Apart from dietary and nutritional counselling and the management of psychosocial issues as described in the previous blog, I spend most of my time treating the tender and trigger points and teaching the patient about the required changes in the breathing technique, postures, movements and exercises that will allow the best possible recovery.
Most people with fibromyalgia have hundreds of tender and trigger points. The general consensus is that there is a systemic problem or a nervous system problem that has caused the development of numerous tender and trigger points throughout the body and so treating these points would not make a difference to the underlying pathological condition. In my experience, treating these points have provided patients with symptomatic relief not only of pain but the associated sympathetic and parasympathetic symptoms such as rhinitis, irritable bowel, urinary incontinence. It is also able to improve central nervous system symptoms such as chronic fatigue, dizziness and insomnia. By improving these symptoms then the patient is more able to comply with exercise programs which will then strengthen their muscles and thus improve functioning.
There may well be numerous risk factors and causative factors for fibromyalgia but once they develop a negative cycle of pain causing disability, immobility, loss of muscle then more pain which can go on indefinitely, then that becomes the pathological process. The treatment I use can be regarded as Laser Acupuncture or Very Low Level Laser Therapy ( VLLLT ). I use 2 lasers, both are 5 mw, one is green with a wavelength of 532nm, and the other a red one at 670nm. I only apply them on the points for 2 seconds each. Some people benefit more from one colour than the other. I palpate the points to elicit some tenderness ( De Qi ) just before I apply the laser. Some people will feel tiredness or worse for a few days if you give too much treatment. In acupuncture terms we would say that they are strong responders. I don’t think that there is much importance between trigger points and tender points. The trigger points classically cause a referred pain pattern when compressed where as the tender points only cause local tenderness. In practise I am only interested in eliciting tenderness as more forceful palpation or compression may exacerbate the patients pain. I am sure that a large number of tender points are also trigger points and all trigger points are also tender. All these points are also acupuncture points; they may be on one of the 12 classical meridians, 8 extraordinary meridians, associated tendinomuscular meridians or Ashi points, some of which we learn from the grand masters when we attend conferences. I refer to Simon and travell’s books and wall charts on a regular basis and I find that the wall charts are useful for patient education as it explains why I am treating one part of their body when their presenting complaint is some where else.
I will discuss CBT for breathing, posture, movements and exercises in the next blog. As mentioned previously, this information is based on my clinical experience and the theories I form to try to explain my observations. For more evidence based studies, you will have to wait about 14 years when I semi-retire and have the time to do some double blind cross over trials. thats it from www.drchrischinbackpain.com