Chronic Fatigue Syndrome and Fibromyalgia

To Whom It May Concern:

I have found everyone we treat having the same principles of what causes fibromyalgia and chronic fatigue syndrome (CFIDS). In other words, everyone's nervous system has been overloaded to the point that any local problem or symptom is affected by that overstressed system, the central nervous system (brain and spinal cord). All those we treat follow the same basic program as set forth for these difficult cases. When you read the article about fibromyalgia and CFIDS it is applying to your case only yours may not have progressed this far.



Plenty of information exists about fibromyalgia and CFS. One thing we read and hear consistently is that the cause remains unknown. No wonder fibromyalgia and CFS are such difficult conditions to treat. If we don't know the cause of an illness, then at best we can only treat the symptoms. And if we only treat the symptoms, the results of the treatment are unpredictable and the condition will continue its course. The key to resolving any condition lies in understanding what causes it. The premise of this article is to unveil the mysterious causes of fibromyalgia and CFS. With that information, a specific and successful treatment can be developed for these conditions. As noted in the introduction, those with CFIDS and fibromyalgia have stress being the major factor that overloads their nervous system, this along with physical injuries they have endured causing the multiple symptoms that they experience. There is no question in our personal and professional experience that the emotional traumas and lack of the feeling of being supported is the reason these conditions don't respond to normal types of therapy. This is why it is essential to have some type of different approach to allow these conditions to resolve. Therapies that work for most conditions simple overload an already overloaded nervous system if applied to those with CFIDS and fibromyalgia and many other conditions. Taking responsibility by reducing the stress in their lives is the first step towards having the ability for these conditions to return to health.. As mentioned previously, support groups in the area, friends and family, counseling, and simply deciding to put oneself first by having healthy boundaries are essential steps to allow the tools of this program to resolve difficult conditions. Once these steps have been taken one of the most powerful aspects of using Dr. Vreeland's neurological exercises is that these exercises are very specific to lowering the abnormal neurological input to the brain and the body. This allows us to follow up with neuromuscular therapy and other tools we have to be used with an appropriate response with those seeking treatment. It has been interesting to note that those changing to food that is organic and not processed, along with eliminating chemicals has made a very significant improvement in the health of those we treat, speeding up their progress towards health. We share research and options for those making these changes.

Along with the stress we have discussed there are many different scenarios that can lead to the development of fibromyalgia and CFS. Researchers continue to identify infectious agents, physical trauma, chemical exposure and emotional trauma as possible precipitators to FMS and CFS. One study by Dan Buskila, M.D., points to physical trauma to the neck as a precipitating factor.1 In Buskila's research, only soft tissue type injuries were studied, like those that result from the classic "whiplash" which occurs as a result of being rear-ended in a car accident. No participants in the study had pain prior to the injury, and those who sustained neck injuries that were visible by x-ray were excluded from the study. Buskila's results state that FMS is 13 times more likely to develop after a neck injury than after a lower extremity injury. This means that even mild physical trauma to the neck increases the risk factors associated with the development of FMS. Buskila's work is but one study that supports the theory that the cause of fibromyalgia and CFS is coming from the neck or cervical region.

Other medical authorities on the subject believe that fibromyalgia and CFS are associated with problems in the central nervous system (the body's way of communicating messages). Fibromyalgia and CFS do exhibit all of the symptoms of an exhausted and depleted central nervous system (CNS). Therefore, it is important to understand a little about how the CNS works. The study of how the CNS works is called neurophysiology. The following neurological laws (a uniform and constant fact or principle) are well established in research and explained in physiology texts and aren't anything new. You may already by familiar with this information. However, it is necessary to understand the following neurological laws in order to better understand what perpetuates these unusual symptoms and leads to a diagnosis of fibromyalgia and/or CFS.

