Spinal Stenosis and Fibromyalgia

by admin on April 28, 2011

Fibromyalgia

Fibromyalgia and Back Pain?

Neck and back pain can both be symptoms experienced by those with fibromyalgia and this can sometimes mean that the start of pain associated with spinal stenosis is ignored as part of the fibromyalgia syndrome rather than recognized as a problem in itself.  Patients with fibromyalgia have a higher sensitivity to pain all over the body, with specific trigger points that may also coincide with areas likely to be implicated in spinal stenosis development.  The relative mobility of the cervical spine, for example, means that the progression of cervical arthritis may go undetected as patients, and their physicians, make the false assumption that neck pain and radicular pain are due to fibromyalgia rather than a pinched nerve caused by a mechanical obstruction such as osteophyte growth.  In this way chronic pain from nerve compression can go unchecked for days, weeks, or months with the likelihood of the nerve being permanently damaged increasing all the while.
Patients with fibromyalgia should report any new pain to their physician for assessment whether it is novel due to severity, location, persistence, or if it occurs with numbness, weakness, or tingling.  Conversely, cervical spinal stenosis and chiari malformation (CM) are thought by some to be misdiagnosed as fibromyalgia, again leading to delays in treatment.  A review by Clauw (et al, 2000) found little evidence of a higher prevalence of cervical spinal stenosis or CM in patients with fibromyalgia although the sample size was too small to accurately detect small increases in prevalence.


Spinal Stenosis Pain Worse in Fibromyalgia

Spinal stenosis and nerve compression in the spine does not just produce back or neck pain however, and the feeling of pain, numbness, or weakness in the extremities or the legs may also be due to a narrowing of the spinal spaces rather than a symptom of fibromyalgia.  Medications that work to relieve pain from muscle tension, or inflammation, or that act as antidepressants or antispasmodics are unlikely to be effective for relieving the pain associated with a trapped nerve in the spine.  Where osteophyte growth is causing nerve root compression it is usually necessary to undergo back surgery to remove the obstruction and allow the nerve to begin healing.

A study in 2003 looking at pain sensitivity in 80 patients with fibromyalgia and 40 healthy volunteers used an electrical charge applied to the lower leg to assess the transmission of the nerve signal and the corresponding pain sensation.  The study found that it took one-third less electrical charge for the fibromyalgia patients to feel pain in the upper thigh and, furthermore, that this pain signal did not actually reach the brain but was processed by the spinal cord itself.  The study demonstrated that nerve impulses amplified by the spinal cord are a key factor in the chronic pain felt by fibromyalgia sufferers, with the added implication that compression of the spinal cord itself through spinal stenosis would further exacerbate symptoms.  In some ways the higher pain sensitivity of fibromyalgia patients may act as an early warning system of spinal stenosis as patients without the syndrome may be less reactive to nerve irritation and allow a problem to persist for longer without being addressed.

Rheumatoid Arthritis, Spinal Stenosis, and Fibromyalgia

Rheumatoid arthritis is also a consideration for anyone attempting to diagnose a condition presenting with pain, fatigue and weakness, especially in the morning.  Unlike osteoarthritis, the joint inflammation and pain of RA is usually symmetrical and tends to ease through the day like fibromyalgia pain before worsening as the sufferer become tired in the evening.  Rheumatoid arthritis can lead to joint hypertrophy causing spinal stenosis, particularly in the neck and shoulders and may be confused with fibromyalgia pain from trigger points.  As severe spinal cord compression can occur if the neck becomes unstable due to RA it is important to identify such a condition rather than, again, assuming symptoms to be those of fibromyalgia.  Those with rheumatoid arthritis (around 2% of the population) are more likely to have fibromyalgia and many symptoms overlap which may cause serious diagnostic confusion and delay the onset of appropriate treatment.

Can Fibromyalgia Cause Spinal Stenosis?

Alterations in posture due to muscle strength and exercise, along with abnormal deposition of fatty tissue in place of muscles, and weight gain associated with some fibromyalgia medications can all put different stresses and strains on the spine and worsen spinal stenosis.  Stiffness due to inactivity can also make acute injury more likely and patients with fibromyalgia are advised to remain active.  Indeed, a large number of sufferers of the syndrome find that exercise actually relieves or reduces their pain both in the short- and long-term.  Exercise can also help counteract the depression that may occur in some fibromyalgia patients.  As the experience of pain and depression are closely associated in a number of ways, this is an important aspect of many treatment regimes for those with spinal stenosis, fibromyalgia, and other painful conditions such as myofascial pain syndrome.  The use of cognitive behavioural therapy as a treatment for such conditions can help patients improve their quality of life as this may allow them to accept limitations without imposing excessive restrictions on their own activities.  For some patients this may also help them to reduce medications and the side-effects that come with them.

