In 1990 the American College of Rheumatology developed the tender point exam, which maps 18 specific points on the body that are extremely sensitive in people with fibromyalgia. In order for your doctor to diagnose you with fibromyalgia, you need to experience pain in at least 11 of these points and have constant, widespread pain for at least three months.
When mild pressure is applied to any of these soft-tissue tender point areas around the neck, shoulder, chest, hip, knee and elbow regions, a patient with fibromyalgia often experiences it as pain. Another symptom: applying pressure to these points may trigger pain in a larger region, such as down your leg.
If you have widespread, frequent pain, above and below the waist, on both sides of your body, and in the neck, chest, or back, ask your doctor to administer the tender point test for a definitive fibromyalgia diagnosis. Once you’ve gotten a diagnosis you can begin to create a treatment plan to help you manage your symptoms
Our approach

• Myofascial Unwinding for balancing the body
• Diet and Exercise Can Calm Fibromyalgia Symptoms
• Alternatives Abound in Fibromyalgia Treatment
• Manage Stress, Manage Fibromyalgia
• Proper Sleep Is Crucial to Managing Fibromyalgia

Put Together Your Fibromyalgia Treatment Plan

If you have the flu, spend a few days in bed, and you’ll likely feel better. Fibromyalgia is different. Symptoms are eased, never cured, and there is no one “remedy” that works for everyone. For these reasons, fibromyalgia patients should develop a personalized treatment plan to minimize flare-ups and the severity of symptoms.
Identify your symptoms
Widespread, chronic pain is a hallmark of fibromyalgia. It’s diagnosed by the presence of tenderness in 18 specific points of the body, with at least 11 of those 18 spots being abnormally tender, even when mildly touched. Fatigue, sleep, and memory and concentration problems (often called “fibro fog”) also are common symptoms of fibromyalgia. You might also experience restless legs syndrome, irritable bowel syndrome, painful menstruation, depression, dry eyes, anxiety or headaches. Make sure you work with your doctor to treat all of your ailments.
Find the right medications
To date, pregabalin (Lyrica), duloxetine (Cymbalta) and milnacipran (Savella) are the only medications approved by the U.S. Food and Drug Administration (FDA) to treat fibromyalgia pain. Tricyclic antidepressants often have been found to be the most efficacious medications for fibromyalgia, especially since sleep and fatigue problems respond well to some antidepressants. But other painkillers, from over-the-counter ibuprofen to prescription-only narcotics, also are prescribed.
Talk to your doctor about what will give you the greatest relief with the fewest side effects. Because there are so many medications to choose from, you may need to use trial and error to help determine which is best for you. If antidepressants don’t work, you may need to incorporate sleep aids or muscle relaxants into your treatment plan.
Explore alternative treatments
For many people, massage and acupuncture, as well as Pilates, tai chi, chiropractic treatment, and various dietary supplements, can provide relief. You also may find it helpful to work with a physician who incorporates complementary medicine into his or her practice.
Make healthy changes
Stress reduction, a healthy diet and regular exercise can reduce fibromyalgia flare-ups, so lifestyle changes should be a part of your treatment plan. Sleep also is crucial for managing symptoms. Devising a treatment plan will require coordinating with your primary care doctor and/or a rheumatologist, physical therapist, naturopathic physician (if you use one) and other health professionals. Make sure everyone on your health care team is aware of your plan, and consult your doctor before making adjustments.