First, the law of FACILITATION2 says that once a nerve impulse passes through a certain set of neurons, it will take the same path on future occasions, and each time it does so the resistance becomes less. Therefore, the pathway becomes facilitated, much like water taking the path of least resistance when it runs down a hill. Each time it rains, the water will choose this path and cut deeper into the earth, which makes it easier for the water to channel down the hill, thus facilitating the pathway. This is how we learn. If we repeat ideas or actions over and over again, the pathway becomes facilitated and we can remember them. Unfortunately, pathways also become facilitated with pain and injuries. If a person has been in pain a considerable amount of time, the neurological pathways of the pain patterns become facilitated, and the nervous system remembers them.

The importance of the facilitated pathways becomes relevant when we look at the ARNDT-SCHULTZ law3 which states that weak stimuli excite physiological activity, moderately strong ones favor it, strong ones retard it, and very strong ones arrest it. There are three primary categories of stimuli: 1) emotional, 2) chemical, 3) structural. Drinking an alcoholic beverage is an example of a chemical stimulus, which would tend to excite the physiology and give the person a warm perked-up feeling. Another drink would continue to favor physiological activity, and the person would still feel pretty good.

With a few more drinks the physiology would start becoming retarded, and the individual would experience loss of coordination, slurred speech, blurred vision, and impaired thinking. Continuing to drink to the point of unconsciousness, would be an example of physiological activity becoming arrested, a shut down of functions. This principle is further explained by Dr. Hans Selye4, the author of "The Stress of Life." Dr. Selye refers to the body's response to stimuli or stress as the General Adaptation Syndrome. The three stages of the GAS are the alarm reaction, resistance, and exhaustion. For example, if a lion jumps out of the bushes, we jump in response; this is the alarm reaction. The next stage is resistance, where the sympathetic nervous system kicks in with the fight or flight mechanism that activates the release of hormones like adrenaline. We either stand and fight the lion or run away. If the threat continues, we reach the exhaustion stage, because we cannot fight or run forever. Our systems are not made to run on sympathetic all of the time. We need to go into the parasympathetics, where we restore and conserve body energy in order to rest and recover. Thus energy-supplying food can be digested.

What we're faced with today is not necessarily sudden life-threatening situations, such as a lion jumping out of the bushes, but rather continued on-going chronic stress situations, on the emotional, chemical and physical (structural) levels. These chronic stressors lead to a sympathetic dominant system and cause the nervous system to go into the exhaustion phase, and people feel burned out.

Many people who suffer from fibromyalgia and CFS are somewhat aware that over-stimulation will perpetuate their symptoms. They know, for instance, that they are chemical sensitive, and that being exposed to fresh paint fumes will trigger their symptoms. Therefore, they go through life dancing around the things that they have figured out by trial and error, such as don't eat certain foods, stay away from chemical agents that give off fumes life fresh paint and new carpet. They are also aware that being emotionally geared up makes them feel worse. They tend to talk very fast, and over-commit themselves. They're upset about their health and the fact that they are told that there is very little that can be done and that they will have to learn to live with their condition. Their families are understandable upset. Then add emotionally stressful events like divorce, a death, or a stressful job situation, and the symptoms of their condition can get worse, because all of these situations are additional emotional stimulation. Some people have discovered, through trial and error, the chemical and emotional aspects of their condition. But, figuring out what is helpful structural stimulation and what is deleterious structural stimulation can be difficult. Whether things like exercise, stretching, and yoga are helpful or harmful depends on the individual. These things would be too much structural stimulation for everyone with fibromyalgia and CFS, and would lead to a worsening of the condition in the long run. Some people's response to chronic stress is fatigue. What they often don't know, until they are evaluated, is that their soft tissue (structure) is hypertonic. The hypertonic condition of their soft tissue is still under pain threshold, so they're not in any pain. That is, until they are given the poke test. Every person with fibromyalgia and CFS has local ischemia, which is a deficiency of blood supply, and trigger points in his or her soft tissues. The fibromyalgia person's response to chronic stress has put him or her over the pain threshold, and being in constant pain is fatiguing.

Therefore, fibromyalgia and CFS tend to go hand in hand because both groups are experiencing very strong stimuli, (i.e. chronic stress) on the emotional, chemical, and structural levels. The work of Edward Pfluger, a German physiologist can explain how emotional, chemical, and structural stressors contribute to the process of the nervous system becoming exhausted. He introduced the following five laws, known as Pfluger's Laws5 First, is the Law of UNILATERALITY. If a mild irritation is applied to one or more sensory nerves, the movement will take place usually on one side only, on the side which is irritated. For instance, if someone injures his or her right hip, the nervous system activity is excited on the right side only, on the side that was injured.

