So, what is causing the pain?  What is causing all the intestinal discomfort?  What is causing the burning stomach and the backing up of acid into the esophagus? With the vast majority of my fibromyalgia patients the answer is usually one of two things.  Either they have a motility problem which is caused by an imbalanced autonomic nervous system or they have “leaky gut”.  Actually many times they have both problems occurring at once.  The imbalance in the autonomic nervous system is because certain neurotransmitters become imbalanced and this we know is part of the overall fibromyalgia syndrome.  This is known as IBS and although recognized by all health care providers, in my opinion, is often handled improperly.  Most doctors try to use medicines to either slow down the digestive process to control diarrhea or speed it up to help with constipation.  They try to buffer the acid with a base or prescribe medicines known as PPIs to reduce the overall production of acid.  Often this type of treatment is not only ineffective, it is counterproductive.

The best way to explain what happens with “leaky gut” is to explain how the intestines work normally.  The absorption of most of our vital nutrients happens in our intestines.  Normally small little microscopic holes allows vitamins and minerals to get through and be absorbed into our blood stream.  In leaky gut, the intestinal lining becomes inflamed and those normally tiny holes become larger allowing macroscopic toxins to pass through.  This creates a severe immune response and changes the levels of many mediating chemicals.  This often causes a tremendous amount of symptoms that are far reaching and often would seem to be unrelated to the actual intestines themselves.  Symptoms as diverse as muscle pain and even rashes can occur because the body is having an immuno response to trying to fight the toxins being absorbed.

Why does this happen?  Why do our intestines either become too slow, too fast or develop “leaks”?  There are several reasons this can develop including severe stress, a disordered flora from antibiotics and an improper diet.  We know for sure that stress changes neurochemistry and therefor can change the motility of the bowels.  This is one reason why when people get nervous, they feel that proverbial “knot in their stomach”.  We also know that the gastro intestinal tract needs a proper flora (beneficial bacteria) in order to work correctly and keep the lining healthy.  Of course we should all recognize the direct effect foods have on the health of the GI system.  Foods that are filled with toxic chemicals and or highly processed are certainly not going to be conducive to stomach or intestinal health.

Often people with severe GI distress feel overwhelmed and don’t know where to begin to start the healing process.   They should all be encouraged that these types of complaints can be greatly alleviated with the right type of approach.  Usually there are a few of factors that need to be addressed but I always prefer to take the critical or main precipitating factor first.  I always recommend stress reduction techniques for anyone who has GI complaints.  Gentle stress reduction exercises like Ti Chi, Qi Gong or Yoga are tremendous to help reduce the release of those powerful stress hormones.  Meditation is extremely effective and in many of my patients has truly helped turn their life around.  In order to restore the correct flora, I often recommend probiotic supplements along with FOS which is a beneficial sugar that the good bacteria like to eat.  This gives them an easier time at getting a “foot hold” and helping the gut to heal.  I also often advise digestive enzymes taken with each meal to help ease the strain of digestion and help carry some of the load until the GI tract becomes healthy enough to work more efficiently.  Lastly and tremendously important is a good healthy diet.

Isn’t it sad that several years ago, many in the medical community refused to accept FMS as a “real” diagnosis? For me on a personal level it was merely annoying but, on a professional level, it became extremely frustrating to be diagnosing patients every single day that were misdiagnosed by the so called “experts” for a long time. It is even worse that many of these patients that were misdiagnosed were being told that there was “nothing wrong” or the problem was “in their head”. This often resulted in patients seeking a second, third, fourth or even a fifth opinion and having test after test repeated. This is so frustrating, especially with all of us thinking now about health care costs. Can you imagine how much unnecessary spending was done just due to ignorance, or dare I say arrogance?

