate and neuro-muscular restoration (coping) cannot keep pace, even tiny traumas become noxious and cause pain. There is hypersensitivity to the slightest noxious (“hyperalgesia”) with normally non-noxious stimuli perceived as pain (“allodynia”). This is pain amplification.

With coping mechanisms overwhelmed, “pain-begets-pain.” Neuro-physiological and pharmacological equivalent for diminished “coping”. Chronic pain researchers have shown reproducible neuro-anatomical and biochemical changes from induced chronic pain in the nervous systems of animal-model experimentation.

With chronic pain, there is on-going hyper-stimulation of the nociceptors, anti-nociceptors, and dorsal horn cells, resulting in dendritic nerve remodeling with inhibition of the normal thalamic down regulation of pain stimulus transmission.

The anti-nociceptive system is not allowed to recover, the inter-relationship between dorsal horn dendrites and the nociceptive and anti-nociceptive receptors doesn”t recover. There is nerve remodeling with dendritic new growth toward the thalamus. There is sympathetic nerve sprouting as well as crossing over of fibers between lamina in the spinal cord. Experimental over stimulation in animals can produce retrograde activation of nociceptors, nerve remodeling, dorsal horn hyper-excitability with the allodynia and hyperalgesia that is common to the chronic pain syndromes. This process can be halted and may be partially reversible.

III. TRIGGERS AND ENABLERS (T&Es)

Triggers. Fibromyalgia is started (triggered) by painful stimuli (traumas) which
overwhelm an individual’’s physical and mental defenses or coping mechanisms.
In my view, fibromyalgia (FM) can be categorized by how it starts. “Secondary” FM (10-30%) has a rapid (within three months) onset associated with a specific traumatic episode or event (macro trauma).

“Delayed-secondary” FM: (20-30%) onsets six months to several years after a traumatic episode or disease that leaves an ongoing, chronic measurable residual (i.e., whiplash, chronic inter-vertebral disc syndrome, rotator cuff injury…).

“Primary” FM: (50% +/-) – also called “idiopathic” — has a gradual onset without
immediately obvious trigger(s). My experience suggests that multiple, chronic,
cumulative micro-traumas are its usual trigger(s).

Enablers. Once activated, the global condition of active FM is kept active by ongoing irritations or traumas, which I dub enablers. Enablers are usually multiple. They may be ongoing residuals of macro-trauma triggers (i.e., whiplash, coccydynea, systemic diseases) or ongoing (micro) traumas (i.e., chronic sinusitis, repeated impact trauma, musculoskeletal dysfunction in the upper or lower extremities, positional sleep traumas…).

IV. THE FIBROMYALGIA SYNDROME (FMS)
THE ULTIMATE CUMULATIVE TRAUMA OVERLOAD SYNDROME

Active Fibromyalgia is manifest or hypersensitive (“hyperalgesia”) widespread myalgia
with extreme sensitivity to the slightest noxious stimulus (“allodynia”). The FMS persists as a widespread neuro-muscular-spasm condition with “pain-begetting-pain.” Living with fibromyalgia is like living in a “pain-amplification-chamber.”

I prefer to use “pain amplification” to express hyperalgesia and allodynia. Fibromyalgia continues because of uninterrupted daily activity trauma amplification (DATA). Amplification of daily activities traumas continues to further injure and prevent recovery of the individual’’s normal coping responses. The fibromyalgic is unable to adequately blunt or cope with even small daily traumas. Until the enablers and the triggers are corralled, the fibromyalgic’’s diminished physical/ mental coping mechanism (thalamic down-regulation) is overwhelmed.

V. OWNERSHIP – RESPONSIBILITY

Control of fibromyalgia is dependent upon the individual, not the health professional.
Fibromyalgia cannot be turned off by some doctor, some special treatment, pill, diet or supplement from the outside. Tools for control are education (understanding), behavior modifications with removal of the T&E’’s, adjunctive medications, physical modalities, and emotional support. These tools can be made available to the Fibromyalgic, however only the Fibromyalgic can elect whether to employ them.

Fibromyalgia can control the individual when it is hyper-active. It becomes a dominant factor that limits home and employment activities, etc.. .

Fibromyalgia may co-exist within the individual when the individual has some ownership of the condition and can temporarily “shut-down” the condition (the echo or amplification effect) by willpower and concentration.

The Fibromyalgic owns the condition when the individual can “turn-down,” then “turn-off” the condition by removing the triggers and the DATA — daily activity trauma amplifiers – that keep it active.