Fibromyalgia/Hypermobility Syndrome

Fibromyalgia is diagnosed in many female patients, often in their 40’s. Their complaints involve headache, migraine, neck, shoulder, arm, hand, back pain, fatigue and lack of endurance. Often they may have other complaints such as poor sleep. Frequently their pain shifts from area to area. Fibromyalgia patients usually are placed on non-steroidal anti-inflammatory medicines and antidepressants. Fibromyalgia patients may be placed on the popular drugs Baclofen and Neurontin.  Exercise is also often recommended. The above are only minimally successful in relief. Fibromyalgia patients seem to note some relief with gentle manipulation and massage. These methods are also temporary.

In my professional experience often the greatest symptom is lack of endurance and the need to change positions. The pain discomfort often is a pulling, aching which worsens with time to a rather severe pain. It lessens with changing from standing to sitting or from these positions to lying. This cycle of course repeats as a chronic complaint. Often times the joints will be noted to crack and pop.

My examinations have almost always revealed an undiagnosed hypermobility syndrome of the congenital or benign types. Although there are many conditions which have joint hypermobility such as Ehler-Danlos, Marfans, rheumatoid, post-polio and other syndromes; by far the most common is the congenital or benign hypermobility syndrome. These people often note that they are very flexible but they thought it was good.

Actually the medical literature states it is commonly missed as a diagnosis. If it is noted it is not understood. Joints have two functions, mobility and stability. If the mobility is in excess as in hypermobility syndrome this mobility is obtained at the expense of stability. It is this instability that yields the plethora of problems. These are not limited to those mentioned earlier, but also include flat feet, bunions, scoliosis, joints popping out of place and arthritis. The problem of hypermobility is considered sex influenced with more females affected than males. Men of course have the problem but are rarely diagnosed as fibromyalgia. They are like some of the women diagnosed by the area affected. These people can be labeled as almost any musculoskeletal diagnosis or even neurological diagnoses from carpal tunnel syndrome, rotator cuff, migraine cephalgia, osteoarthritis, anterior cruciate tear, temporal mandibular joint dysfunction, spondylolisthesis and others.

The cause of the congenital or benign hypermobility is that through genetics the body doesn’t make enough collagen or doesn’t make a good quality collagen. Collagen is the principle structural protein of the body. The ligaments, tendons, cartilage, discs and connective tissue are all made from this collagen; hence the whole body is structurally weakened. Many of the women became symptomatic at age 40 and were incorrectly diagnosed and therefore ineffectively treated. Because of the structurally weaker collagen protein all things having to do with structural support are more prone to problems.
 
Some of these are flat feet, bunions, varicose veins, knee deformities and arthritis, patellar tracking dysfunction, hernias, hemorrhoids, spondylolisthesis, scoliosis, low back problems, thoracic problems, neck problems, shoulder problems, wrist and hand problems, heart valve defects, temporal mandibular joint problems, neck problems often causing various headache and balance problems. Of course all of the above give rise to the “fibromyalgia” symptoms of hurt all over, lack of endurance, malaise, and fatigue.

So what is it all about? In my experience the vast majority of those with the fibromyalgia diagnosis actually have a congenital hypermobility syndrome easily found but only rarely previously diagnosed.  In those few diagnosed, usually by a physical therapist, the advised exercise therapy doesn’t lead to a resolution. Only one was advised to have bracing. This is on the right track but does nothing to fix the instability. Surgery at best is of no help and often causes a worsening. Reconstructive therapy, prolotherapy, sclerotherapy, or regenerative injection therapy in my experience has been effective in providing lasting improvements and relief. It does this because it is the only known proven therapy to cause a growth of the weakened tendons, ligaments and joints. There are some particular problems bringing about the resolution because of the genetic nature, getting the spinal tensions (torsions) corrected and of course understanding the causes of the complex pain problems so they can be resolved. The above are purely my viewpoints and experiences that often times are not shared by other experts.

• Patients must not be ill with bacterial infections, Lymes disease, cancer treatments, rheumatoid treatments, lupus, fevers or other uncontrolled illnesses.
• Patients must not be on cortisone or other immunosuppressant medications.
• Patients must not be on schedule II pain medications. Some of these are Oxycontin, MScontin, Opana, Demerol, morphine, Bilardid, Duragesic, Fentanyl and like medicines.
• Patients must have adequate mental status to understand instructions, complete forms and perform therapy.
• Patients must have an attitude of cooperation.
• Patients must have adequate abilities to perform activities of daily living or provide for their own assistance of above.
• Patients must have adequate self and family support.

 

In Dr. Faber’s experience most patients can notice significant changes without prescription medicines or surgery in 12 treatments to the affected area. This is a very significant goal which has been repeatedly obtained even in people who have suffered many years severely. Many factors affect one’s health, however, thus results cannot be guaranteed.

