Prof. Dr. Dr. med. Johann A. Bauer, Falkenweg 1, CH-6340 Baar, Switzerland

Fibromyalgia syndrome (SFM)

What is FMS? What is fibromyalgia?

FMS (fibromyalgia syndrome) is an illness of the supportive tissues and the locomotive apparatus with pain and manifestation of tiredness in the muscles, ligaments and sinews (bodily tissues consisting of fibres). «Fibro» denotes the fibre constituent, «my» the muscle constituent and «algia» the state of pain. We can Germanise the term and talk of «Faser-Muskel-Schmerz» (FMS) i.e. pain in fibres and muscles, but the term «Fibromyalgia» has come to be used too.

How is fibromyalgia diagnosed?

Laboratory examinations are usually free from peculiarities, especially it is not possible to prove any changes, which we find with classic rheumatism or chronic polyarthritis (CP). This correct and important fact leads – as opposed to real rheumatism – to us speaking of «false rheumatism». Whereas in the case of real rheumatism, cortisone must be used, according to American rheumatologists cortisone must not be prescribed for fibromyalgia.
In 1990 American rheumatologists published a «multi-centre-criteria-study», in which clinical examination criteria were set. Patients had to be in pain for at least three months and had to display at least 11 of the 18 points et, which are painful under pressure. The doctor presses with their thumb or index finger, for study reasons, apparatus was used, which exert precisely definable pressure per centimetre squared. Places sensitive to pressure are know as «tender points» and must not be confused with «trigger points» in the case of myofascial pains, which are spontaneously painful and may evoke pain in a different part of the body under pressure – we refer to this transferred effect as «referred pain», comparable with remote effects when using acupuncture points.
It was just these similarities, which lead to the above-mentioned possibility for confusion that provided Bauer and Heine with an impulse to consider and explore what they had in common. It was proved that the «trigger points», according to the work group around Melzack, were 71% the same as the acupuncture points and that the acupuncture points according to Heine were the same as the anatomically definable vascular-nerve fasciculus in 80% of cases, so in fact the acupuncture points could be distinguished and also labelled as acupuncture holes, from which vascular-nerve fasciculi protruded. When looking at the 18 «tender points», Bauer found it striking that these also corresponded to the known acupuncture points. For Bauer, this was an impulse to investigate theses holes during hand and foot operations, the position of which corresponded with acupuncture points. Such holes were found on the limbs and it was ascertained that 6 to 8 of such holes were clustered in specific areas, this being seen in patients who complained about migratory pain independently to operation.
This was how diagnosis with the aid of acupressure was born. During implementation of this, procedure is completely the same as when searching for painful «tender points», the difference being that all points on the colon, lung and pericardial meridian are found in turn. The extremely large number of points allows for a much more precise diagnosis that is afforded by the 18 «tender points». It was possible to show that fibromyalgia very often begins in one quadrant and not until ten years time does the full picture known as generalised fibromyalgia become clear, which is what American rheumatologists have in mind when they require the patient to feel pain in all four quadrants. Fibromyalgia begins, for example, in a young girl when she begins tuition and is erroneously diagnosed as having tendonitis. Years later she feels pain in her shoulder, neck, nape of the neck and later still also on the other side or the leg on the same side. Pain in the small of the back, especially during or after pregnancy. In the end after ten or more years, «everything hurts»: The 1st stage in this example was affliction of one upper quadrant, the 2nd stage was affliction of one of the neighbouring quadrants, the 3rd stage is a fully developed picture of generalised fibromyalgia.
Fibromyalgia can be proved with the aid of acupuncture diagnostics and from this moment on, diagnosis ceases to be a quandary.

Symptoms and accompanying syndromes

Pain
In the case of fibromyalgia, pain knows no boundaries. There is no order to the intensity and expansion of this pain. This could concern constant pain, but it could also be changeable pain if this concerns part of the body in terms of strength, duration and frequency. It could be evident as the «everything hurts» syndrome, but also as «migratory pain». Patients describe it as a deep muscle pain, burning sensation, cramp, shooting pain, stabbing with a knife or a knife lodged in their body. Pain and stiffness are often worse in the morning and the afflicted muscle groups often hurt more. Pain can appear in the jaw joints, which could escalate to extreme facial pain. This can then be augmented by problems with the maxillary antrum and the teeth. This often leads to extraction of teeth and the patient complaining of phantom pains in teeth, which no longer exist.