Fibromyalgia Pain

Fibromyalgia affects many areas of the body and sometimes the mind

Osteoarthritis, Spinal Stenosis, and Fibromyalgia

One interesting study on osteoarthritis, which is a common cause of spinal stenosis, found that in a group of depressed people over 60yrs old more than half had osteoarthritis which was relieved to a significant degree when their depression was treated even when their joint pain was not itself directly addressed (Lin, et al, 2003).  Osteoarthritis is more common in those over fifty and frequently coincides with the menopause, in women, and the andropause, in men.  A cluster of other potential stressors occur at a similar time, such as menopause-related hypothyroidism, marital breakdown and empty-nest syndrome after children have left the family home, and psychosocial issues around retirement.  Fibromyalgia is almost always connected to chronic stress, either as a possible causative factor or in terms of exacerbation, and the onset of both conditions simultaneously may compromise accurate diagnosis.

Treatments for spinal stenosis and fibromyalgia are likely to be considerably different, with one often addressed by conservative anti-inflammatory medications initially and surgery where appropriate and the other almost never necessitating surgical intervention but frequently responding well to lifestyle interventions.  Mistaking the spinal stenosis symptoms of neck pain, back pain, radicular pain, and/or myelopathy for the symptoms of fibromyalgia (or vice versa) can cause an unhelpful delay in getting appropriate therapy for the patient and adversely affect their prognosis.


References

Clauw, D.J., Petzke, F., Rosner, M.J., Bennett, R.M.  Prevalence of Chiari

malformation and cervical spine stenosis in Fibromyalgia. Arth. Rheum. 43: S173, 2000


Lin EH, Katon W, Von Korff M, Tang L, Williams JW Jr, Kroenke K, Hunkeler E, Harpole L, Hegel M, Arean P, Hoffing M, Della Penna R, Langston C, Unützer J; IMPACT Investigators, Effect of improving depression care on pain and functional outcomes among older adults with arthritis: a randomized controlled trial, JAMA. 2003 Nov 12;290(18):2428-9.


Nielsen LA, Henriksson KG. Pathophysiological mechanisms in chronic musculoskeletal pain (fibromyalgia): the role of central and peripheral sensitization and pain disinhibition. Best Pract Res Clin Rheumatol 2007; 21: 465–80.


Staud R, Smitherman ML. Peripheral and central sensitization in fibromyalgia: pathogenetic role. Curr Pain Headache Rep 2002;6: 259–66.


Gur A, Oktayoglu P. Central nervous system abnormalities in fibromyalgia and chronic fatigue syndrome: new concepts in treatment. Curr Pharm Des 2008; 14: 1274–94.

{ 3 comments… read them below or add one }

Lynette April 29, 2011 at 10:30 pm

Thank you for this thorough and very informative review. I have suffered with fibromyalgia since 2001 and even though I have a herniated disc at T9-T10 and many changes in the neck area from auto accidents, all pain, all symptoms, all problems are always said to be fibromyalgia. If I have chest pain, they say it is fibromyalgia. Scary. You really have to be your own advocate. You bring up a concern of mine, that the real issue causing the most urgent problem is not being addressed because fibromyalgia is treated as the answer to all of the problems once you have that diagnosis in your file.

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Jan June 14, 2011 at 11:18 am

I was glad to see this article. I recently learned I have cervical stenosis and compression on the cord. It is much worse in the neck extension position. I had a positional MRI. I was diagnosed in 1999 with FM. At that time, an xray done on my neck showed loss of normal curvature and mild compression at C5-6. The finding was taken as just typical and not impressive for a 44 year old patient and was not considered in making the diagnosis of FM.

The case you are making regarding the association between spinal stenosis and fibromyalgia is actually much stronger than your article and references suggest. You missed the outstanding research of Dr. Manuel Martinez-Lavin on the auton0mic nervous system and Dr. Andrew Holman on positional cervical cord compression in patients with FM. Their findings leave little doubt regarding a dysfunctional auton0mic nervous system (heart rate variability studies) and a very high prevalence of cervical spinal cord compression in patients with FM, respectively.

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Deborah Peters September 3, 2011 at 11:33 am

Great article, I have Fibromyalgia. You are so right Lynette, you have to be your own advocate! I have had it since 1995, the best treatment to “feel normal” is very strong nutrition and exercise. And always listen to your body, we know when something “is off” as oppose to the norm. Never hurts to get a 2nd look by a variety of experts, I like D.O.’s for that reason.

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