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BODYWORK FOR FIBROMYALGIA "I met the criteria for a diagnosis of fibromyalgia, but my doctor and physical therapist didn't really think the official diagnosis was all that critical," says this previously energetic professional journalist. No matter what anyone called it, conventional medicine offered almost nothing for Shomon. Instead, she sought out alternative treatments for her fibromyalgia pain. "My doctor's recommended treatment was to continue the combination of myofascial release bodywork, acupuncture, thyroid hormone replacement, natural sleeping aids, and key dietary and lifestyle changes that I already had in progress," says this patient turned alternative medicine advocate. PAIN AS A WAY OF LIFE What does fibromyalgia really feel like? "Imagine that last night you drank two glasses of wine more than you would have liked, but no water, and eaten no food. You went to bed late, and got up early. You are stiff, achy, and tired—all the time," says Chanchal Cabrera, member of the National Institute of Medical Herbalists, a prestigious British herbalist, fibromyalgia patient, and author of Fibromyalgia: A Journey Toward Healing (McGraw-Hill, 2002).1 Fibromyalgia syndrome (FMS) is an enigma, and just attempting to digest the swamp of contradictory research and opinions might become a headache of migraine proportions, but this much we know: it involves serious, widespread muscular pain and fatigue. And, if that's not enough, there's the loose assemblage of chronic symptoms, including foggy thinking, PMS, and allergies, that's fairly consistent between patients, but has no obvious laboratory tests.2 Strangely, it overlaps with many other diseases—70 percent of patients also have irritable bowel syndrome, for example.3 get sick, with a cold, or after heavy exercise, symptoms often worsen. Many people feel the worst ache at certain "tender points," and 18 When people "The fact that fibromyalgia is not visible contributes to the lack of respect you may experience from others." Mary Shomon, client, Washington, D.C. very common ones actually define the disease. Yet, Cabrera sees no significant correlation with the location or pattern of tender points and takes issue with the whole concept of tender points as a way to diagnose FMS. "It's ridiculous to base diagnosis on 18 specific points," she says. "It's not a fair way to diagnose. It's just a good clue. A person might have 50 or 100 points and they move around." The misery of FMS affects about 2 percent of Americans, making it the second most common musculoskeletal disorder after osteoarthritis.4, 5, 6 Accounting for 10–30 percent of all rheumatology consultations, FMS appears mainly between the ages of 35 and 55 and occurs 7–10 times more frequently in women.7, 8 THE BODY BLOWS A FUSE The cause of FMS remains elusive. But that's probably because the huge spectrum of symptoms actually starts from many causes. Jacob Teitelbaum, 82 massage & bodywork may/june 2009 MD, medical director of the Annapolis Center for Effective CFS/Fibromyalgia Therapies, in Annapolis, Maryland, equates FMS to the body "blowing a fuse" if the energy account becomes overdrawn. "The blown fuse is hypothalamus suppression," Teitelbaum maintains.9 "The hypothalamus controls sleep, hormonal function, temperature, and autonomic functions, such as blood pressure and blood flow. The hypothalamus uses more energy for its size than any other organ. When there is an energy shortfall, it goes offline first. FMS has no one cause," says Teitelbaum, himself a former FMS patient. The hypothalamus decreases its function as a protection in the face of what it perceives as overwhelming stress, which can stem from infection, injury, or emotions. FMS patients have genetic differences in the stress-handling ability of their hypothalamus, pituitary, and adrenal regulation (the HPA axis). The muscles end up short of energy and in pain. CAN WE TURN TO CONVENTIONAL MEDICAL TREATMENT? The stigma surrounding fibromyalgia still surprises Shomon. "Those of us who have suffered through it know, from firsthand experience, that it is a very real condition. We didn't dream it up, wish it upon ourselves, or develop some psychosomatic syndrome, and we can't just think it away, buck up, and feel better, or 'get over it' by sheer determination. Some doctors—and some of our families and friends—even think that fibromyalgia is psychosomatic, evidence of laziness, malingering, or is due to some inherent emotional or character weakness. The fact that fibromyalgia is not visible contributes to the lack of respect you may experience from others," she says. Still, many people do better when they find the proper pharmacological regimen. Conventional treatment