When a patient presents with chronic pain, tiredness, tenderness in the joints, and typically associated depression and loss of sleep, a number of diagnoses come to the mind of the practitioner. First and foremost would be the widely recognized autoimmune diseases like rheumatoid arthritis, lupus, and their brethren. Western doctors would often test in this situation for systemic inflammation, and treat aggressively with strong medications if the condition persisted.
However, the diagnosis may not be simple, and in fact may ultimately be found to be fibromyalgia. Typically affecting far more women than men, fibromyalgia mimics some of the symptoms of common autoimmune disorders, including diffuse pain, joint tenderness and stiffness, extreme tiredness, sleep disruption, and associated debilitating psychological symptomology.1 Fibromyalgia is startlingly common, affecting at least 2 percent of the population in the developed world (Marcus, 2009).2 Complementary medicine has an important role to play in offering patients relief from this difficult disorder.
Evaluating the Challenges
What is challenging about fibromyalgia is its disputed pathophysiology. There are investigators who hypothesize that the disorder is a dysfunction of pain processing in the central nervous system, with potential behavioral and psychological complicators.
However, many patients challenge this model, pointing out that their lack of energy and depression are a result of their symptoms, and not their cause. In short, it is can be challenging to unpack whether the behavioral and psychological symptoms create the condition, or are the logical result of chronic pain with no good rationale for its existence (Marcus, 2009).2 Many fibromyalgia patients go from doctor to doctor seeking relief. Failure to find that relief must also exacerbate depression, anxiety, and hopelessness.
Conventional Western medicine has tried various therapies with fibromyalgia. Pharmacologic approaches have included the use of opioids and non-opioids for pain, anticonvulsants, and antidepressants. There are side effects for all of these drug-based remedies, and the addictive nature of the opioid class of medications is well-known. Anticonvulsants have been identified as leading to patient torpor, while clinical toleration for antidepressants, especially those in the selective serotonin reuptake inhibitor class, vary from patient to patient.
The SSRI antidepressants are thought to work by increasing brain levels of serotonin and norepinephrine to counter pain. The anticonvulsants, on the other hand, block the ability of nerves to send as many signals to the patient's brain that signal that they are experiencing pain. Opioid and non-opioid pain relievers work in familiar ways to reduce systemic inflammation and block pain signals.
These conventional possibilities may be used in concert with complementary approaches that include psychotherapy, exercise, and herbal supplements, physical exercises and mindfulness-based therapy. However, it must be noted that the overall effectiveness for these complementary approaches have not been impressive, and in fact they have been less efficacious compared to conventional pharmacological approaches. Even mindfulness-based cognitive psychotherapy, so helpful with other chronic illnesses, has come up comparatively short when fibromyalgia is the presenting problem.
Alternative Approaches
With that said, there are several promising alternative medical approaches to fibromyalgia of which acupuncture is specifically a part.3 Going back as far as 1998, the National Institutes of Health Consensus Development Conference on Acupuncture recognized the therapy's possibilities for this disorder, as part of an overall treatment approach.4 As a pattern in point, the physical therapy associated with Traditional Chinese Medicine (TCM) has addressed chronic pain in that region of the world for 2,000 years, and seems to have positive effects in the west as well.
Deare, et al. point out that compared to programs of either no treatment or basic medical therapy, acupuncture has shown improvement in stiffness and discomfort at low to moderate levels. Suggested treatment is 2 sessions of 25 minutes per week over 4 weeks; there is low to moderate-level evidence that compared with no treatment and standard therapy; electro-acupuncture is another modality that may provide benefits, with up to 5 Hz of stimulation at such acupuncture points as L14 and ST36.4 Patients will seek treatment. More than 90 percent of fibromyalgia patients seek alternative remedies in their first two years of diagnosis, and 20 percent of patients have sought acupuncture treatment in the same period.
Crucial to all fibromyalgia treatment is a strong alliance between doctor and patient. Studies show that too many patients feel minimized and dismissed by their doctors, believe that their doctors are skeptical of their reported symptoms, or are being treated by inexperienced or under-educated doctors.5 When doctors can empathize with patients, understand that their reporting of symptoms is generally being done in good faith, and grasp that patients want to be partners in treatment, a multidisciplinary approach that blends western medicine with TCM approaches, including acupuncture or electro-acupuncture, can be used to help restore patients to health, and to the quality of life they want and deserve.
References
Resources
Chronic pain afflicts over 20% of the adult population. Sadly, most MDs have essentially no education in treating pain, beyond offering a few toxic medications. Then they tend to steer people with pain away from those health practitioners who are trained. This puts the acupuncture community on the front lines for addressing this epidemic.
When the body is going through a stressful event, the sympathetic system is activated. This activation will help the body with a life-threatening situation. If this state is activated for prolonged periods of time, it starts to consume energy. These traumatic events that generate stressors in the autonomic nervous system (ANS) will eventually become internalized.
| Digital Exclusive
One of the things that makes acupuncture so difficult to measure is that the medicine actually does contain some esoteric aspects. There have been numerous studies that demonstrate the neurochemical reasoning behind why acupuncture points stimulate the autonomic nervous system to enact change However, not all the benefits of TCM can easily be measured by randomized, controlled trials. But does that make them fundamentally and definitively untrue?
| Digital Exclusive