Fibromyalgia and Meningeal Compression, Dr Paul Whitcomb
What is Meningeal Compression?
MC is an encroachment on the covering of the spinal cord and brain. One of the subset of symptoms that we believe it creates is Fibromyalgia, others are RSD, Brachia Neuralgia, Trigeminal Neuralgia, Irritable Bowel Syndrome, Restless Leg Syndrome, Unexplained Diffuse Pain, Depression, Chronic Fatigue, Anxiety, Failed Back Surgeries and so much more. Because of the Magnitude of the shear numbers we will spend more time on Fibromyalgia, but also on many other of its manifestations. Let’s look at Fibromyalgia first.
The name Fibromyalgia is in fact a misnomer. Originally it described fibrous deposits in the muscles, causing pain. The only truth to this is that some patients have muscle spasms so severe that they become fibrous. This adds to the problem, but has nothing to do with the cause of Fibromyalgia.
In the past FMS patients have been called hypochondriacs, and many times were referred to psychiatrists. And it was not uncommon for sufferers to be institutionalized. Only recently has this disorder gained recognition as a condition that deserves attention. In general patients are receiving more respect today and are believed when they say they have a problem. Yet they may still be looked upon as drug addicts, or presumed to have a self-serving motive, when all they really need is someone to believe them and get them help.
So Fibromyalgia is still a very poorly understood disorder. Typically diagnosed by the presence of eleven or more of eighteen specific “tender/trigger Points,” it is characterized by widespread pain and tenderness, and is frequently associated with nervousness, irritability, anxiety, fatigue, depression, and insomnia. In addition to this we often find chemical sensitivities, allergies, Restless Leg Syndrome, cold or burning hands and feet, and Irritable Bowel Syndrome. This is an abbreviated list, for the manifestations seem to be endless.
Some authorities believe that 5-6% of the population in America has Fibromyalgia. That brings the total close to eighteen million sufferers. Women are far more likely to be diagnosed with the condition than men. This may be because they are built with smaller bones and therefore have smaller tolerances in the areas that cause Fibromyalgia. This leaves them much more susceptible. In addition they participate in all of the same sports and drive all of the same motor vehicles as men, and are subject to the same traumas. Logically, then, in any accident, they would be likely to experience more severe damage to the skeletal structure.
Fibromyalgia is different from most diseases in that it takes away the individual’s ability to fight. After years of fatigue, depression, and pain—not being able to focus on anything but poor health and pain, and just trying to get through the day—the patient becomes discouraged and the spirit weakens. Family members, too, can become worn out with the disease and may abandon their stricken loved one. This is devastating to an already distraught victim of this insidious predator. Current research offers little hope and only brings more discouragement.
Afflicted, abandoned, alone, these sufferers resign themselves to living with this new destructive life partner, often in dark bedrooms, separating themselves from others, to live out long, lonely days without rest or comfort. Some cannot endure this suffering and take their own lives.
Symptoms may vary from person to person. They may be severe as in a severe case of RSD or Fibromyalgia or be less severe in a milder case of Fibromyalgia, mild Facial pain, fatigue, tight necks and shoulders or Trigeminal Neuralgia. Including the whole galaxy of symptoms would be impractical, because the nervous system controls the entire body and can affect all the systems. Here, then, is a partial list:
Insomnia: Insomnia is particularly troubling in almost all Fibromyalgia patients. It becomes worse in relation to the degree of pressure on the Meninges. (See “Cause and Effects of Fibromyalgia.”) The anxiety, the pain, the overactive central nervous system, and adrenaline overproduction from triggering the sympathetic nervous system, makes sleep almost impossible.
Fatigue: Fatigue naturally goes along with insomnia, but it is a level of fatigue that goes well beyond what would be expected with ordinary insomnia, and it has a much deeper impact.
Emotional instability, depression, irritability, and nervousness: These Fibromyalgia symptoms are often the most difficult to deal with, since they affect the very core of the being and destroy joy and enthusiasm. Life becomes miserable for the sufferer as well as for those around him.
Mild to severe body pain: This can vary from headaches; pressure at the base of the skull; neck pain; arm pain or numbness; torso pain; hip, thigh, and leg pain; or numbness and facial pains. Some of our patients have entire body pain. Often this will be worse in the morning and evening.
