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Fibromyalgia and its Ischemic Pain
By: William ND, PhD, Member World Sports Medicine Hall of Fame

To most physicians the pain of Fibromyalgia Syndrome is a mystery. Its unrelenting and debilitating pain is often relegated to being of psychosomatic origin due to the fact that it does not decrease with the use of NSAID's, opiates or psychotropics. In the present mindset of medicine if these medications do not relieve the pain then it must be all in the patients mind! If this is so, than the pain of an MI (heart attack) must also be all in the patients mind.

We know that for 3 days following a heart attack the patient will have angina, oft-times severe. We also know that for post MI pain, medicine does not normally administer pain killers. Why? Because the pain of a heart attack is the pain of ischemia (the lack of oxygen or Adenosine Tri Phosphate for the cells to breathe). Ischemic pain we know can only be relieved by restoring either proper O2 or ATP levels to the involved tissues.

Let’s use a simple example we’ve all experienced. When you were a child you likely at some time put rubber bands or string around your wrist and cut the blood supply off to your hand. At first the hand went numb. Then while turning an interesting shade of blue or purple, it began to throb. The more you moved your fingers and contracted the muscles the more the hand hurt. The longer the time the circulation was occluded from the area the harder the hand hurt. At that same moment in time, if you mainlined heroin that hand would still have hurt despite the fact that the strong opiate was swimming round your system and brain killing all other pain. Why? Pain meds have no effect on relieving the pain of ischemia!

OK, so ischemic pain can’t be relieved by pain killers or anti-depressants, so how does this relate to Fibromyalgia. Easy, in FMS we have a build up of fibrin (the fibro of Fibromyalgia) through and across striated muscle around the body. There is also the growth of fibrin in the micro circulation essentially plugging these tiny blood vessels in the effected areas. The combo of decreased blood supply, with the strangulating effect of the fibrin on muscle tissue, (remember what fibrin can do to strangulate intestines after abdominal surgery), creates the environment of ischemia. This is also why when these patients are taken through bouts of aerobic exercise or high intensity resistance exercise their pain greatly increases. *

What can be done to decrease the fibrosis? Until recently, nothing. There has been really nothing in either the allopathic or naturopathic armamentum that was capable of lysing away scar tissue or fibrosis. The only treatment allopathic medicine has had up to now to try to control fibrosis growth has been to use cortico steroids to lower the level of inflammation knowing that inflammation is one of the things that produces fibrosis. Plastic surgeons have used this technique on their post op patients with mixed results and cortico steroid therapies used with FMS patients have proven to be failures.

With the advent of oral systemic enzyme research and application all branches of the healing arts now have a powerful and effective tool for the safe lysing away of fibrosis and the non- toxic control of inflammation. First used in Germany and Japan against fibrocystic cysts of the breast and to prevent post operative scar tissue in abdominal and orthopedic surgery, the effect of orally administered highly fibrinolytic systemic enzymes has been documented in both research and clinical use. (See abstracts in this web site).

The safety and complete lack of toxicity of systemic enzymes make it the primary treatments of choice against inflammation (as they are used in German emergency medicine) and the only choice available for the lysing away of scar tissue or fibrosis.

With FMS patients, to be effective, an activation dose of the enzymes should be found and maintained for at least 3 months. After which an attempt can be made to reduce the dose. Experience of the docs using systemic enzymes with their FMS patients has shown that in roughly 50% of the patients their maintenance dose will be about 50% of their activation dose. For the other half of this patient population the dose will have to be maintained at the high activation dose as lowering it causes inflammation to return.

(I must interject a personal note both as an FMS patient myself and as one who has treated hundreds if not thousands of FMS patients in the last 15 years: many, many FMS patients are actually Munchausens patients and not true FMS patients. The true FMS patient is anxious to do anything that might alleviate their pain including exercise, nutrition and self applied therapies. The malingerer will be wanting the doctor to do something to relieve their pain and and reinforce their need for being dependent. If they are getting better they will doctor hop to another doc as relief is not really what they really want. These patients will have the “victim” mindset and be seen to be manipulating their families for secondary gain. With these misdiagnosed FMS patients NOTHING WILL WORK, EVEN IF IT IS. While these patients can enrich practices by their frequent visits, they can also pose a problem and even be an insurance liability as they will bad mouth one doc, his or her treatment plans and bedside manner to the next doc they hop to in a never ending line of pity seeking and manipulation. Once I discovered this about certain FMS patients while I was in practice, I refused to work with these folks. If the patient would not exercise, if they would not take their enzymes, if they would not follow the therapeutic guidelines - I would not work with them. Using enzymes, nutrition and the correct type of exercise, over 88% of my FMS patients did not remember they had FMS after the first 8 to 16 weeks of work! I booked no malingering, as most of the time I was worse off than the patients I was working with and I did not have the time, patience or energy to deal with the “pity me” Munchausens patient).

Fibromyalgia is a multi-faceted disease demanding a multi-faceted solution and since a major aspect of the problem is the pain of ischemia, the only treatment available is also the safest treatment available, the use of highly fibrinolytic orally administered systemic enzymes, to safely lyse away the fibrin, free strangulated muscle tissue and open peripheral circulation by lysing away the fibrin that is clogging the blood vessels. If the unrelenting pain of FMS can be dealt with then the rest of the problems relating to the condition can be ameliorated with ease.

* While exercise is a must for these patients to rebuild their strength, overcome atrophy, increase the vascular bed there by improving circulation and oxygenation and to increase the number of mitochondria to relieve the chronic fatigue / EBB aspect of the disease; the exercise must be strength work of low intensity but high resistance, (i.e. 3 to 4 sets of 3 to 5 repetitions with 70% or more of the 1 rep max.) with long rest periods of 2 to 5 minuets in-between sets. Aerobic exercise is not generally recommended but if done must not be over 8 minutes or of high intensity (over 50 to 60% of max HR) as the patient will have no tolerance for it, either in their energy reserves or their recuperative capacity. (Current Adaptation Reserve, Siff and Verkhoshansky, 1999). As per Karvonin and Cooper 7 to 8 minutes is the minimum time aerobic work can be done for while gaining a benefit to the heart and vascular system. Please read the article: How To Keep From Having A Heart Attack - Do Less Aerobic Exercise at www.drwong.us.

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