Fibromyalgia: Are Chiropractic Adjustments Appropriate?

Fibromyalgia is an epidemic and disabling myofascial condition. The typical patient says he hurts all over, sleeps poorly, and feels chronically tired and depressed. Some DCs who are IMEs assert that chiropractic treatment isn't proper for these patients. One notorious Oregon IME wrote to me after reading some of my articles on myofascial therapy. He objects, he said, to DCs giving fibromyalgia patients series of spinal adjustments; so he tells insurance companies to disallow chiropractic claims for treatment of these patients.

I didn't react favorably to the IME's view. I'd just completed a year-long study that suggests his objection is nonsense. In the study, I repeatedly adjusted a subject's C5-C6 cervical segments. This dramatically reduced the irritability of her infraspinatus trigger points.¹ (The infraspinatus, of course, is innervated by C5-C6.)

The irritability of my subject's trigger points reduced gradually -- under the influence of a series of cervical adjustments. We found that the more frequent the adjustments, the more dramatic the relief from trigger point irritability. This study has an important implication: Repeatedly adjusting any fixated part of the spine may reduce the irritability of trigger points in muscles innervated by that part of the spine.

This corresponds to what I've seen in many fibromyalgia patients I've repeatedly adjusted. Chances are this Oregon IME hasn't watched how fibromyalgia patients respond to repeated adjustments. Otherwise, he wouldn't be hassling his fellow DCs for providing this service. In contrast to this IME, others outside our discipline appreciate the value of chiropractic care for fibromyalgia patients.

For example, respected rheumatologist Dr. Frederick Wolfe points out that chiropractic treatment helps these patients. Dr. Wolfe is a well-known investigator of fibromyalgia, and is clinical professor, Department of Medicine, University of Kansas School of Medicine. In 1985, he and his colleagues interviewed 81 fibromyalgia patients and 81 control subjects using a structured questionnaire.²

Wolfe wrote,² p.13 "In our current series, we asked patients to indicate if a drug or treatment had reduced their pain ... Of interest is that patients reported more benefit from 'life-style' modifications such as rest and relaxation than from other interventions. Chiropractic treatment also scored among the most effective measures" (emphasis mine).

In 1991, I talked with Dr. Wolfe about his study.^3,4 He reminded me that he used a questionnaire to elicit answers from fibromyalgia patients. "And what we reported," he told me, "is what they said -- not whether in fact it was true. It's sort of like asking people whether they took a vitamin and it made them feel better. Fifty percent of people might say yes, but that's an association rather than a causal relationship."

I asked about chiropractic rating among the most effective measures. "Yes," he answered, "I think that's actually a very useful comment in that ... see, that's a different kind of statement. One could generally say that there's more of a causal relationship. It's easier to determine. I'd put more validity in that. These are patient reports. Maybe they're all false, and it may be that they're all true. But I think actually that's a valid comment. People tell us that frequently. (emphasis mine)

I asked if he knew what treatment the chiropractors gave the patients. "No," he said, "and it's funny you should call because I had a resident in here today. We were sitting and talking about chiropractic treatment a little bit, and since he's an MD, he didn't think much of chiropractic treatment. And I was saying, 'Well, you know, chiropractic treatment works at least as well as medical treatment, and for many conditions it seems to work better,' which is not the conventional teaching."

He went on: "I think there's nothing we've seen since that time (since the 1985 study) to change our minds about that (that chiropractic treatment ranks among the most effective measures). "My guess is that because physicians don't deal well with these ... that is, nonchiropractic physicians don't deal well with such problems, chiropractic physicians probably do better."

Spinal adjustments are, of course, the mainstay of chiropractic treatment. And it's safe to assume that whatever other treatment Wolfe's fibromyalgia patients received, they also had spinal adjustments.

Since I talked with Dr. Wolfe, I've come across a study of spinal manipulation with fibromyalgia patients. Dr. Bernard Rubin conducted the study at the Texas College of Osteopathic Medicine. He studied the effect of spinal manipulation, drugs and placebos on fibromyalgia patients. Patients received one of fours forms of treatment: 1) placebo and no manipulation; 2) placebo and manipulation; 3) alprazolam (also called Xanax, a benzodiaze-pene), ibuprofen, and no manipulation; and 4) alprazolam and ibuprofen with manipulation. Rubin writes that the drugs were effective. But manipulation improved the patients' overall sense of well-being. Manipulation involved massaging the paraspinal soft tissues and adjusting the spine. The researchers used these two procedures to remove muscular or bony impediments to normal nerve conduction and blood and lymph flow.⁵ p.45

It's interesting that Dr. Wolfe, a renowned rheumalogist, look favorably on the chiropractic treatment of fibromyalgia patients. In stark contrast is the opposing view of some chiropractic IMEs. We must hold these DCs accountable for their judgments. We have good reason to contend that chiropractic adjustments help these patients. If the IME disagrees, he should have to answer a critical question: "Where's your contrary evidence?" The biomedical literature tells us one thing: Contrary evidence doesn't exist, except in the prejudicial noggins of some IMEs. For humanitarian reasons, these examiners should face the fact -- the available evidence (albeit meager) favors the chiropractic care of fibromyalgia patients. These suffering patients deserve whatever benefit they may get from any form of health care. And considering the current evidence, chiropractic seems to provide some.

References

1. Lowe JC: The effect of cervical spinal manipulation on the sensitivity of infraspinatus trigger points. Scheduled for publication, J. Myofascial Therapy, 1993.

    

2. Wolfe F: The clinical syndrome of fibrositis. Am. J. Medicine 81 (suppl 3A): 7-14, 1986.

    

3. Wolfe F: Personal communication, March 8, 1991.

    

4. Lowe JC: Documentary Evidence. Houston, McDowell Publishing Company, 1991.

    

5. Backstrom G and Rubin BR: When Muscle Pain Won't Go Away. Dallas, Taylor Publishing Company, 1992 (study scheduled for journal publication).