Headaches. Usually there is pressure at the base of the skull, and there is sometimes associated pain in the occipital (back side of the skull) and upper cervical spine (neck). Many patients have severe, migraine-type headaches. FMS headaches may vary in location and intensity. We have seen almost every possible combination—unilateral, bilateral, facial, occipital, mild, severe, and sometimes accompanied with nausea and vomiting and even seizures.
Irritable Bowel Syndrome: This is present in most sufferers, and is caused by the sympathetic nervous system firing constantly, preventing the parasympathetic nervous system from controlling digestion. The sympathetic nervous system is meant to help us run or fight in emergencies. Its constant firing increases adrenaline production and brings with it anxiety (a feeling of forthcoming destruction). The parasympathetic system works well when we are relaxed, and controls things like food digestion and normal, relaxed bodily functions.
Rashes: Some Fibromyalgia patients will develop rashes on their legs, arms, face, back, or other areas. They are common and almost always go away with the treatment.
Trigeminal neuralgia: Observations suggest that the tugging on the trigeminal nerve as it exits through the Meninges can trigger this symptom. Trigeminal neuralgia is characterized by facial pain, often lancing—usually severe, though it can be mild. The patients we have seen with this condition usually respond well to treatment and immediately to our test.
Calcium deposits under the skin: These are common, usually under pea size, but we have seen them much larger. They can be very painful and even cause bleeding with movement in rare cases.
Communication problems: These are common Fibromyalgia symptoms, and generally suggest a severe case. Many of the patients we see who are this ill are unable to answer questions or keep on the subject. In severe cases will loose their speech.
This lack of focus usually abates in the first two weeks of treatment.
Anxiety: Anxiety is often one of the most severe problems. Many patients don’t even realize they have anxiety until it is pointed out. It is brought on by the sympathetic nervous system firing continuously. It will push the patient like amphetamines, even though he/she may be totally exhausted, and keep them active somewhat; but it is this anxiety that also prevents sleep and rest. Panic attacks—feelings of a need to protect oneself or to run away—are common. When anxiety disappears (usually around four weeks, our patients become very tired and restorative sleep follows. This is when we see leaps in their improvement.
This can be an independent symptom of MC or combined with Fibromyalgia symptoms.
All of the glands of the body can be affected, i.e.: the pituitary, the thyroid, the adrenals, the reproductive glands, the pancreas, etc. These glands malfunctioning can create a host of physical problems as well as mental and emotional problems. This is why balancing hormones give a person a boost.
RSD or CRPS (Complex regional pain syndrome): This is until now, a complex misunderstoodproblem associated with an accident or a surgery. After the event the body part involved will continue to display pain and often cause circulatory problems as well. The pain can be excruciating. This is why a surgery may appear to have failed, but in reality, is a meningeal Compression caused by the surgery itself or possibly increased by the surgery.
Our Test for Fibromyalgia, RSD, Trigeminal Neuralgia, and unexplained diffuse pain.
The advancement in the test for Meningeal Compression will definitely change the way Fibromyalgia, RSD, Trigeminal Neuralgia, and unexplained diffuse pain is looked at forever. For the first time we can prove where Fibromyalgia, RSD, Trigeminal Neuralgia comes from with a simple test. Not only this, but we can usually alleviate most to all of the patients symptoms in five to ten minutes with this test. The test is not only diagnostic but also prognostic. Those we are able to receive relief from their symptoms with the test, will almost always respond to treatment. The relief that comes from the testing is usually profound and lasts from minutes to days. We would like to say more about the dramatic changes that we see with the test but it would sound like we were making it up. The test is not perfect, like anything, but for those who have MC it almost always gives them relief in minutes. We are now able to temporarily remove the pulling of the Meninges, partially in minutes, relieving many of the symptoms of Fibromyalgia, RSD, Trigeminal Neuralgia, failed back surgeries and in rarer cases hearing loss visual problems, severe knee problems and help the pain from rheumatoid arthritis. Relieving the symptoms proves this is where the problem originates and finally solves the mystery of suffering. If we can relieve patient’s symptoms we can make a positive diagnosis of Meningeal Compression. If we can make this positive diagnosis, we can usually alleviate the symptoms with treatment. As a disclaimer on some of these diseases: we realize that there can be other causes of diseases like RH, strokes, hearing problems and blindness, but with some of these cases it appears that the disease causes a MC through a channel of intensity or trauma to the body from the condition, thus causing a MC and increasing the symptoms of the condition significantly.
