Fibromyalgia: definition, causes and treatment

Fibromyalgia: definition, causes, prevention and treatment

Fibromyalgia is a widespread pain disease that is characterised by 11/18 tender points (9 pairs). These tender points are in the neck, shoulder, chest, elbow, the lower back, the hip and the inside of the knee.

There are psychological deficits associated with fibromyalgia. These includes fatigue, depression and sleep problems.

There are also some physical symptoms:

-nausea
-irritable bowel
-numbness
-dizziness

Causes

The cause of fibromyalgia is thought to be because of the brain interpreting stress and pain signals abnormally. It may be due to the effect of the pain signals on the central nervous system and the secondary changes it makes to the brain.

Stress Hormones

Abnormalities in the hypothalamic pituitary adrenal (HPA) axis can cause fibromyalgia. The HPA axis is responsible for the stress response (fight or flight), depression and sleep.
Lower levels of norepinephrine and cortisol are seen in people with fibromyalgia and this is linked to inappropriate stress responses to:

– Infections
– Accidents
– Stress
– Hormonal disorders such as Cushings
– Medications

Central sensitisation

Some research suggests that in people with fibromyalgia, the brain interprets pain differently to non – fibromyalgic people. Overactivity of the pain processing areas of the CNS have been seen in people with fibromyalgia, as well as high levels of substance P which is associated with a high level of pain awareness.

Treatment

Food such as eggs, cheese, pineapple, tofu, turkey, nuts and seeds and salmon can boost serotonin levels. Sun, exercise, probiotics and a positive mental attitude can also increase serotonin.

CBT (cognitive behavioural therapy)

Cognitive behavioural therapy is is a form of treatment for being with mental health issues such as depression and anxiety. It focusses on changing dysfunctional, habitual, subconscious thought processes into healthier ones in order to effect behaviour positively.
In fibromyalgia, behaviour and what action is taken (I.e exercising) is crucial to recovery. Altering maladaptive thought processes which stop people from exercising, may relieve fibromyalgia.

Psychotherapy

Emotional trauma is a potentially a cause of fibromyalgia, therefore psychotherapy may be beneficial in dealing with unresolved conflicts in the psyche. It may also act as a preventative treatment.

Massage, Physical therapy, Yoga and Pilates

As physical injuries can trigger fibromyalgia, physical therapy from an osteopath, chiropractor, physiotherapist or sports masseuse may be of great benefit in preventing fibromyalgia from occurring. Yoga and Pilates taught by a recommended instructor may also act as a preventative.

 

Foot pain – causes and treatment

It can be so debilitating when you’ve got foot pain. This article will explain the possible causes and treatment of foot/feet conditions.

Basic foot anatomy

The foot consists of the following bones: the fibula, tibia, talus, calcaneus (heel), navicular, cuboid, three cuneiforms, 5 metatarsals and 3 phalanges on each of the little toes and two on the big toe. The foot has tendons, muscles and ligaments that allow us to run, jump and dance. The Achilles’ tendon attaches the calf muscle to the calcaneus. It is named after the Greek hero “Achilles” who was said to have been dipped into holy water by his mother in order to protect him but as she held him at the heel, the Achilles remained the only area of vulnerability as it did not come into contact with the water. This tendon is the thickest in the body and allows for jumping and standing on tip toes.

Conditions organised by areas of pain

Heel pain

This could be a condition called plantar fasciitis. This is inflammation of the long ligament that connects your heel to your toes. The pain is often felt in one foot or both feet first thing in the morning and is painful with the first few steps.

Treatment

– Often good arch support can help or even prevent this condition. Seek advice from a recommended and qualified osteopath or physical therapist.

– Leg and foot stretches can help alleviate the condition

– Rolling a golf or tennis ball, on the sole of the foot

– Rest

Heel spurs

Heel spurs are another cause of foot pain and they often go hand in hand with plantar fasciitis. Pain is usually felt in the heel. The spurs are abnormal bony growths on the heel of the foot which can occur when you overuse your feet (excessive walking and running). You can also get them from abnormal foot wear or running/walking posture. People with high or flat arches may be more likely to suffer from heel spurs. Many people have heel spurs but don’t feel any foot pain.

Treatment

– Wear a heel pad
– Rest your foot
– Wear insoles or arch supports
– Wear good trainers that have a cushioned shock-absorbing sole.

