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HEALTH CONCERN? BioHealth Health Concerns

Chronic Fatigue and Fibromyalgia

Contributing Author: Ross, Steven D.C, F.A.S.B.E, D.A.A.P.M.

Ross StevenDr. Steven Ross, President and Co-Founder of The Institute For Integrative Medicine. The IFIM is an evidence based educational institution focusing on teaching the integrative practitioner the evidence based medicine, business, marketing acumen and personal development needed to succeed in their practices. Dr. Ross has been practicing Integrative and Functional Diagnostic Medicine since 1982. He maintains an active practice in the southern California while consulting with patients and doctors worldwide. He is the author of Curing the Cause and Preventing Disease; a guide not only for patients seeking a new and scientific method of treatment but, also for health care professionals interested in incorporating evidence based treatment plans in helping their patients achieve optimum health without the use of dangerous drugs.

» Website: http://www.theifim.com/

Since the early 1990s, fibromyalgia has become an increasingly common diagnosis. It is estimated that 10% to 20% of new patients in a rheumatology practice have fibromyalgia syndrome (FMS), and approximately 2% of the U.S. population (three to six million people) are thought to have the condition. Since most doctors do not recognize the pattern of symptoms as fibromyalgia, my belief is that this number is much higher. Because of the widespread musculoskeletal manifestations of this condition, patients suffering from it are very likely to seek complimentary and alternative medicine. This paper will review FMS, with an emphasis on complimentary and alternative medicine.

Chronic fatigue symptoms overlap noticeably with fibromyalgia symptoms. Both syndromes are associated with sleep disturbances, flu-like aches, fatigue, and general malaise. However, fibromyalgia syndrome is not typically accompanied by fever. Also, chronic fatigue syndrome (CFS) does not require pain to be present for its diagnosis, as does FMS.

Fibromyalgia Defined

The condition we now know as fibromyalgia appears to have been recognized for many years, but was known years ago by other names. In the mid 1800s, European literature refers to a "neurasthenia" and "spinal irritation" (exaggerated tenderness to palpation). In 1904, Sir William Gavers coined the term "fibrositis," which appeared in North America rheumatology texts in 1940. After WWII, 50% to 70% of rheumatological referrals from the British armed forces were for fibrositis. In 1981, Yunas et al. began using the term fibromyalgia, since the condition was shown to not involve inflammation and in 1987, an editorial appeared in JAMA acknowledging the existence of fibromyalgia.

Chronic Fatigue Defined

There is no known single cause of CFS. Some authorities believe it is a condition shared by many different underlying diseases rather than an entity unto itself. Others believe it is caused by a defect of the immune system. Hormonal deficits, low blood pressure, and viral infections have been studied as possible causes or contributors. The postulated causal link with Epstein-Barr virus hypothesized in the mid-1980s has been discounted.

There has been some correlation between chronic single or multiple viral infections, but CFS has also been noted in the absence of any apparent viral infection. Food allergies are commonly associated with this disorder, as is candidiasis, intestinal parasites, and toxic chemical exposure.

Exposure to toxins has been suggested to play a significant role in the development and progression of both fibromyalgia and chronic fatigue syndrome, as approximately 47% to 67% of patients with FMS and 53% to 67% of patients with CFS have reported at least one episode of symptom exacerbation after specific chemical exposure.

Another area of interest is the link between intestinal dysfunction and FMS. Although statistics vary, research suggests that up to 70% of patients with FMS complain of symptoms associated with irritable bowel syndrome (IBS). IBS is a functional disorder characterized by chronic abdominal pain with alternating diarrhea, and constipation. In comparison with healthy subjects, patients with IBS also tend to experience extra intestinal symptoms that overlap with FMS complaints, including increased nerve sensitivity, morning stiffness, headaches, sleep disturbances, and fatigue.

Improved GI health can be achieved with a nutritional regimen known as the 4R-GI Restoration Program, which addresses the four primary stages of healing: Remove, Replace, Reinoculate, and Regenerate. This is an essential part of our "detoxification" program that we will discuss later.