The second law, the Law of SYMMETRY, states that if the stimulation is sufficient, motor reaction is manifested, not only by the irritated side, but also in similar muscles on the opposite side of the body. Back to our example, if the person's right hip pain continues, he or she will start to experience pain in the left hip. This is due to sensory nerves from both hips entering the spinal cord at the same level and the signal spilling over from one side to the other.

The third law is the Law of INTENSITY. Reflex movements are usually more intense on the side of irritation; at times the movements of the opposite side equal them in intensity, but they are usually less pronounced. In our example, both of the person's hips are in pain, but the pain on the right side is more intense than that on the left.

Next is the Law of RADIATION. If the excitation (noxious pain signals) continues to increase, they enter the internuncial pool of the nervous system, which shunts sensory impulses into proper motor (muscular) actions. The noxious pain signals are then propagated upward in the internuncial pool and reactions take place through efferent (motor) nerves coming from the spinal cord segments higher up. Efferent nerves transmit signals exciting muscular contraction, influencing nutrition, growth, and secretions. So, if the pain continues, the pain signals not only spill over to the left hip, they also start radiating up the spinal cord.

It is very important that we recognize the process of the law of radiation. This is because the internuncial pool has an excitatory nature.6 If, for instance, strong sensory stimuli (pain) enters the cord for 2 milliseconds, the discharge through the motor root will last for 20 milliseconds. That's ten times longer. An example of this is illustrated by the experience of burning your finger on the stove. Your hand jerks back very quickly, and for one second you think, "Why did my hand do that?" Then you get the message that you finger hurts. This is a comparatively small injury with a large motor response. It is a protective mechanism. The normal nervous system response to pain is to contract and resist. If we had to wait for the sensory stimuli to go all the way to the brain and tell us that we are burning ourselves and then decide to move our hand, we would sustain far greater damage. Our nervous system is smarter than that. The sensory stimuli from our burning finger only has to travel up our arm, and into the internuncial pool of the spinal cord where it gets magnified ten times and comes out in a ten-fold motor response.7 That's why with a relatively small injury like burning the tip of our finger, we jerked our arm back about two feet. The nervous system knows that we need to get the finger off of the stove, and we need to do it ASAP. And it will tell us about it later; about two seconds later!

As a protective mechanism this response works in our favor. It works against us, however, when we are in constant pain. Using the hip pain example again, pain signals go into the spinal cord, and motor response is to contract and resist. The nervous system sends a signal constricting blood vessels in the area in order to control any localized bleeding, leading to local ischemia, or lack of blood to the tissues. So, normal blood supply in that area is reduced, depriving it of nutrients and oxygen, as well as causing the build up of metabolic by-products such as lactic acid and pyruvic acid. These acids, which are neuroirritants, make the area more painful, leading to more contraction. If this process continues, the pain stimulus going into the internuncial pool of the spinal cord starts to radiate up the cord. The internuncial pool is going to magnify that sensory input by ten and then look for the quickest and easiest pathway to shunt that ten-fold motor response. It will pick an old injury, which is a facilitated pathway, and reactivate it. This is the reason old injuries reoccur under stress. Now that hip pain is radiating up the cord, it finds an old shoulder injury and reactivates it. But maybe you don't remember injuring your shoulder, so why does it hurt? You may not remember falling and getting injured, but the nervous system keeps a record of the past history of the organism.8 The nervous system is the memory system of the body. Therefore, if remembers old injuries. Furthermore, it is the memory capability of the nervous system that makes facilitation possible. The longer we have been in pain, the more facilitated the pathways become, and the easier they are to reactivate. Therefore, with this individual past record of stress and pain each nervous system would have its own way of responding to future occasions of stress and pain.