Myofascial Unwinding for balancing the body
Myofascial Unwinding is an advanced form of Myofascial Release technique, which is intended to reduce the increased body pressure or tension aroused due to myofascial dysfunction; which is the cause of the debilitating pain suffered by fibromyalgic patients.
Here a myofascial practitioner applies well controlled forces and stretches to the body by using extremities as lever. It’s a slow procedure and need 2-3 months of treatment for its complete cure. In my experience MFU is the only effective technique in its management. If MFU can be combined with the below described procedures; the effects will be four fold.
Diet and Exercise Can Calm Fibromyalgia Symptoms

A healthy diet and regular exercise are essential to anyone who wants to feel well. For someone with fibromyalgia, those two things play a critical role in helping to reduce pain, increase energy and improve quality of life.
Studies have shown that walking, strength training, stretching exercises and swimming in a heated pool can alleviate fibromyalgia symptoms. Regular exercise appears to enhance the body’s response to stress, which often triggers symptoms. It also improves endocrine function to help the body better process pain and regulate sleep patterns.
Here are the keys to an effective exercise program:
• Start slowly. Begin with gentle stretching, walking, bicycling or swimming.
Create a routine. Exercise should be a regular part of your life. Schedule time for it on your weekly calendar and take advantage of small opportunities to exercise throughout your day, such as using the stairs instead of the elevator.

• Have fun with it. Yoga, Pilates, strength training, tai chi, bicycling, walking, jogging, low-impact aerobics or swimming all are recommended. Mix it up so you won’t get bored.
While exercise is one of the most proven ways to battle fibromyalgia, the jury is still out on the issue of nutrition. A balanced diet can help increase your energy level and reduce your risk of other health problems, but more research is needed before experts can identify if specific foods affect the risk of flare-ups. Many people with fibromyalgia, however, have reported a reduction in symptoms by avoiding certain things, such as caffeine and alcohol. Experiment by cutting foods from your diet that seem to intensify your symptoms. To maintain your health, though, make sure your diet remains well-balanced.
Improving your diet can make you healthier and may even reduce your pain and fatigue. Add that to a regular exercise regimen and you may be on the road to more pain-free days.

Proper Sleep Is Crucial to Managing Fibromyalgia

It’s a vicious cycle: A poor night’s sleep makes your fibromyalgia symptoms worse, and then the pain makes it hard to fall asleep at night. Restless legs syndrome, a problem for many people with fibromyalgia, also can keep you from getting the rest you need.
Sleep is a crucial piece of the fibromyalgia puzzle. In fact, some research shows that disruptions during the deepest levels of sleep can cause the onset of fibromyalgia symptoms.
Try these suggestions to get better sleep:
Adopt a daily routine
Try to go to bed and wake up at the same time each day. Avoid daytime napping and create a nighttime relaxation ritual. This could include a warm bath, reading or listening to music as a way to wind down.
Watch your diet
Avoid caffeine and alcohol in the late afternoon and evening. Caffeine can make it harder to fall asleep and alcohol can disrupt sleep. Also, avoid spicy or fried foods if they cause heartburn or indigestion. And so your bladder won’t wake you, try not to consume any liquids right before bed.
Time your workouts
Exercise can help you sleep better at night. Some experts advise finishing at least three hours before bedtime because the stimulation may make it difficult to fall asleep right away. Others, however, point out that exercise can relax you and help you fall asleep shortly after participating in it.
Medication can help
If lifestyle changes are not enough, medication is an option. Tricyclic antidepressants can help you achieve restorative sleep, but they may leave you drowsy during the day. If you have restless legs syndrome, your doctor may prescribe sedatives such as diazepam (Valium). On the downside, the extended use of benzodiazepines can lower your pain threshold and ultimately exacerbate pain. Plus, they can be extremely addictive. Sleep medications and muscle relaxants can also help, so talk to your doctor about your options.