Stone bruise

This is an impact injury to the fat pad of the heel usually caused by a jumping injury.

Treatment
– Rest
– Ice
– Cushioned shoes

Mortons neuroma

This is the thickening of neural tissue in between the third and fourth toes and can cause pain, numbness and tingling over the ball of the foot.

Treatment

– Wear an insole which reduces the pressure around the nerves
– Minimise time spent wearing heels or shoes with narrowed toe space
– Physical therapy from an osteopath, chiropractor or physiotherapist.

Sesamoiditis

Near the big toe, there are two bones connected by tendons called sesamoid bones. If the tendons become inflamed this results in pain around the big toe which is called sesamoiditis. This is a form of tendonitis which is common among ballet dancers and runners.

– Wear flat, cushioned shoes
– Rest
– Ice
– Wear a foot pad under the big toe
– Tape the big toe to immobilise the joint and allow healing

Gout

This is a form of arthritis which commonly effects the big toe causing excruciating pain, swelling, discolouration (purple toe).

Treatment
– avoid food that make gout worse such as fish, meat, poultry, high purine veg, alcohol. An osteopath will be able to discuss this in more detail.
– rest
– ice
– medication

Bunions

A bunion is a bulge at the side of the big toe. It is usually caused by ill fitting shoes or shoes which do not have enough toe space. Ageing is a risk factor. Try switching to more comfortable shoes, and wear shoe inserts too (see a recommended orthotic specialist). Remember prevention is better than cure so wear wide, comfortable shoes to avoid bunions. See a podiatrist for further advice.

Hammer toes usually occur in the second third and fourth toes, when the middle of the toe bends and creates a hammer like appearance. It can come from a muscular imbalance and also from wearing ill fitting shoes.

Treatment

– exercises to stretch and strengthen toe muscles
– wear shoes with a wide berth at the toe end

Claw toe

This is a condition where the toes are unable to straighten. It is usually the result of alcoholism or diabetes and the consequential nerve damage which causes weakening of the joints, ligaments and muscles.

Treatment

– wear better fitting shoes
– do stretches for your feet and legs
– seek treatment for alcoholism and diabetes
– try orthotics

Ingrown toe nails

This is when the skin of the toe or toes grow over the nail. It can be painful and lead to infections.

Treatment

-soak the feet in warm water 4 times a day.
-apply gauze between the skin and the nail once a day
– see your doctor if the above does not help

Turf toe

This is when you feel pain at the base of the big toe. It’s an overuse injury usually caused by a strain. The typical symptoms are pain, swelling and restriction at the base of the big toe. A differential diagnosis may be sesamoiditis or a sesamoid fracture.

Treatment
-rest
-ice
-elevation
-immobilisation with a boot or by taping or strapping
-crutches so no excess weight is put on the toe

It can take 2-3 weeks for the pain to go. After this, therapy with an osteopath or another physical therapist is recommended to regain the strength and movement of the toe and foot.

Fracture

A fracture can occur anywhere in the foot. If you have any pain when standing or walking, or if you’ve had an accident, it may be best to get an x ray. Small breaks may only require rest and ice.

Hallux rigidus

This is an arthritic condition which causes stiffness in the base of the big toe, making it difficult to walk run, jump or squat. Usually there’s a problem with upward movement of the big toe. It can get be alleviated with stretching and exercises.

Treatment

-shoe inserts to improve the alignment in your feet
-lifestyle changes
-different types of shoes

Diabetic neuropathy

The feet may be affected in diabetes. Symptoms can include:

– loss of sensitivity to pain and temperature in the feet.
– tingling burning or prickly feeling in the feet
– sharp pain or cramps
– extreme sensitivity to even light touch

All of these symptoms are usually worse at night.

If you have diabetes, a foot examination should be carried out each year.

In summary, always seek help from a GP and osteopath/podiatrist of you are experiencing any pain in your feet. A prompt diagnosis should be made and subsequent treatment.

If you have any questions on the above please contact me. I’ll be happy to help.

http://www.webmd.com/pain-management/guide/foot-pain-causes-and-treatments

http://www.mayoclinic.org/symptoms/foot-pain/basics/causes/sym-20050792

http://www.webmd.com/pain-management/picture-of-the-feet

http://www.webmd.com/fitness-exercise/turf-toe-symptoms-causes-and-treatments