Pain is something that everyone has experienced and understands. It can range in severity from a mild annoyance to crippling and from occasional to chronic. There are many diagnoses for painful conditions, including the very common fibromyalgia. Fibromyalgia is a condition that is characterized by chronic, widespread muscular pain, joint stiffness, and other symptoms. Luckily, acupuncture can offer significant and lasting relief from fibromyalgia pain and its accompanying symptoms.
Fibromyalgia, also known as fibromyalgia syndrome (FMS) is a condition that most often affects women between the ages of 20-50, and is characterized by chronic, widespread muscular pain, joint stiffness, and may be accompanied by mental level symptoms such as insomnia, fatigue, and depression. Research is currently unsure of an underlying organic disease that causes FMS but is often associated with diseases such as rheumatic pathologies, psychiatric or neurological disorders, infections, and diabetes. The etiology of FMS is not yet fully understood, and several factors are theorized to be involved; these factors include dysfunction in the central nervous system, the autonomic nervous system, neurotransmitters, hormones, immune system, as well as external stressors and psychiatric conditions.
Let’s use some Chinese medical knowledge to utilize acupuncture for fibromyalgia. Chinese Medicine identifies fibromyalgia etiology as stemming from an external invasion of the six climates or internal disharmony caused by the seven emotions. Unregulated eating and drinking, as well as aging, are also etiological causes for the development of fibromyalgia.
Researchers Bellato, Marini, Castoldi, Barbasetti, Mattei, Bonasia, and Blonna note that Western Medicine holds dysfunction of the central nervous system, particularly central sensitization, as the main mechanism involved in FMS, and is defined by increased response to stimulation mediated by CNS signaling. This sensitization is the result of spontaneous nerve activity, enlarged receptive fields, and an augmentation in stimulus response which is transmitted by primary afferent fibers. Bellato et al. note the phenomena of a “windup” which describes the increased excitability of spinal cord neurons, saying that “after a painful stimulus, subsequent stimuli of the same intensity are perceived as stronger; this occurs normally in everyone, but it is excessive in fibromyalgic patients.” Another suspected mechanism involved in FMS is the descending inhibitory pain pathway, which modulates spinal cord responses to painful stimuli; in fibromyalgic patients, this pathway seems to exacerbate the central sensitization of stimuli, resulting in sensations of more intense pain.
Chinese Medicine theory explains that FMS often stems from a liver-spleen disharmony arising from LR qi stagnation as a result of the external invasion or internal disharmonies. As a result, the smooth flow of qi will be impacted. The SP qi may become deficient following external and internal imbalances, as result of the stagnation of the LR qi, as well as from poor eating and drinking habits; SP qi deficiency can also lead to the accumulation of dampness, leading to further stagnation and obstruction. If SP qi deficiency continues, it will be unable to create new blood, which goes to further LR blood deficiency and stagnation. The deficiency of LR qi and stagnation of LR blood, along with SP qi deficiency, as well as dampness and heat, can manifest with severe pain and other FMS symptoms. Understanding these mechanisms allow for us to design our acupuncture for fibromyalgia treatment plan.
Fibromyalgia manifests with symptoms of pain, tender points on the body, fatigue, sleep disturbances, memory problems, anxiety, depression, morning stiffness, numbness, tingling, and headaches, irritability, diarrhea and/or constipation, abdominal distension and pain, painful menstruation, loss of strength in the extremities, epigastric pain and distension, cold hands and feet, a pale complexion, and dizziness. A Chinese medical practitioner would expect to feel a bowstring, fine pulse, which may be soggy, in the right middle position; a fat, pale, yet dark tongue with thin white fur may also be present.
Fibromyalgia can be suspected when a patient presents with widespread chronic pain, fatigue, and sleep disturbances. Kodner explains that there is no preferred method of diagnosing fibromyalgia, and suggests using “tender point” diagnostic criteria when performing a diagnosis, pressing with one’s fingers in various areas of the body until nail marks are left in the skin; these areas include the occiput, trapezius, supraspinatus, the prominence of the greater trochanter, the upper quadrant of the buttock, the lateral epicondyle of the humerus, and the knees. Kodner suggests that fibromyalgia should be diagnosed based on clinical findings, and that tender point examination can be used to support the fibromyalgia diagnosis.
In addition to gathering symptom information, a CM practitioner would feel the patient’s pulses and look at the patient’s tongue. The practitioner may also perform a physical examination, in which they may palpate the body to find points where the pain is the most intense. Upon data assessment, the CM practitioner would diagnose this person with the pattern of Liver Invading the Spleen. With this diagnosis, we are able to begin building our acupuncture for fibromyalgia treatment.