Further common symptoms are:

Pain during menstrual bleeding, chest pains and heart problems / cardiac neurosis.
Tiredness
Patients describe tiredness in various different manners. Some are physically tired, others are psychologically drained and unable to concentrate. All of their energy has melted like ice. Some describe a lead weight in their limbs, which depletes all of their strength.
Sleeping disorders
Patients do not usually have problems falling asleep. Sleep itself is however disturbed, as if the pain woke patients from their deep sleep. Sleep apnea often occurs and also shivering and pulsation of the muscles during sleep (uncontrolled movement of the arm and leg right up to «restless legs syndrome») and grinding of the teeth. The sleep pattern is completely different to that of patients suffering from depression.
Irritated colon
20 to 40% patients suffer from stomach pains, constipation, diarrhoea, bloating and nausea. It sometimes seems that the pains are «suspended on the costal arch from the inside to the front and the back» or that they originate in the gall bladder.
Headaches
Bouts of pain accompany pain in the nape of the neck, tinnitus and swelling of the eyelids. Migraine is however rare.
Neurological symptoms
Numbness and pins and needles are indicated in the limbs, exaggeratedly sensitive areas of skin, swellings in the hand and foot, dexterity problems and problems with types of walking. Neurologists however do not see any pathological changes.

Diagnosis often stated instead of fibromyalgia:

Arthrosis of the shoulder joint, neck, chest or backbone syndrome, back pains, bowing of the intervertebral discs (which still does not require operation because this does not concern a real rupture), arthrosis of the sacroiliac joint, facet syndrome, arthrosis of the hip and knee joint, trochanterodynia, Achillodynia, exostosis of the heel and splayed foot. But this list could also include osteoporosis and multiple sclerosis!
The most hated diagnosis among patients is «somatoform disorder», because in the regular language of patients and especially their surroundings, this is translated as «it is all a psychological matter!» and patients are then subject to humiliation as if on a conveyor belt. At the same time, depression must be understood as reactive neurosis to pain.

What are the causes of fibromyalgia?

In general, doctors have the following attitude: pathogenesis unclear, diagnosis difficult, treatment symptomatic. Fibromyalgia is incurable.

New paths related to safe diagnosis and causal treatment have opened up the way for recognition that in the case of fibromyalgia, acupuncture points are plugged, in which acupuncture holes were recognised. As a consequence of bodily or mental stress the free nerve endings exude among other things protein, which coagulates on the spot and blocks up the hole. A blocked hole can be surgically unblocked in such a way that if possible it will not become blocked again. The tension, which appears in the fibre fasciculi can be removed, relieving cuts are advisable, in short, delicacy of hand surgery and surgery to peripheral nerves is required including microsurgery techniques. Understanding that the arms and legs contain what are literally «switching boxes for the meridians», allows the surgeon to carry out an operation during which 6-8 acupuncture points that control one quadrant are searched for from one of the cuts. Stress theory easily covers all known factors, which worsen existing fibromyalgia or change the latent to the manifest: weather, draught, cold, too demanding training, building, renovation, hormonal changes, blows of fate and mental stress. But this also includes illness, viral and bacterial infections, injury, real rheumatism, luxury and thyroid illness. Many factors but only one mechanism!

Treatment of fibromyalgia

In the first months, treatment usual until now is indicated: anti-inflammatory, medicines to decrease swelling, muscle relaxants, agents to improve mood, careful medical exercise, physical therapy, treatment using cold and for an irritated colon, consultancy with a diet specialist. The regular proposals for treatment should not however draw attention away from disturbed meridians. Patients can learn to massage themselves in the correct places in the correct direction according to the Chinese motto «A soothing wind brings relief». In more advanced cases surgical uncovering of blocked acupuncture points is necessary. The results are very good indeed, 90% fin their complaints disappear and do not return.

Postscript to the patient’s guide to the problems of fibromyalgia.

Patients rightly ask:
- Who will believe me?
- Who will help me fight against indignity and ignorance?

The information contained in this article does not claim to be complete and serves only for the purpose of presenting this little-known yet frequent clinical picture and to provide the readers with an impulse to concern themselves in more detail with fibromyalgia.

Prof. Dr. Dr. med. Johann Bauer
E-mail: office@fms-bauer.ch
Internet: www.fms-bauer.com

Copyright (c) 2005 FMS-Bauer All rights reserved.