Manage Stress, Manage Fibromyalgia

When you have fibromyalgia, stress has a powerful grip on your life. It can cause the disease to flare-up, resulting in shooting pains, extreme fatigue, and cognitive problems like confusion and memory loss—often called “fibro fog.” In fact, many people report that a traumatic event brought on their first symptoms of fibromyalgia, leading some researchers to speculate that stress can actually trigger the disease. The National Institute of Arthritis and Musculoskeletal and Skin Diseases currently is funding research into whether fibromyalgia is caused by a breakdown in the way the body responds to stress.
Stress is known to trigger flare-ups in people with fibromyalgia, so restoring calm to your everyday life can help reduce your symptoms. Here are some coping techniques that can help you have more pain-free days.
Identify Your Stressors
Analyze your day and look for potential stress hot spots. For example, some people don’t mind sitting in traffic, but others fume as they creep along during rush hour. If you feel hurried to get out the door on time every morning, consider waking up earlier (and going to bed earlier to compensate). If talking on the phone to a certain family member is stressful, consider changing to an email-only relationship. Figure out which situations you can control and make the necessary adjustments to make your days easier.
Develop Coping Techniques
Much of life’s stress is unavoidable, but you can learn to react to it while keeping your calm:
• Schedule time to relax or meditate every day. The more you do it, the better you’ll get at relaxing. Then, when you experience a sudden stressful situation, such as a heated discussion with your boss, you’ll know how to take a few minutes afterward for deep breathing exercises or a short walk.
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• Don’t dwell on the past. One component of stress involves regret over things we could have done differently. Live in the moment and focus on what you need to do now to control your illness.
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• Request accommodations at work. If your fibromyalgia makes mornings difficult, ask to work from 10 a.m. to 6 p.m., for example, instead of from 9 a.m. to 5 p.m. If sitting at your desk all day leaves your body aching, ask for a better chair or for regular breaks so you can walk and stretch.
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• Find support. Talk to others who have fibromyalgia to share coping strategies and encouragement during your bad days.
Managing stress will not cure your fibromyalgia, but it can help you gain some control over your symptoms. Allow yourself to relax and your body will thank you
Alternatives Abound in Fibromyalgia Treatment

Odds are if you have fibromyalgia, you have heard about alternative treatments that may help you feel better. In fact, 90 percent of fibromyalgia patients have reported trying such alternative therapies as massage, acupuncture, dietary supplements or chiropractic treatment to ease their symptoms.
While research has yet to prove that all alternative therapies work in treating fibromyalgia, there is a lot of evidence that supports acupuncture as a successful treatment. Using super-thin needles, acupuncturists stimulate various pressure points to provide pain relief. Some studies show that electroacupuncture, in which an electric current is pulsed through a needle, is more effective than the traditional method.
Many people with fibromyalgia find different alternative methods effective. And like mainstream fibromyalgia treatments, what works for one person might have no effect on another. Bottom line: You have to shop around to see what is best for you.
Here are some other options:
Massage: Massage therapists work on the muscles and soft tissue of the body to alleviate pain, muscle spasms and stress. However, the National Center for Complementary and Alternative Medicine reviewed research about the effectiveness of treating fibromyalgia with massage and found that the benefits are only short-term.
Cognitive behavioral therapy: Often called CBT, cognitive behavioral therapy has been shown to be among the most effective non-medication treatments for fibromyalgia. CBT helps change the way you think about pain with the goal of changing the way your body responds to pain, thus making the pain less severe. It may also help improve sleep.
Though studies on the following methods have been deemed insufficient by some medical experts, they are still widely used by people with fibromyalgia, with varying degrees of success.
Dietary supplements magnesium and SAM-e are often used to treat fibromyalgia. SAM-e is a naturally occurring compound in our bodies that helps in the production of dopamine and serotonin, which regulate mood and control the pain response. Preliminary research has shown evidence that SAM-e supplements may work to keep symptoms in check, but further study is needed. Magnesium is helpful in hundreds of ways, like converting food into energy, strengthening the immune system, and maintaining normal nerve and muscle function. Some researchers believe that a deficiency of this mineral contributes to fibromyalgia symptoms, though research into its efficacy has been inconclusive.
Finding the alternative treatment that works for you will require some experimentation. Ask your doctor for recommendations and be sure to tell him or her which treatments you already are using. This is especially important with dietary and herbal supplements since they can interact with other medications and possibly cause side effects.

For more details please contact Dr. Ajimshaw @ dr.ajimshaw@rediffmail.com or ajimsha@aimst.edu.my