This leads us to the last law, the Law of GENERALIZATION. When the irritation becomes very intense, it is propagated in the medulla oblongata of the brain stem. This is the area of the brain that determines and sets muscle tonus throughout the body. So when the noxious stimuli radiates up the spinal cord and is propagated in the medulla it becomes a focus from which stimuli radiates to all parts of the cord, causing a general contraction of all muscles of the body. This systemic muscular contraction leads to increased strong stimuli which leads to exhaustion and a loss of function. Therefore, those who suffer from fibromyalgia and CFS are experiencing the law of generalization.

Understanding how noxious signals affect the central nervous system is a key point to understanding fibromyalgia and CFS. But not all signals are noxious. Some signals in the central nervous system are good and essential. In fact, the CNS relies on them in order to function properly. Some examples are: hearing, taste, smell, touch, proprioception (balance). All of these signals are essential to the CNS. It is only when the noxious signals out number the good signals that conditions like fibromyalgia and CFS surface. Dr. Kurt Vreeland9 explains that this is the basis of the central integrative state of the CNS. To further understand this process he explains that the nervous system works on the basic principle of excitation and inhibition. The physiology of a neuron has excitatory postsynaptic potentials (EPSPs), and inhibitory postsynaptic potentials (IPSPs). If there is enough of a stimulus the signal is excited at the synapse and carried on to another neuron; but if the signal is weak, it does not go on to the next neuron. It is inhibited at the synapse. This is important because the central integrated state of the central nervous system is based on the right balance of EPSPs and IPSPs and it is dependent on afferent input-the signals going to the brain.

Furthermore, the thalamus portion of the brain functions as the telephone operator of the brain, fielding all primary perceptual experiences, and it is the relay station for kinesthesis or movement, vision and hearing. It sends signals to the cortex, basal ganglia and the hypothalamus. The hypothalamus part of the brain controls the endocrine system (like the thyroid and adrenal glands). It also controls the autonomic nervous system, which is the automatic functions like heartbeat and breathing. The autonomic nervous system is divided into two parts; the sympathetic (fight and flight) and the parasympathetic (repair and regenerate). If the signals going to the thalamus are weak, they are inhibited, and the signal stops in the thalamus. Therefore, the hypothalamus doesn't get the signals and all of the things under its control, such as the autonomic functions (repair and regenerate), are affected.

The lack of these afferent signals is called deafferentation. Dr. Vreeland tells us that the symptoms of deafferentation are nausea, dizziness, diarrhea, constipation, decrease in proprioception, chronic pain syndromes, depression, hypothyroidism, headaches, vasospasm, retinal degeneration, macular degeneration, diabetic retinopathy, ulcers, skin rashes, and aging-just about anything that is a functional disorder. Similarly, the definition of fibromyalgia is a rheumatic disorder characterized by chronic achy muscular pain of the low back, neck, shoulders, back of the head, upper chest, and of the thighs, legs, feet, or any other areas of the body that may be involved, painful menstrual cycles, anxiety, palpitations, memory impairment, irritable bladder, skin irritations, dry eyes and mouth, a need for frequent eyeglass prescription changes, dizziness, impaired coordination, sleep disorders, malabsorption, restless leg syndrome, bruxism, and depression. The definition of chronic fatigue syndrome is achy muscles and joints, anxiety, difficulty concentrating, fever, headaches, intestinal problems, irritability, jaundice, loss of appetites, mood swings, muscle spasms, recurrent upper respiratory tract infections, sensitivity to light and heat, sleep disturbances, sore throat, swollen glands (lymph nodes), temporary memory loss, depression, and-most of all-extreme and often disabling fatigue.10 Interestingly, these three definitions are very similar. The question arises, could the symptoms of fibromyalgia and CFS be perpetuated by the lack of afferent signals (deafferentation)? When we look at the similarities in the previous definitions of fibromyalgia, CFS and deafferentation, the answer appears to be yes. We have found this to be true in our clinical experience with our patients.

The next question is how does the lack of afferent signals (deafferentation) happen? One way that deafferentation occurs is by nerve compression. It is like putting a kink in a garden hose; the water can't' get through. If there is pressure on a nerve, the signal can't get through. So, if compression exists in the neck, and considering that 90% of the nerves in the body pass through the neck, a lot of nerves can be affected. This is backed up by Dr. Buskila's research stated earlier; people are thirteen times more likely to develop fibromyalgia after a whiplash accident.

