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About
the Reviewer
Dr Kim Humphreys is Head of Academic Affairs at the Anglo-European
College of Chiropractic. In addition to his educational duties, his research
interests lie in clinical outcome measures, neuroanatomy of the upper
cervical spine and whiplash syndrome.
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Fibromyalgia
Syndrome: A Practitioner’s Guide to Treatment is the sixth book in
a rapidly expanding collection by the prolific author, Leon Chaitow. As
ever, Dr Chaitow has produced a timely piece of work that should become
a most useful resource for a variety of health care professionals as well
as students in-training. The increasing recognition by practitioners of
patients with a chronic condition dominated by pain and fatigue as well
as other consistently associated signs and symptoms gives credence to
the notion of a Fibromyalgia Syndrome. The need for an authoritative text
on the subject of Fibromyalgia Syndrome (FMS) in general and the management
of FMS patients in particular has long been overdue. Unfortunately, the
critical mass of evidence for the existence of FMS as well as a rational
argument for its management have not been forthcoming until recently.
I believe Leon Chaitow has seized the appropriate time to bring forward
an eclectic, comprehensive and convincing piece of work on FMS. With the
focus of the book clearly as a guide, it should be most helpful to health
care practitioners from many different approaches and backgrounds.
Fibromyalgia Syndrome: A Practitioner’s
Guide to Treatment contains 14 chapters of which Dr Chaitow has written
9. The other chapters have been compiled by an impressive group of contributors
from the fields of general medicine, rheumatology, acupuncture, physical
medicine and chiropractic. This book, perhaps more than any of his previous
works, should cross the boundaries and find appeal from complementary
and alternative as well as traditional medical practitioners, as it addresses
patients’ common presenting complaints of chronic pain and fatigue with
associated constitutional signs and symptoms. Perhaps more importantly,
it provides a rational way forward in what might otherwise be a long,
difficult and many times confusing management approach.
The text is generally laid out as
one would expect, with an introduction to fibromyalgia followed by diagnostic
considerations and hypotheses, finishing with treatment and management
approaches from an eclectic perspective. One of my very few criticisms
of the entire text is that the flow of specific chapters on treatment
and management occasionally appears out of order in a few places. For
example, more general chapters that give an overview and interdisciplinary
approach are interspersed with specific treatment chapters. Additionally,
the book ends with a chapter on strain counterstrain rather than a concise
summary, pulling together the strands from a well-written, well-researched
and timely text. Without a summary or summary chapter, the reader is left
somewhat hanging.
Leon Chaitow and contributors present
14 extremely well-researched, easily read and comprehendable chapters.
Chapters 1 is an excellent introductory chapter on the history and definition
of fibromyalgia. Dr Chaitow introduces early, issues related to a multidimensional,
multifactorial aetiology, as well as the need for an interdisciplinary
solution. Chapter 2 addresses the constellation of associated symptoms
related to fibromyalgia, including their prevalence, associated stressors,
relationship to the immune system, homeostasis and adaptive capacity of
the individual. I found this an excellent chapter that integrated many
different perspectives. Chapter 3 was a brave attempt at explaining and
giving evidence for a number of commonly associated conditions related
to fibromyalgia. However, I felt there was some confusion, as distinct
conditions were mixed with clinical signs and symptoms. For example, irritable
bowel syndrome was included with fatigue, pain and sleep disorders. In
general, it was another excellent chapter rich with information, rational
links and arguments to help demystify the sometimes confusing clinical
picture of fibromyalgia.
I found chapter 4 particularly interesting
as it reviewed various hypotheses related to the aetiology of fibromyalgia.
Although the chapter was short, Dr Chaitow skilfully explored the rational
arguments and relevant supporting evidence for various theories and hypotheses,
including dysfunction of the immune system, nociception, stress and thyroid
hormones as well as an integrative hypothesis. Chapter 5 is dedicated
to a comparison of fibromyalgia and chronic fatigue syndrome. Although
this chapter is informative, I found it disappointingly short and felt
it could have been added to the end of chapter 3.
Chapter 6 written by Peter Baldry,
Emeritus Consultant Physician, begins the treatment section with acupuncture,
dry needling and superficial dry needling. This chapter presents the evidence
for the use of acupuncture and its variations from the more medical perspective
of pain relief through deactivation of trigger points or points of maximum
tenderness. This is a very evidence-based chapter that unfortunately does
not address issues related to more traditional and holistic acupuncture
methods.
Paul Watson, Research Fellow for
Rheumatic Diseases at Hope Hospital in Salford contributed chapter 7 on
the interdisciplinary management approach to pain in fibromyalgia. Dr
Watson briefly reviews the biopsychosocial model of pain and then goes
on to suggest an interdisciplinary approach to pain management related
to cognitive behavioural therapy, education, exercise and physical activity.
He also addresses issues related to sleep management, relaxation, psychological
coping skills as well as self-management for relapses. Chapter 7 is informative,
well-written and easy to read.
Chapters 8 and 9 concentrate on the
medical approach to diagnosis and treatment of fibromyalgia. A significant
portion addresses problems medical doctors face in terms of providing
adequate management and care of patients with fibromyalgia. The medical
history and physical examination, as well treatment related to education,
medication, nutritional advice, exercise, and physical therapy are explored.
Chapter 10, written by chiropractors
Drs John C and Gina Honeyman-Lowe, investigates the metabolic rehabilitation
of fibromyalgia patients. The premise for this chapter rests on the hypothesis
that FMS is a manifestation of inadequate thyroid hormone function related
to hypothyroidism or cellular resistance to thyroid hormone. Drs Lowe
present the evidence for this hypothesis as well as the clinical workup,
diagnosis and treatment protocol. They review their management approach
which includes nutritional supplements, thyroid hormone, exercise and
physical treatment. I think this chapter provides critical information
on essential nutritional and metabolic treatment necessary for the rehabilitation
of FMS.
Chapters 11 and 12 are very useful
chapters that explore the evidence for what treatment approach seems to
be working as well as evidence for treating associated disorders. The
evidence for a variety of treatments is explored including patient education
and advice, aerobic exercise, acupuncture, chiropractic, homoeopathy,
osteopathy and probiotic strategies, to name a few. Chapter 12 concentrates
on the management of associated conditions such as ‘foggy brain’ syndrome,
yeast infections, fatigue, irritable bowel syndrome and sleep disturbances
among others. I found these two chapters to be extremely useful and informative.
Chapters 13 and 14 take on a musculoskeletal
approach to the treatment of fibromyalgia. Chapter 13 addresses a bodywork
approach, whereas chapter 14 concentrates on self-treatment of some FMS
tender points using the strain counterstrain technique. In chapter 13,
patterns of dysfunction are identified as well as the assessment and treatment
using neuromuscular, muscle energy and positional release techniques.
The self-help chapter for patients reviews ways in which neck and upper
back tender points can be managed through the strain / counterstrain technique.
In summary, I highly recommend Dr
Leon Chaitow’s new text on FMS and its management. Practitioners from
all backgrounds who treat fibromyalgia patients should find this an extremely
useful reference text and guide to help them through the sometimes difficult
management of FMS.
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To obtain a copy of this book, please telephone Harcourt Publishers Limited
on Tel: 020-8308 5710.
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