Positive Health Online

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.

* To obtain a copy of this book, please telephone Harcourt Publishers Limited on Tel: 020-8308 5710.