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A 34-year-old member asked:

is there a clear top treatment for fibromyalgia? what is it?

2 doctor answers3 doctors weighed in
Dr. Rita Agarwal
Anesthesiology 35 years experience
Good pain specialist: Physical therapy, heat, massage, acupuncture, chiropracter, activity, Lidoderm patches, Neurontin or lyrica, (pregabalin) anti-seizure medications, muscle relaxants and anti-depressant medication all may have a role.
Dr. Laurence Badgley
General Practice 53 years experience
Natural Therapies: Best cure for fibromyalgia (fm) is practices of those who have been cured. Several former sufferers have committed their healing journey to book format, & the usual book search will discover these writings, which commonly detail a composite of natural approaches. Gentle reconditioning of global muscle tone via aquatherapy is important. On a pain board at quora.Com, i review several therapies.
Dr. Laurence Badgley
General Practice 53 years experience
Provided original answer
In the course of examining numerous fibromyalgia patients over the years, I observed that many had unequal leg lengths and varying signs and symptoms of pelvic girdle instability (per Occupational Disabilities Guidelines).  In 2007, I attended the 6th Interdisciplinary Congress on Low Back and Pelvic Pain in Barcelona to present my study of pelvic girdle disorder.  At this meeting, I became aware of the work of Dr. Andry Vleeming and his discoveries about sacroiliac joint function and disorder.  I also met Dr. Vert Mooney (Professor Emeritus of Orthopedics at the University of California at San Diego) and studied his investigations of the sacroiliac joint.  The work of these men and my own clinical observations have taught me that the sacroiliac joint has a normal range of motion and is susceptible to injury more readily than was taught to me in medical school (1960's).  In 2009, I published (Practical Pain Management) my methods of diagnosis of sacroiliac joint dysfunction.  It is possible to prove that the joint is unstable.  An unstable sacroiliac joint causes the overlying body tower to lean to one side, which imposes significant mechanical stress on muscles, tendons, ligaments, and fascia of the upper body tower.  An unrecognized mechanical force parameter is body weight motivated by the ambient gravitational field.  I believe that fMRI and biochemical changes found in fibromyalgia sufferers are all secondary effects and not primary cause expressions.  Widely ranging trigger points are proven sites of ischemia and biochemical change (Dr. Shah), and are true peripheral neuropathic pain generators, which explain the pain of fibromyalgia.  Chronic fatigue, fibro fog, and depression all arise from interrupted sleep secondary to nocturnal pain.  People with unstable pelvises experience increased pain when they lie on the sleep surface because the ground force of the mattress is imposed upon the pelvic ring; traversing to the loosest part of the ring, the injured and subluxing sacroiliac joint, stressing ligaments of this joint.  Sacroiliac joint disorder is a joint movement disorder and is not an inflammatory disorder (per medical literature).  The Occupational Disabilities Guidelines present the methods of diagnosis of sacroiliac joint disorder.  The world literature is of consensus that MRI, CT, and nuclear scans are not helpful for diagnosing sacroiliac joint disorder.  I have published a booklet on Quora.com, on my Pain Board, wherein I present my findings and theories.  In October 2013, I am invited to the 8th Interdisciplinary Congress on Low Back and Pelvic Pain in Dubai to present a novel imaging technique I have invented to image sacroiliac joint subluxation disorder, which is a joint mobility disorder found in between 10 and 30 percent of people with chronic low back pain; as reported in the world medical literature. 
May 28, 2013
Dr. Laurence Badgley
General Practice 53 years experience
Provided original answer
The reason for a "spectrum of disorder" for fibromyalgia is that the cause, pelvic girdle instability due to pelvic ligament laxity, manifests differently in individuals & genders.  The body musculoskeletal tower is constantly stressed by gravity & a body tilted above an unstable pelvis incurs widely ranging chronic muscle spasm leading to varying densities of painful trigger points. The delicate female pelvis is more easily injured & women have an higher incidence of Joint Hypermobility Syndrome (inherited trait) that contributes to pelvis instability.  Female pelvices are subject to varying intensities of permanent injury related to frequency of childbirth.  In both sexes, severity of symptoms is a function of musculoskeletal deconditioning & upper body mass borne by an unstable pelvis.  On a Pain Board at Quora.com a medical researcher discusses these dynamics, which are the true cause of fibromyalgia. 
Jun 9, 2013
Dr. Laurence Badgley
General Practice 53 years experience
Provided original answer
A doctor at Heathtap.com, a Rheumatologist, commented that he has, "found no increased incidence of hypermobility in my scores of patients with FM".  His comment is not atypical.  In 1999, a study in England revealed that amongst Rheumatology referrals only  4.67% of persons with the joint hypermobility phenotype were being recognized, despite criteria for evaluating JHS.  A study reviewer stated, "hypermobility is under-medicalized!" (British Society of Rheumatology  members' Hypermobility Syndrome perception survey,  1999 [Grahame R, Bird H.  Rheumatology 40 (5): 559-69, 2001].  As early as 1966, it was stated, "another view is that isolated ligamentous laxity is a mild mesenchymal developmental disorder which lies at one end of a spectrum of heredofamilial connective issue disease with a fully-developed picture of Marfan's and Ehlers-Danlos at the other (Kirk JA, Ansell BM, and Bymster EG.  Ann Rheum Diseases 1967 26: 419-425. In 1993, a study tested an hypothesis that joint hypermobility is participant in the pain of fibromyalgia.  338 children between 9 and  15 were evaluated with findings that 13% had joint hypermobility and 6% had fibromyalgia per ACR criteria.  81% of the children with fibromyalgia had joint hypermobility.  40% of the children with joint hypermobility had fibromyalgia.  One conclusion was, "the study suggests that there is a strong association between joint hypermobility and fibromyalgia in school children (Buskila et al.  Joint Hypermobility in School Children.  Annals of Rheumatic Diseases.  Vol: 11, No. 1, pp39-42).  In 1998, a study in Spain compared 66 women with fibromyalgia to 70 women with other Rheumatologic  diseases.  The study found that 27% of women with fibromyalgia had joint hypermobility compared to 11.4 % of women with other Rheumatologic disorders (Acasuso-Diaz and Collantes-Estevez.  Joint Hypermobility in Paients with Fibomyalgia.  Arthritis  Care and Research,  Vol: 11, ( FitzCharles opined, in 2000, "there is increasing evidence that at least a sub-group of patients with soft tissue musculoskeletal pain, widespread pain, or fibromyalgia are hypermobile.  Clearly, hypermobility is not the only or the major factor in the development of widespread pain or fibromyalgia, but rather a contributing mechanism in some individuals" (FitzCharles M.  Is Hypermobility a Factor in Fibromyalgia?"  Journal of Rheumatology, Vol: 27. no.7, pp 1587-1589, 2000. A book devoted to the subject was published (Elsevier in 2010).  "Hypermobility, Fibromyalgia, and Chronic Pai n", edited by Professor Rodney Grahame; past editor of "Rheumatology", and held presidency of British Society for Rheumatology.   Somewhere in the midst of practicing medicine for 48 years, I discovered a truism about the practice of medicine follows:  "within the practice of medicine what is not looked for is rarely seen".
Jul 25, 2013

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