Fibromyalgia is typically managed with various medications. Anti-inflammatory agents are used to manage pain, and psychiatric medications, such as selective serotonin reuptake inhibitors, are used to manage sleep issues and general well-being. Opioids are also prescribed for patients in some cases. Patient education, exercise, and cognitive behavioral therapy are also used to manage fibromyalgia and its associated physical and mental symptoms. An acupuncture practitioner would address the pattern of LR invading the SP with the treatment strategy of subduing LR qi, tonifying SP qi, and restoring the smooth flow of qi. To use acupuncture for fibromyalgia, the practitioner could use LR3, LR13, LR14, CV12, PC6, ST36, and SP21. Ashi points may also be used at areas of local pain. LR3, LR13, LR14, and PC6 may be dispersed, followed by tonifying CV12, ST36, and SP21. Moxa may be used on CV12, ST36, and SP21.
Martin, Sletten, Brent, Williams, and Berger developed a partially blinded, controlled, randomized control clinical trial to test the hypothesis that acupuncture improves symptoms of fibromyalgia. Fifty participants were randomly assigned to one of two conditions: true acupuncture and sham acupuncture. All subjects were diagnosed with fibromyalgia and symptoms were measured and tracked with the Fibromyalgia Impact score and the Multidimensional Pain Inventory at baseline, immediately following treatment, at 1 month, and 7 months following treatment. The patients in both groups were positioned so they could not see the treatment they were getting, and received the same points (LI4, ST36, LR2, SP6, PC6, and HT7); while the acupuncture group received true needling acupuncture, those in the control group had the point stimulated with fake needles. Patients received treatment every 2 to 4 days during 2 to 3 weeks for a total of 6 treatments. Upon completion of the study, the authors analysis determined that the acupuncture group had more positive symptom reduction than that of the control group. The effect sustained significant improvement over the control group for one month out, but the effect was not statistically significant at seven months.
In order to prevent fibromyalgia, in addition to acupuncture treatment, engaging in regular exercise is suggested to be an effective strategy. In addition to this, minimizing emotional and mental stress is useful for prevention; engaging in activities such as meditation and relaxation exercises can be suggested. In some cases, weight loss may be advised. Western medicine and Chinese medicine practitioners would both agree that eating a balanced diet is of utmost importance, and both would recommend meditation and relaxation exercises. A Chinese medical practitioner may also suggest eating energetically sweet foods, such as grains, to help to tonify and support the SP and SP qi.
While fibromyalgia cannot be cured, pain relief is possible! By using acupuncture for fibromyalgia, we are able to alleviate pain and increase patient wellbeing all without using pharmaceutical medications. Contact me to learn more about acupuncture and learn more about how we work to manage your pain.
References
Bellato, E., Marini, E., Castoldi, F., Barbasetti, N., Mattei, L., Bonasia, D. E., & Blonna, D. (2012). Fibromyalgia syndrome: etiology, pathogenesis, diagnosis, and treatment. Pain Research and Treatment, 2012, 1-17. doi:10.1155/2012/426130
Flaws, B., & Sionneau, P. (2005). Fibromyalgia syndrome (fms). In The treatment of modern western medical diseases with chinese medicine: a textbook & clinical manual (2nd ed., pp. 241-251). Boulder, CO: Blue Poppy Enterprises.
Kodner, C. (2015). Common questions about the diagnosis and management of fibromyalgia. American Family Physician, 91(7), 472-478.
Martin, D. P., Sletten, C. D., Williams, B. A., & Berger, I. H. (2006). Improvement in fibromyalgia symptoms with acupuncture: results of a randomized controlled trial. Mayo Clinic Proceedings, 81(6), 749-757. doi:10.4065/81.6.749
DISCLAIMER: this blog post is intended for informational purposes only. Do not perform any treatments included in the post yourself. This includes, but is not limited to, acupuncture, herbal medicine, and Chinese nutritional therapy. They should only be performed by educated and licensed acupuncture practitioners.
National Institutes of Health (NIH) studies have shown that acupuncture is an effective treatment alone or in combination with conventional therapies to treat the following:
Nausea caused by surgical anesthesia and cancer chemotherapy
Dental pain after surgery
Addiction
Headaches
Menstrual cramps
Tennis elbow
Fibromyalgia
Myofascial pain
Osteoarthritis
Low back pain
Carpal tunnel syndrome
Asthma
It may also help with stroke rehabilitation.
If you are curious about the benefits of acupuncture, scheudule an appointment for a personal consultation, and evaluation.