Another way deafferentation occurs is by a lack of mechanoreception, which happens with a lack of proper movement. They send afferent signals to the brain concerning touch, pressure, vibration, hearing, balance, blood pressure, and muscular contractions. All of these types of information (signals) are essential to maintaining the central integrated state of the central nervous system. Without them deafferentation will occur leading to systemic loss of function.

It seems like a paradox; too much stimulation eventually leads to exhaustion (Arndt-Schultz law), and on the other hand, the central integrative state depends on stimulation. Don't get confused, we are talking about two different kinds of signals. Understand that nerve receptors are specifically classified either by location or by type of stimulus they detect. Some examples are thermoreceptors which detect changes in temperature, nociceptors detect pain, photoreceptors detect light, chemoreceptors detect chemicals in the mouth (taste), nose (smell), and body fluids, and mechanoreceptors detect mechanical pressure or stretching, and include stimuli related to touch, pressure, vibration, proprioception, hearing, equilibrium, and blood pressure.11 So, pain is one kind of a signal and function is another. Pain is detected by Nociceptors (C fibers) and mechanical function is detected Mechanoreception (A-1 afferents). They have an inverse relationship to each other. More of one decreases the other. Large diameter Mechanoreceptors, the 1-A afferents go through the thalamus; the small C fibers (the ones that carry pain signals) called nociceptors go to the brain stem. So, there's a separation in the anteriolateral system and the dorsal column of the spinal column. Essentially pain is one area and function is another. Generally, with pain or any kind of pressure on the nerve, like a vertebra out of alignment, the large diameter axons degenerate first. The C fibers, the ones that carry pain signals, don't undergo degeneration until the end. Because we need pain as a protective mechanism, we will lose function, and still have pain. The nervous system is trying to tell us, through pain signals, that something is wrong.

Simply, if we have an increase in pain (C fibers), we have a decrease in function (1-A afferents). The central integrative state of the central nervous system is dependent on the 1-A afferents, from mechanoreceptors. Without them we start to get a loss of function. However, it also works the other way. Because pain (C fibers) and function (1-A afferents) have an inverse relationship, we can increase the 1-A afferents, then the C fibers decrease. This is important! If we get an increase of 1-A afferents (function) we get a decrease in pain (C fibers)!

Everyone has experienced this phenomenon. If a person hits his or her thumb with a hammer, the instinct is to shake it or rub it, because those two actions increase the 1-A afferent signals and decrease the pain. This principal can be applied to chronic pain and dysfunction. Increasing afferent signals daily to the point of reaching a net gain will lead to a decrease in the chronic pain and a return of function. Therefore, the missing link in treating these conditions involves increasing afferent signals though mechanoreception.

Furthermore, Dr. Vreeland says that, "fibromyalgia is caused by nerve compression, lack of the proper cervical curve, postural distortions, lack of mechanoreception, and weakened or faulty back-up systems, like mitral valve prolapse."

Michael Jones12 agrees with Dr. Vreeland and has found that the utilization of these principles to be the key to success in treating these conditions. Jones further believes that the missing link in treating these conditions involves increasing afferent signals though mechanoreception. Jones developed a program that relieves cervical compression, facilitates the proper cervical curve and movement of each individual cervical vertebrae, puts the body back into structural homeostasis, and increases mechanoreception (afferent signals). When we accomplish all of those things we can expect a reversal of the symptoms. Jones, along with a local orthopedic surgeon, is currently documenting full resolution of fibromyalgia and CFS. His approach is explained as follows:

First, utilize research from consults with Dr. Vreeland's bank of tools to know where to apply neuromuscular therapy.  For example, most information to the brain comes from the left side of the body with the cervical area having the most capacity with the soft tissue of the face and the costal area (ribs) having the second most. Releasing these tissues allows good signals (A's) to be sent to the brain rahter than bad ones (C's) so the body can return to  normal function (homeostasis.) Then decrease the soft tissue pain with neuromuscular therapy, thereby decreasing the activity of the C fibers.

