Fibromyalgia and Craniocervical Abnormalities

Fibromyalgia and Craniocervical & Cervical Spine Abnormalities

Some fibromyalgia patients have undiagnosed cervical spine abnormalities. Below are a few examples of studies indicating a detailed neurological evaluation of patients is necessary.

Study Results 2004:  Clinical evidence for cervical myelopathy due to Chiari malformation and spinal stenosis

“Fibromyalgia is a form of non-articular rheumatism, characterized by widespread musculoskeletal pain. By some estimates it affects 6 million Americans.  Patients were primarily women (87%) of mean age 44 years, who had been symptomatic for 8 years. The predominant complaints were neck / back pain (95%), fatigue (95%), exertional fatigue (96%), cognitive impairment (92%), instability of gait (85%), grip weakness (83%), paresthesiae (80%), dizziness (71%) and numbness (69%).  88% of patients reported worsening of symptoms with neck extension. The neurological examination was consistent with cervical myelopathy. A detailed neurological evaluation of patients with fibromyalgia in order to exclude cervical myelopathy, a potentially treatable condition.” (USA)  Reference

 

2012 Positional Cervical Spinal Cord Compression and Fibromyalgia (FM): A Novel Comorbidity With Important Diagnostic and Treatment Implications.  Positional Cervical Cord Compression (PC3) was defined as cord abutment, compression or flattening with a spinal canal diameter of <10 mm by magnetic resonance sagittal flexion, neutral, and extension images. The dynamic cervical spine images were obtained in 70 patients: 49 of 53 with fibromyalgia, 20 of 22 with chronic widespread pain (CWP) and 1 of 32 with connective tissue disease, based on history and examination.  Among those who received magnetic resonance imaging [MRI], 52 of 70 patients met positional cervical cord compression criteria…

  •                71% of fibromyalgia group [35/49]
  •                85% of chronic widespread pain group [17/20]
  •                Two patients had a Chiari malformation (FM)
  •                 1 had multiple sclerosis (CWP) and 1 had multiple myeloma (CWP).
  •                Extension views for 8 patients with cervical spinal cord flattening 

 

Medical Investigation

  1. A detailed neurological assessment including upper thoracic spinothalamic sensory level, hyperreflexia, inversion of the radial periosteal reflex, absent gag reflex, Romberg sign, clonus, Hoffman sign, impaired tandem walk, weakness, dysmetria and dysdiadochokinesia
  2. Hypermobility assessment such as the Beighton core
  3. MRI Brain with craniocervical junction ruling out conditions such as Chiari malformation, disease of the brain parenchyma and empty sella
  4. Dynamic uMRI cervical spine and craniocervical junction in neutral, flexion and extension positions (or supine MRI cervical spine and craniocervical junction, if dynamic MRI is not available)
  5. Contrast-enhanced CT imaging of the cervical spine investigating Chiari malformation, stenosis and craniocervical junction measurement abnormalities

Conservative Management Suggestions*

(*discuss options with your treating physicians before trying the following suggestions)

  1. Exercise i.e.Walking, aquafitness or walking in water (the pressure of the water pushes more blood up and into the brain) at least 30 minutes a day
  2. Drink enough water daily (i.e. 11 cups daily for women and 15 cups for men)
  3. Daily gentle neck stretches in the morning and nighttime as recommended by a PT or Upper Cervical Chiropractor
  4. Proper Body Postures as recommended by an Occupational Therapist
  5. Upper Cervical Chiropractic NUCCA, Atlas-Orthogonal or Blair
  6. Physiotherapy (PT)
  7. Diet – Eat foods that improve brain health like 1 cup berries, leafy greens, walnuts, pumpkin seeds, omega-3, tumeric, coconut and avocados.
  8. Talk to your physician about appropriate surgery options