So after years of my having to convince many patients that they indeed did have Fibromyalgia after their doctors pretty much dismissed them, I thought maybe we were finally on the way to a better level of understanding. This was because of all the recent campaigns, advocacy and even advertisements centered around Fibromyalgia. I guess it was naive of me to believe that with the FDD approval of specific meds for Fibro i.e. Lyrica, Cymbalta and Savella that the medical opinions would change. Then again I should realize that in order for that to happen, providers would have to admit that all the patients they “blew off” were in actuality really suffering from something they should have diagnosed. What an interesting dilemma the health care profession faces. Do they admit that they were wrong for all those years and swallow their pride or do they continue to ignore those patients that suffer from Fibro and preserve their egos at the peril of the patient?

It is unfortunate but lately I am still seeing much of the latter. Almost every single day at least 1 or 2 of my Fibro patients comes in and tells me that their PCP told them that they “don’t believe in Fibromyalgia”. The definitive word there is “believe”. This is absolutely amazing with the research that is now available to every health care provider. Is it possible that they are living in the Stone Age or maybe just haven’t kept up with all the latest studies done by the American Pain Society, The National Fibromyalgia Association, The American Arthritis Association, The National Institute for Neurological Diseases, The American College of Rheumatology or several other organizations? Most of these studies have been widely published in their best medical journals.

I actually think that it is not lack of information because they are all required to have continued education and even if it’s not the subject that is being taught at their seminars, the journals and the pharmaceutical reps are certainly providing them with plenty of information. That is why I am frustrated and upset. I have to assume that is isn’t ignorance but pure pride that keeps some doctors from admitting they were wrong.

Now, what should you do if you suspect that you have Fibromyalgia and your doctor says you don’t? In my opinion and what I tell my patients, that all depends on what their doctor says and how they explain their findings in their case. After all, there are many times that other conditions mimic the symptoms of Fibro. Tests may indicate that you indeed have something else easily treatable in which case your doctor was correct in saying you do not have Fibromyalgia. Then there is the other situation where your doctor may say those words “I do not believe in Fibromyalgia”. Maybe the tests came back negative and your symptoms are totally related to Fibro and your doc says they don’t “believe” in it. Well…that is where I tell my patients to run. It would be a terrible mistake to stay with any doctor who says they don’t “believe” in Fibromyalgia. Fibromyalgia is NOT a religion. It is a health condition like any other. Does your doctor then not believe in Multiple Sclerosis? How about Irritable Bowel Syndrome or Migraine Syndrome? After all, they are also syndromes that you cannot see on X-ray or blood tests. So, I tell the patient if they don’t believe in Fibro, you should not believe in them. It is then time to find another doctor, pure and simple. I know it may be difficult for some people to switch doctors but it is crucial for those of you that fall into this category with those disbelieving doctors. The 2 main obvious reasons for finding someone who understands and believes is because there is no way you can get well if you remain undiagnosed and also the fact that your doctor is totally out of touch. As stated before they are either too proud to admit that they were wrong for all those previous years of having a dismissive attitude toward Fibromyalgia patients or they just are not up on the latest studies. In either case, isn’t it reason to leave and find someone that will not only diagnose you correctly but also really understand?

In Chronic Myofascial Pain (CMP), the patient usually complains of more localized or regional pain. CMP patients have what is known as trigger points not the tender points found in Fibro. Trigger points differ greatly from tender points but often to an inexperienced practitioner they can be difficult to differentiate. The primary thing doctors need to observe is what is known as a referral patern. With trigger points and Chonic Myofascial Pain, the pain is referrred in a very specific pattern. FMS patients do not have this radiating pain patern when pressure is placed on a tender point.

Another important factor is that with Fibro, there is usually some degree of CMP that co exists. We call this co morbidity because it is one condition layered on top of the other. When patients present themselves with CMP, we often find that is all they have and Fibro is not present.

This is a very crucial point for people to understand because the treatment for these conditions is vastly different. CMP is much easier to treat because it is not systemic and is more a primary condition of the muscles. The trigger points that develop in CMP can easily be worked on and often when the trigger point is ‘broken up” the pain referral zone calms down and symptoms disappear. With Fibro, the treatment needs to be a more inclusive, overall approach because the condition involves many factors, numerous body systems and multiple causes. This is why it is vitally important to get an accurate dignosis by someone who has a good amout of experience telling these two conditions apart.