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Fibromyalgia and Heel Pain

Discussion in 'General Issues and Discussion Forum' started by Han, Nov 3, 2005.

  1. Han

    Han Welcome New Poster

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    Good Morning All,

    Need some help/advice...

    I have a 62 year old female patient who was diagnosed by her GP with plantar fasciitis. Her previous podiatrist issued some orthoses to her, and up until about six months ago had successful pain relief. When she presented to me, she was not tolerating the orthoses at all and said the heel pain had returned (more medial over the tubercle) in both feet. She also has fibromyalgia. She takes Lithium and also has trouble with sleeping so also takes various sleeping tablets to help. The patient did not mention she was bipolar when I went through general medical questions, and I am not sure whether Lithium helps the fibro, but observing her, I would say it is a likley possibility that she has bi polar.
    I have tried footwear alterations and advice, RICE methods, physiotherapy, silicone heel cups, adjustments to the orthoses, off the shelf insoles, strapping etc etc but nothing seems to help the patient.

    I communicate frequently with her physiotherapist as she sees him fairly regularly, and says he finds any treatment he gives her (shoulder, hip, back) has never been able to relieve pain she feels anywhere else in her body.

    Any suggestions would be appreciated!

    Cheers :confused:
  2. Craig Payne

    Craig Payne Moderator


    A key pathophysiological feature of fibromyalgia is an aberrant central pain control mechanism or central hyperexcitability. The most commonly believed hypothesis is that it is due to an aberrant processing of sensory input in CNS. This means that as the tissue mediators of inflammation excite receptors, there are changes in pain sensitivity in those with fibromyalgia that is affected.....so have no real suggestions, just an explanation for what you are seeing .... any pain in fibromyalgia is difficult to manage.
    Last edited: Nov 4, 2005
  3. Felicity Prentice

    Felicity Prentice Active Member

    I concur with craig. For people with fibromyalgia the pain is very real, but the aetiology tends to be difficult to pin down, thus making treatment difficult.

    Lithium is not usually used for the treatment of fibromyalgia, so I would imagine that it is being used for mood stabilisation in bipolar disorder. The more likely choice for fibromyalgia would be one of the other mood stabilisers such as sodium valproate. None of my reading indicates that bipolar would affect pain directly, other than chanding the individual's ability to 'cope' (in depression it can be the straw that breaks the camels back...)

    I would be leaning towards the more supportive and adjunctive therapies, such as myotherapy, TENS, soft covers on orthotics, and a gentle listening ear. Good luck.


  4. Scorpio622

    Scorpio622 Active Member

    I have treated hundreds of patients with FM in earnest as a physical therapist and a few as a DPM over the years- and have drawn three conclusions from this experience:
    1) FM is a manifestation of psychological dysfunction and its associated sleep deprivation, and thus treatment must be targeted on these issues
    2) Physical treatments fail miserably
    3) I do not want to treat people with FM
  5. pgcarter

    pgcarter Well-Known Member

    How do you feel about folks with chronic fatigue syndrome? are they imagining it also?
  6. John Spina

    John Spina Active Member

    Try a good antidepressant on this patient.If that does not help,refer to a rheumatologist.
  7. Thorn

    Thorn Welcome New Poster

    Dear Han
    Fibromyalgia patients can be very challenging and difficult to treat, as no two patients present the same,they also share symptoms with many other condition namely cronic fatigue syndrome , M.E. this is why they cause so much hair pulling from practitioners.
    But help is at hand please try this web site http://www.myalgia.com/overveiw2.htm it contains a lot of useful information especially from Dr Robert Bennett. who is reguarded by many with the condition as the foremost expert of this illness
  8. Scorpio622

    Scorpio622 Active Member

    With regards to FM, it depends on your definition of "imagining". In my opinion, I do believe that FM patients are experiencing pain, but it is unknown if they are experiencing true nocioception. This is certainly different from myofascial pain syndrome- which has an identifiable area of nocioception that is treatable. (As far as chronic fatigue syndrome- I have very little experience or knowledge.)

    Your comment is quite typical of most FM patients and some clinicians alike. There is a widespread reluctance to accept the mind-body connection for fear of branding the patient a loon and perhaps appearing dismissive to the patient’s complaints. Nothing could be further from the truth. In fact, every ineffective treatment rendered to these patients just feeds the monster. IMHO, these patients need a psychologist, a personal trainer, a good night’s sleep, and more happiness in their lives. Stop sticking them with tiny needles, giving them drugs, and shoving orthotics in their shoes. Of course, I could be wrong.
  9. DaFlip

    DaFlip Active Member

    The classification of a syndrome does untold damage to the patient and often gives them little benefit to expedite recovery. This does not mean their syndrome or symptoms are non existant, just that giving it a 'name' may create a pattern of illness behaviour which slows recovery.