Treatment Regimens

After many years of doing this therapy, we have found the following treatment regimens to be the most successful in treating fibromyalgia/hypermobility syndromes. These regimens are based on 2 factors: 1. distance from clinic and 2. Time away from work/home. Patients may pick any of the following:

A. Local (0-200 miles from clinic) receive treatment weekly or every 2 weeks

B. Regional (200-500 miles from clinic) receive 2-4 treatments per week and repeat every 2-4 weeks

C. Remote (500 or more miles from clinic) Receive up to 4 treatments per week until 12 treatments are received.

At 12 treatments most patients note significant improvements. Frequently more are needed for total or maximum resolution not requiring more treatments of any kind or requiring much less treatments.

Treatment Regimens after 12 Treatments

Providing significant improvements are noted, continue above treatment frequencies of A, B, or C above. A decreased frequency of treatments may be possible depending on individual response. In time, although variable due to individual needs, a resolution or a stable improved status is expected.

Complications Encountered

When consulting expert physicians, surgeons, prolotherapists, reconstructive therapy therapists and neural therapists concerning fibromyalgia/hypermobility syndrome, keep in mind the above quote and the whole of what is presented here on fibromyalgia/hypermobility syndrome which is of necessity extremely brief. Most physicians will relate hypermobility syndrome to Ehlers-Danlos syndrome which is a quite rare type of hypermobility syndrome. There are many conditions which yield a hypermobility syndrome. The most common that Dr. Faber has encountered by far is the congenital to benign familial hypermobility syndrome.

The most frequent complication encountered in the treatment of fibromyalgia/hypermobility syndrome is just that, it is complicated. It is frequently not diagnosed and therefore not understood nor treated with success. The problem is mainly weakened structural protein-collagen most often from genetic causes. The body does not make enough structural collagen or it does not make a strong structural collagen. Thus joints are not well supported and in time become symptomatic even without noted injury or overuse.

If the above were not enough of a problem it is noted that fibromyalgia/hypermobility people are more sensitive to pain as their poorly produced collagen doesn’t insulate or protect the nerves as well as normal collagen does. Further their nerves are very sensitive to stretching. The hypermobility/fibromyalgia people are already at least halfway to being overstretched.

Often these people have had hard, forceful adjustments producing a cracking sound and some relief but may have led to an overstretching and an actual worsening. Fibromyalgia/hypermobility syndrome patients often require special skills in doing the prolotherapy as to the sequence of areas treated. In other words these people although “too loose” are prone to becoming too tight with prolotherapy treatments. The doctor must be skilled enough to recognize this or the patient may not be successful with the prolotherapy. The doctor needs to carefully guide the patient through their initial maze of “too loose” and “too tight” and “over stretched.” The above is based upon Dr. Faber’s observations and his ability to correct and foresee these problems to bring about success.

A considerable amount of fibromyalgia/hypermobility syndrome patients are allergic or hypersensitive to the dextrose, phenol, sodium morrhuate solutions most commonly used by the vast majority of prolotherapists. An allergic reaction presents differently in the joint, tendon, ligaments of a prolotherapy patient--pain and dysphoria being the most common symptoms. Many prolotherapists will interpret the above as a proper response to prolotherapy. Dr. Faber’s experience in fibromyalgia/hypermobility syndrome patients is to recognize it as allergy and change to non-allergic proliferants. Some patients may require lower doses than others. More is not always better.

In general if the patient has pain in the day or two or longer following treatment Dr. Faber feels this is of great concern and does evaluation for what the problem may be. Most expert prolotherapists say it is normal to expect pain and swelling after a treatment and advise the patient to go through it. Dr. Faber has, himself, personally experienced complications with prolotherapy/reconstructive therapy as he has had extensive treatments from many expert prolo/reconstructive therapists. A word to the wise:

• Not all experts are equal.
• Experts disagree frequently and have a right to do so.
• The majority are not always right.
• The biggest is not always the best.
• The most convenient is not always the best.
• Most advances in man’s history have come from a single person or two people.
• In medicine like life few things are true 100% of the time.
• Stick with something you start if you feel it’s worth your while.
• If you do what you’ve always been doing, you get what you’ve always been getting.
• Your life has meaning if you put it there.
• Taking no action is a choice.
• To thine own self be true.
• Take good care of yourself; you are all you’ve got.
• Love yourself, forgive yourself, and enjoy yourself.
• You only have so much time, make the most of it.
• Most successes are not accidents or luck.
• Most successes are results of careful evaluation, planning and continued action.
• If at first you don’t succeed, try, try again.
• Nothing succeeds like success.

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