We are now teaching this test in the U.S. and many other countries around the world. We would like to describe the test here in more detail but it is impossible to explain without and advance knowledge of anatomy and years of experience with palpation.
Cause and Effects of Meningeal Compression and Fibromyalgia
A pulling on the Meninges by way of encroachment or twisting appears to cause MC. This intrusion could indicate a tumor or other malformation, but we find that it is most often due to a change in the Cervical spine that cause this encroachment, which can reduce or distort the space through which the spinal cord and Meninges must traverse.
Any tugging on the Meninges (remember the Meninges attaches to the spinal nerve roots, the brain, the spine and the cranial nerves) can have devastating effects on this critical and sensitive nerve action, which in turn can produce a galaxy of undesirable symptoms.
The Meninges are the three membranes that envelop the brain and spinal cord: the dura mater, pia mater, and arachnoid. This strong bag-like envelope holds the cerebrospinal fluid, which brings nutrition and healing to the brain and spinal cord. It is attached to all of the nerves that pass through it.
Nerve roots are extensions of the spinal cord that turn and exit between each vertebra, sending and receiving impulses that control virtually the entire body, even the smallest parts. Since these nerves pass through the Meninges, naturally it follows that every bodily system can be affected by the pulling of the Meninges. These nerve roots also extend fibers to the brain, which transmit impulses that are then received as pain, burning, itching, hot, cold, tingling, or numbness, as well as other parasthesias (that is, odd feelings).
The pulling and irritation of these nerve roots cause nerve fibers to fire maverick impulses to the brain. The brain interprets these fired impulses as pain, itching, burning, coldness, numbness, or other odd feelings. The body, in response to stimuli from irritation, will often twitch or spasm, thus prompting the restless leg syndrome, muscle tightness, and spasms often experienced by Fibromyalgia patients. In more severe cases, the patient will lose the use of one or more of the limbs. Spasms may cause an arm to curl on the chest or oblige the patient to walk on the toes of one foot, or limp.
We have also seen some who have had one-sided pain (see section on one-sided FMS). Interestingly, this condition usually abates more rapidly. If Fibromyalgia were a systemic disease or an allergic reaction or a combination of stress, toxins, and trauma like many are saying, it couldn’t affect just one side of the body, but pulling on the Meninges could.
Typically Meningeal Compression irritates the nerve roots. When it hits levels that are diagnosed as Fibromyalgia, nerve impulses bombard the sufferer’s brain, overwhelming the autonomic and sensory pathways, keeping them in pain, awake at night, fatigued, and depressed.
The variations of Meningeal Compression are as complex as the nervous system itself.
Nerve roots also carry impulses from the brain to the body, most of which tell the muscles to work on command. But in this case, because the nerves fire without legitimate cause, the muscles contract when they are supposed to be at rest. After years of contraction the muscles form scar tissue (resulting from the constant buildup of waste products from the metabolic process and the lack of blood flow in the contracted muscles).
And thus we have the name for Fibromyalgia–fibros indicates scar-tissue-type deposits, myo means muscle, and algia means pain. We have called this a misnomer, since you can readily see that we’re looking at a result rather than a cause. But the name helped all of us as practitioners to look more closely at Fibromyalgia, identify it, and study it more carefully. A more accurate term would be Meningeal Compression Syndrome–an encroachment on the spinal cord structures in the neck involving a Meningial tug or pulling created by Stenosis (narrowing or stricture of a duct or canal).
The results can be devastating. Try to imagine impulses from all over the body firing at one time, muscles contracting without cause, and the brain receiving impulses that you are in pain. Maybe you itch, or have burning or cold hands or feet. . We have had cases where the patient’s arms would wave involuntarily while lying in bed. One little girl had a flapping arm. I these cases there was a full recovery.