    From memory the worst person to send a patient with FM is to a psych professional. If i recall correctly and i'll check later there have been studies done which suggest the most appropriate person to manage these type of 'conditions' is a manual therapist with training in pain based management. This does not deny a team approach may help but we must remember to not overstimulate people who are going through active phases of their symptoms. Thus success can often be achieved by doing less or keeping it below pain threshold levels, which may mean very little physical activity.

    There are significant gains being made in the understanding of pain patterns and the mind/body connection. The cortisol pathway is a must read to understand how stress can mediate as musculoskeletal pain. Moseley would be a good author to read for most people who treat from manaul therapy/podiatric base. His book with Butler is a great reference.
    DaFlip :mad: not just bad on the inside
  10. Craig Payne

    Craig Payne Moderator

    Here are my notes I give students on fibromyalgia:
  11. Han

    Han Welcome New Poster

    Hi Everyone,

    Just wanted to say a big thankyou for all the advice and information. Its been extremely helpful and given me a little more scope

    Cheers again
  12. Craig Payne

    Craig Payne Moderator

    One thing I would add, is check around the plantar intrinsic muscles for trigger points - I have seen some with "plantar fasciitis" get better with foot orthoses, but the change in mechanics initiated trigger points in the intrinsic muscles that resulted in the pain remaining the same .... given the trigger point isssue in fibromyalgia, its worth looking.
    Last edited by a moderator: Nov 7, 2005
  13. Freeman

    Freeman Active Member

    I have had some tremendous successes (and some failures too) with very soft, more accommodating orthotics with FM patients. I have had better luck doing foam box and weight bearing casts than with the plaster slipper casts. I do believe these folks are wading through deep water which really don't ask about, however, I hear more than my share of what I don't need to know from them. So I listen a bit, encourage them to walk and work out. When in doubt, under correct and go softer. I never use rigid materials for them because I see them back saying they can't tolerate them.

    I can't say that that seeing FM on the patient info sheet fills me great cheer, but I always give them my very best efforts and hope.
    Best regards,
    Freeman Churchill
  14. Kent

    Kent Active Member

    I was recently talking to a musculoskeletal physician about fibromyalgia. He gives his patients some dry needling/accupuncture at irritable trigger points but he seems to think that kinesiology is the best thing for fibromyalgia.
  15. Morgan

    Morgan Member


    Having read some of the above comments I agree with most of the points made. I have encountered some patients who suffer with Fibromylagia and chronic fatigue who have tried a form of psychotherapy called Mickel Reverse Therapy. They have found this the only form of treatment that actually gets to the source of their problem. For example, one patient of mine with fibromyalgia leads an extrordinary life - mother of 5 children, works night shifts only, single parent... She claims that the firbromyalgia started around 4-6 months after starting to work the night shifts. No wonder!
  16. NewsBot

    NewsBot The Admin that posts the news.


    ScienceDaily are reporting:
    Acupuncture Relieves Symptoms Of Fibromyalgia, Mayo Clinic Study Finds
  17. John Spina

    John Spina Active Member

    According to the principles of Chinese Medicine, acupuncture is said to open up channels that are clogged.This may proveide a clue into the treatment of this disease.Maybe fibromyalgia is a short circuiting of an electrical impulse(s) in the body,in much the same way MS is said to be.
  18. METaylor

    METaylor Active Member

    Half of women with FM have low vit D (2 studies) and Vitamin D deficiency (Osteomalacia = bone pain and muscle weakness) is often misdiagnosed as FM. It is very difficult to get enough sunlight to make enough vitamin D when working shift work and sleeping during the day. The other main causes of FM include thyroid deficiency (see John C Lowe's work, incl book 'The metabolic Treatment of FM')Magnesium and B vitamin deficiencies, food intolerance, mercury overload and lastly, multiple ligamentous lesions, treatable by prolotherapy - see article by Reeves on treatment of 31 severe FM patients http://www.kalindra.com/prolo_reeves.PDF
  19. NewsBot

    NewsBot The Admin that posts the news.


    ScienceDaily are reporting:
    Pain From Fibromyalgia Is Real, Researchers Say
  20. NewsBot

    NewsBot The Admin that posts the news.