Second, facilitate the anterior (front) to posterior (back) movement of the cervical vertebrae. This helps restore the cervical curve, and returns the movement within the full range of motion of each individual cervical vertebrae, taking the pressure off of the spinal column, and maximizing mechanoreception. This is accomplished with a technique developed by Michael Jones called the Jones Hyperextension Intersegmental Technique (JHIST).

Third, further balance other areas of the body which will now respond to neuromuscular therapy because the central integrated state (balance inhibitory and excititory signals) of the central nervous system has been normalized utilizing the knowledge gained from Dr. Vreeland.

Fourth, teach people to recognize the body's signals (gas gauge) in order to understand when they are taking more from their bodies than they are putting back. These are called monitoring methods. These unprecedented techniques are done each and every day, because regaining our health happens each and every day of our lives. A few examples are: AM heart rate, axillary temperature, morning perception, number of hours of sleep, evening perception of amount of stress in the day (life count units). Mastering these monitoring methods is a vital ingredient to resolving these conditions. Without them full resolution cannot be expected.

Fifth, it is interesting to see the very significant improvement of those who chose to engage in a liver and colon cleansing program. Our typical unhealthy American diet and the overwhelming amount of chemicals we ingest and utilize with our cleansing products is a real concern. Some of the improvements we have had with those who chose to use these options would not have happened unless this path was taken. We share these opportunities and research with those who have this interest.

In summary, with fibromyalgia and CFS, the pain signals are overwhelming the brain (CNS) and the proper signals are not getting through to the brain. If we restore the proper curvature and movement of the neck and alleviate the nerve compression in other areas of the body, more of the good signals can get through to the brain. With this accomplished on a daily basis, the nervous system's memories of injuries (facilitated pathways) will become dim memories. Although these memories never go away entirely, the dysfunction will go away if the memories remain dim. People can expect to become pain and dysfunction free, have an increase of energy, and return to a normal lifestyle.

Experienced by Michael Jones, BA Psychology, Licensed Massage Therapist trained in Neuromuscular Massage Therapy

In May of 1988, Michael Jones suffered a severe bicycle accident and was diagnosed with an incurable condition, including a 35-50% permanent disability. Michael's 10 year search for answers to his condition parallels the "Hero's Journey" story, where the hero descends into darkness, suffers, learns from his suffering, and re-emerges with wisdom and a gift that he brings to the world. This search led Michael to develop JHIST-Jones Hyperextension Intersegmental Technique. He can be reached at (330) 491-0544 or on the web at __________________________

1 Buskila, et al., Arthritis and Rheumatism 40(3):446-452, March 1997.
2 Specificity and the Law of Facilitation in the Nervous System by James F. Vannerson, and Dorland, The American Illustrated Medical Dictionary.
3 Dorland, The American Illustrated Medical Dictionary, 21st edition, W.B. Saunders Co.. Philadelphia. See under law.
4 The Stress of Life by Hans Selye.
5 Edward Freidrich Wilhelm Pfluger, German Physiologist, 1829-1910.
6 Bonica, J.J., The Management of Pain, Lea and Feibger, Philadelphia 1953.
7 Hardy, James D., Wolf, Harold G., Goodell, Helen, Pain Sensations and Reactions, William and Wilkins Co., Baltimore, 1952, p. 177
8 Speransky, op. cit., pp. 118, 1107.
9 Dr. Vreeland is a chiropractor in Vermont, who is board certified in neurology and applied kinesiology and is board eligible in orthopedics. He is a Diplomat of the International College of Applied Kinesiology and a Diplomat in the American College of Chiropractic Neurology. He also serves as the team physician for the U.S. Olympic Ski team. Neuromuscular Therapy Update, Vol. V Issue.
10 Prescription for Nutritional Healing, Balch and Balch.
11 Tortora and Grabowski, Principles of Anatomy and Physiology, 7th Edition, 1993, p.445.
12 Michael Jones, BA, MT. Developed the JHIST method of therapy.

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