But even worse, the sympathetic nervous system fires nonstop. This is the system that is involved when you think you are alone in a dark house and someone startles you. It is meant to help you run or fight in survival situations. When it is firing indiscriminately, the result is constant anxiety, and maybe panic attacks. This constant firing also causes adrenal fatigue. Sleep becomes difficult or impossible.
Let’s pause here for a moment to take a closer look at the Autonomic Nervous System, to better understand what is happening. The ANS includes two subsystems: the Parasympathetic Nervous System and the Sympathetic Nervous System. The PNS has sometimes been called the “rest and digest” response. The PNS slows and relaxes many functions of the organs and body systems. For example, the PNS will dilate blood vessels to the GI tract, while slowing the heart beat and decreasing the force of the heart’s contractions. These effects help to lower the metabolic strain on the body, resulting in energy conservation. The PNS can divert blood back to the skin and the gastrointestinal tract. And the increased blood flow to the GI tract aids digestion.
The Sympathetic Nervous System is frequently referred to as the “fight or flight” system, as it has a strong effect on organs and physiological systems. For example, the SNS constricts blood vessels feeding blood to the GI tract and skin, while dilating skeletal muscle and lung blood vessels. Bronchioles also dilate, allowing more oxygen to be exchanged in the lungs. At the same time, the SNS increases heart rate and contractility of the heart. This vastly increases blood flow to the skeletal muscles and diverts blood away from organs such as the GI tract, which are not important during the “fight or flight” response.
The sympathetic and the parasympathetic nervous systems cannot be active at the same time. Therefore an active SNS shuts down the PNS and the actions associated with it, like sleep and digestion. And now we have another complication. Since normally the parasympathetic nervous system operates during rest or relaxation, when the “fight or flight” response is in motion the parasympathetic nervous system yields to the operation of the SNS. This accounts for insomnia and irritable bowel syndrome. At this point we have a volatile situation.
Now let’s talk about the cranial nerves. They also pass through the Meninges and are therefore affected; they can fire without proper control as well. This can cause changes in the function of the cranial nerves and affect hearing, vision, facial muscle function, smell taste, and anything that is controlled by the cranial nerves.
Pulling on the Meninges causes nerves to fire garbage impulses. The huge amounts of garbage information from the sensory nervous system overwhelms the brain, and the “domino effect” brings about nervousness, depression, fatigue, insomnia, pain, bowel dysfunction, anxiety, irritability, and sensitivity to light. Often the sufferer will want to sit in a quiet room to try to stop some of the damaging input. Rarely will you see these victims listening to loud music or looking forward to a party.
This is what Meningeal pulling can do. Yet with appropriate treatment we have seen the vision cleared, speech returned, and sense of smell regained. Some who said it sounded like they were under water have even had their hearing return. One woman who could only sit and cry with facial pain had relief within three weeks of treatment. These reports seem impossible. They also seem impossible to us, but seeing these things daily bring the impossible to life.
Why Meningeal Compression and its Subset of Diseases Often Start with Trauma, Surgery, Stress, and Genetic Predisposition
We believe the explanation is quite simple. The delicate relationship between the foramen magnum and the cervical spine is very often impacted by injuries involving the neck. The spinal cord and its covering, the Meninges, traverse gently through these structures with little room for error. In true Meningeal Compression, as we have seen, the boney structures are displaced in such a fashion that it causes a pulling on the Meninges, affecting many of the spinal nerve roots that are attached to it. So trauma must inevitably be implicated as a starting place for this condition. We may have physical trauma, surgery, or even mental trauma involved, as well as genetic predisposition.
1. Physical Trauma
The Number One cause of Meningeal Compression is trauma caused by auto accidents. So many people are left with Fibromyalgia—mild or severe—after auto accidents, that there can be little question of the connection.
Foreman and Croft, in their book, “Acceleration / Deceleration of the Cervical Spine,” describe the effect of whiplash on the neck. We learn that a head, that weighs 10-14 pounds, can reach a pulling weight of 100-140 pounds in a 15 mph rear-end accident. If you happen to be rear ended by a semi truck going 5 mph this can be equal to being hit by a Volkswagen going 50 mph. If a car or truck is traveling at 35 or 50 mph, the pressure pulling back on your head and neck is as if you were on your back and someone dropped a 300 lb. weight attached to your neck by a strap. This impact only lasts for a fraction of a second, but 300 lbs. can do a lot of damage. This is precisely what happens in an auto collision; the head is thrown back and forth like this two or three times, snapping the neck severely, nearly always causing some irreversible damage that leads to long-term degeneration and in many cases leaves the victim with MC.