    The July issue of American Family Physician out today has a review of Fibromyalgia
  21. METaylor

    METaylor Active Member

    How depressing! Pity the poor patients who are treated with this paradigm - Count your 11 tender points and learn how to ignore the pain with CBT, gradually increase exercise even though it hurts and take drugs to suppress everything into a fog to reduce your misery. How could a senior author who is board certified in both occupational medicine and general preventive medicine and public health, not be aware of the evidence of vitamin D and fibromyalgia or undiagnosed coeliac disease for a start. Surely the fact that it is a multi-system condition should make one look for a connecting cause before prescribing treatment. Thank goodness podiatrists have access to a chat room like this where people can share websites that have more practical options.
  22. NewsBot

    NewsBot The Admin that posts the news.

    Ivanhoe Newswire are reporting:
    Study Suggest Cause for Fibromyalgia Pain
  23. NewsBot

    NewsBot The Admin that posts the news.

    Looks like the above is an important study, as ScienceDaily have also picked up on the story:
    Fibromyalgia Pain Caused By Neuron Mismatch, Suggests Study
    Full article.
  24. NewsBot

    NewsBot The Admin that posts the news.

  25. scottma

    scottma Member

    Dear Han:
    An article published by Robert M Bennett, Jessie Jones, Dennis C Turk, I Jon Russell and Lynne Matallana: An internet survey of 2,596 people with fibromyalgia, BMC Musculoskeletal Disorders 2007,8:27, which is available from: http://www.biomedcentral.com/1471-2474/8/27
    This article gives you an idea how patients respond to various treatment .
    Good luck
    scott ma
  26. greatwhite

    greatwhite Active Member

    Pity the poor professional who has to deal with it! I imagine that there are a great deal of 'hypochondriac' patients who are wrongly diagnosed with said condition just so that the practitioner can offer an explanation. No matter what form of treatment is offered this type of patient is impossible to satisfy. This is immensely frustrating and unfair to those who genuinely have the condition which, in my opinion, may be treated succesfully with any of the above options or combination of (yes, even including psychological assistance in some cases!).
    Last edited: Jan 6, 2008
  27. NewsBot

    NewsBot The Admin that posts the news.

    ScienceDaily are reporting:
    Fibromyalgia Pain Linked With Central Nervous System Disorder
    A Psychophysical Study of Auditory and Pressure Sensitivity in Patients With Fibromyalgia and Healthy Controls
    Michael E. Geisser, Jennifer M. Glass, Ljubinka D. Rajcevska, Daniel J. Clauw, David A. Williams, Paul R. Kileny and Richard H. Gracely
    The Journal of Pain Volume 9, Issue 5, May 2008, Pages 417-422
  28. NewsBot

    NewsBot The Admin that posts the news.

    Attitudes Towards Fibromyalgia: A Survey of Canadian Chiropractic, Naturopathic, Physical Therapy and Occupational Therapy Students
    Jason W Busse, Abhaya V Kulkarni, Parminder Badwall, Gordon H Guyatt, the Medically Unexplained Syndromes Study Group
    BMC Complementary and Alternative Medicine 2008, 8:24 (31 May 2008)
  29. admin

    admin Administrator Staff Member

    Press Release:
    First treatment for Fibromyalgia pain now available in Canada
  30. Pod on sea

    Pod on sea Active Member

    So in this instance would you still use orthotic therapy?
  31. NewsBot

    NewsBot The Admin that posts the news.

    Press release:
    Weather conditions do not affect fibromyalgia pain or fatigue
    Individual patients may experience some weather sensitivity
  32. MichaelCornelison

    MichaelCornelison Welcome New Poster

    Fibromyalgia is more often than not a complex one to deal with. Every time the cause turns out to be different and I end up looking at factors from food intake to psychological stuff. Hmm..
  33. Stanley

    Stanley Well-Known Member

    I have had a fair amount of success with fibromyalgia patients. I figured it might be helpful if I shared my thoughts based upon my clinical findings and readings.
    I find it to be a physical manifestation of the emotion anger.
    To understand how this happens, you have to understand the difference between the mammalian and human brain. The human brain has a sense of time; therefore it can have cognitive reasoning. The mammalian brain doesn’t have this sense of time, and therefore works through association and reinforces this with emotion. The mammalian brain has 3 outputs, autonomic, hormonal and motor. It appears that the motor output tightens the fascia in preparation for running or fighting. There are smooth muscles in the fascia, and it seems as if this is the cause of the pain and stiffness in fibromyalgia. I generally will see the tightness in the fascia as a mild equinus. This is not to say that every time there is a mild equinus that there is an emotional problem, as the most common cause for mild equinus appears to be an inversion sprain of the forefoot with its associated restrictions of the cuneiforms. Neither does every fibromyalgia patient show the mild equinus, as another manifestation of the emotional trauma the patient experienced could be called a “position of comfort”. That means that sometimes the patient appears to want to revert back to the position prior to emotional insult.
    Hormonally, the stress of an emotional problem will result in secretion of cortisol and adrenaline. Eventually, the adrenals become exhausted, and the clinical findings of postural hypotension and ligament pain especially at the TMJ, cervical ligaments, and iliolumbar ligaments (two of the tender points in fibromyalgia), and I suspect the plantar fascia.
    The left side of the brain is more concerned about language and that is the side that first is confronted with the emotional insult. It appears that it takes approximately five years before it causes dysfunction on the right side of the brain which is more symbolic. For most situations, it takes approximately 1 year to exhibit a fibromyalgia point, so it takes approximately 10 years from the original emotional insult to be diagnosed using the tender points. The exception seems to be automobile accidents, in which fibromyalgia can appear much sooner.
    Emotional problems can cause structural brain changes especially in severe emotional traumas (such as multiple rapes as children), and these are patients that do not respond as well to my treatment. I recently read an article about mindful meditation being able to provide positive changes in brain structure, but I have no experience in this area.
    The treatment that I use involves increasing blood flow to the mammalian brain. The reason why this is important is that there is no evolutionary reason for a mammal to process out a threatening situation. There may be all the data necessary to resolve an emotional issue, but unless there is processing of this data, the problem will persist.
    Therefore for mild to moderate fibromyalgia, what is needed is data and processing. Psychologists help with inputting good data into the human brain and as a result will indirectly also cause processing. Since this is not a direct means of increasing blood flow to the mammalian brain, it works over time.
    I find that a more direct way of achieving the desired result is to use the appropriate acupuncture point. I use a 1 point technique which is the beginning or end point in the skull of the yang meridian. In the case of anger it is the Gall Bladder meridian, therefore GB1. The only trick of this is to access the emotional system by having the patient touch the emotional neurovascular reflex point on the forehead while doing the pulse diagnosis and the treatment. I do not use needles to treat the acupuncture point. Rather I will drag the fascia. The fascia has Ruffini corpuscles in it which respond to tangential tension. I palpate the fascia (which takes time to learn), and then I drag it in the direction of ease, (not disease). I hold it for about 10 seconds and recheck the tension in the fascia. I repeat until the fascia moves evenly in both directions. The way I evaluate whether the treatment is helpful is by rechecking ankle dorsiflexion to see if I have affected a positive change.
    This technique appears to work well with mild to moderate fibromyalgia patients, but there is recurrence. If the patient has not resolved the situation that caused the fibromyalgia in the first place, it will recur. For instance, if a woman is angry about her abusive husband, and she has GB1 stimulated, then she will feel improved until she sees her husband. Referral to a psychologist will be helpful to have the patient understand her issues that allow her to put up with this situation, and work through her issues so that she can make a positive change in her life. Another time it will recur is if the patient becomes angry again. If this happens then a referral to a psychologist is needed to help the patient with conflict resolution/anger management/assertiveness training, and to help understand why the patient allows this to occur.

  34. NewsBot

    NewsBot The Admin that posts the news.

    Press Release:
    Study finds evidence of nerve damage in around half of fibromyalgia patients
    Small study could lead to identification of treatable diseases for some with chronic pain syndrome
  35. NewsBot

    NewsBot The Admin that posts the news.

    Press Release:
    Fibromyalgia Sufferers Get Significant Pain Relief From IV Lidocaine
  36. Admin2

    Admin2 Administrator Staff Member

    Press Release:
    Pleasure and pain brain signals disrupted in fibromyalgia patients
  37. NewsBot

    NewsBot The Admin that posts the news.

    Assessment of enthesopathy in patients with fibromyalgia by using new sonographic enthesitis index.
    Ozkan F, Bakan B, Inci MF, Kocturk F, Cetin GY, Yuksel M, Sayarlioglu M.
    Rev Bras Reumatol. 2013 Aug;53(4):335-340.
  38. NewsBot

    NewsBot The Admin that posts the news.

    Resistance exercise training for fibromyalgia.
    Busch AJ, Webber SC, Richards RS, Bidonde J, Schachter CL, Schafer LA, Danyliw A, Sawant A, Dal Bello-Haas V, Rader T, Overend TJ.
    Cochrane Database Syst Rev. 2013 Dec 20;12:CD010884.

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