Now if we think of the head, heavy as it is, thrashing severely on the little bones of the neck, it is no wonder its normal resting position can be changed. This change produces a pulling on the Meninges—which we have seen attaches to the spinal nerve roots—triggering the misfiring of nerve signals that activate the condition we call “Meningeal Compression”.
Since the cause of Meningeal Compression has not been understood, the association with spinal stenosis created by subluxations (also misunderstood) and Meningeal pulling, has been overlooked. Yet our experience suggests that this is a very common cause of Meningeal Compression. Since this underlying cause was not recognized during our schooling, the corrective techniques we are taught actually intensify the Subluxation, making Meningeal Compression worse.
Most Fibromyalgia and RSD patients can remember a trauma or surgery close to the initiation of their symptoms, though some may not. This is usually a car accident or a blow to the head. For example, we have treated injuries of prisoners of war in Vietnam who were hit in the neck with rifle butts; diving injuries in pools; auto accidents; falls; fights; surgeries; childbirth; etc. Other causes include injuries to the neck by way of hitting or whipping the head or neck.
One patient who came to us with a severe case of Fibromyalgia was injured when he slammed on his brakes on the ice to keep from hitting a bus. He avoided a collision, but did hit dry pavement, which snapped his neck—without hitting the steering wheel—and from that time on suffered with Fibromyalgia until treated in our facility. There was no contact with the head and he was only traveling 25 mph.
We are relatively fragile creatures who were not made to do some of the things we do, and eighteen million (estimate of Fibromyalgia suffers accepted by many) Americans will no doubt agree with us. Not to mention the one million two hundred thousand RSD patients and the countless failed surgery patients who didn’t have failed surgeries at all but have on going cycling pain from the insult to the neck during surgery.
We have a good friend who is an anesthesiologist; and after having so many patients claiming their symptoms began after surgery, we sat down and did our best to discover what was happening that could be causing Fibromyalgia during or after surgery. He had no idea how it could be occurring. He told us of the great care and consideration that was taken in the surgical room by almost all of the people he knew. He explained how they supported the neck with foam supports, or sometimes an IV bag, and how gentle they were with the patients. Yet we have had many patients tell us they came out of surgery screaming in severe pain that never let up until treated in our office.
This area needs much more research, which possibly may most effectively be done by a coordinated effort of chiropractors and anesthesiologists. But our initial thought was that when you sleep you have muscle tone, and if you are uncomfortable you roll over or move to adjust your position to relieve the pressure. When you are under anesthesia your muscles have no tone; they are flaccid with no control at all, and you can’t move if you need to. During this time we believe the neck vertebrae are compromised, literally pushing up against the Meninges. Whatever the cause may prove to be, we have seen too many cases of Fibromyalgia and RSD initiated or increased by surgery to be ignored—probably 40% of the patients we see.
- Mental Stress
The connection between mental stress and spinal stenosis secondary to cervical alignment might seem to be a stretch, but we have had many people tell us that their Fibromyalgia started immediately after the death of a loved one, mental abuse, a divorce, or a variety of other stressful conditions. And having recognized the intimate relationship between cervical problems and FMS, it is fair to consider that stress can also be a factor. Though we are not exactly sure how this sort of movement can be caused by stress, we now believe it is. Our presumption is that since stress causes muscle tightness, it can ultimately bring about a shift in alignment. As you would expect, stress control is a very important part of our treatment protocol.
- Genetic Predisposition
One more factor we must consider is genetic predisposition. Our primary focus on spinal stenosis and trauma seemed to preclude a relationship with genetic disposition. But our stance on this has changed after seeing far too many families with multiple Fibromyalgia sufferers. At present there seems to be a genetic weakness that allows certain families to develop FMS more easily than others. We believe it is likely due to the hereditary size and formation of the bones. We had a patient who had thirteen family members with Fibromyalgia. Much more research on this issue is needed.