Fibromyalgia Criteria:

The American Academy of Rheumatology has set forth the following criteria for the diagnosis of fibromyalgia:

  1. Subjective aching for at least three months.
  2. Subjective stiffness for at least three months.
  3. Widespread pain (bilateral, above and below the waist, includes axial skeletal pain).
  4. Tenderness to palpation (4 kg pressure) at 11 to 18 (bilateral) points as follows:
    1. Upper trapezius (shoulders)
    2. Supraspinatus (upper back)
    3. Gluteal region (buttocks)
    4. Pectoralis Major (second rib)
    5. Inferior Sternocladomastoid muscle ("lower cervical spine")
    6. Greater Trochanter (hip joint)
    7. Medial knee (inside of knee)
    8. Suboccipital (base of skull)
    9. Lateral Epicondyle (elbow)

In addition to the above criteria, sleep disturbance, fatigue, weakness, and irritable bowel syndrome may also be present.

Chronic Fatigue Criteria

  1. Persistent, severe fatigue brought on by less than 50% of normal exertion. This fatigue must last for six months or longer, and must be unaffected by any amount of rest.
  2. Low grade fever (around 101 degrees)
  3. A sore throat
  4. Lymph node tenderness
  5. Generalized aches and pains
  6. Sleep disorders
  7. Psychologically related symptoms such as feelings of depression, isolation, and anxiety.

General Examination and Treatment Goals

Any treatment regimen must begin with a thorough evaluation of prior treatment history, including the provider(s) that have already been consulted, and prior treatment, medications, etc., and any successes and failures.

The goal in any treatment plan must take into consideration the patient's ability to optimize sleep quality and quantity. Educate the patient with emphasis on he or she becoming the active director of his or her treatment.

Increase exercise and activity through guided, achievable goals. Improve aerobic capacity.

Optimize posture, ergonomics, biomechanics, and assess diet and nutritional status, as well as making the patient aware of other health care resources when appropriate. FMS and CFS are typically multidisciplinary problems.

Specific Treatment Considerations

Diet: When considering what determines your state of health, two aspects need to be understood. One is your genetic heritage, which up until recently we thought was an unquestionable factor unfortunately beyond our control. The other is your environment, which you have, fortunately, considerable influence over. Of the environmental factors, second only to your thoughts and emotions is your diet and nutritional balance.

In all fairness, when looking to improve your health, perhaps nutritional factors should be considered and engaged even before your thoughts and emotions. There are several reasons for this:

  1. Most find nutritional factors easier to control than their thoughts and emotions.
  2. Certain nutritional factors make dramatic differences in your ability to think clearly, stabilize your moods, and enhance your overall sense of well-being.
  3. We can assess your nutritional needs with more accuracy than your mental–emotional needs.
  4. We can effectively address your specific nutritional needs with targeted nutritional programs.

Let's now address the dietary fundamentals that lay the foundation you need to optimize the results of your targeted nutrition program. Contrary to what some might have you believe, your daily food and beverage choices do not require a degree in nutrition, just common sense and common practice. You start with the following distinctions.

  1. Choose simple whole foods, those Mother Nature has always provided for us.
  2. Eat them in their natural form, or as close to it as possible. Less processing generally means more nutritional value.
  3. Eat as wide a variety of these minimally processed, whole natural foods as circumstances allow to maximize your exposure to various nutrients while minimizing your repeated exposure to potential contaminants (e.g. pesticides, insecticides, etc.).
  4. Pay special attention to ensuring sufficient high quality, low fat proteins in your diet. Balance every 15 grams of protein with two to three cups of low starch vegetables as often as possible.
  5. Be moderate with your starch intake. Avoid processed whole grains and whole vegetables.
  6. Balance starch/carbohydrates with quality proteins wherever possible.
  7. Be sure to get at least three pieces/servings (1/2 to 1 cup) of fresh fruit and four to six cups of fresh vegetables every day.
  8. Reduce animal fats (fatty meats, dairy fats) and eliminate hydrogenated oils, trans fats, and processed vegetable oils (i.e., all fried foods, margarines, commercial salad dressings, oils, sauces, confectionaries, and baked goods). Instead, substitute monounsaturated oils for low heat stir-fries, light sautéing, salad dressings, and baking (e.g., olive oil, canola and almond oils). Choose Omega-3 rich, properly shielded (from air, light, and heat) oils, such as flax, pumpkin, and walnut for salad dressings and sauces. These nutritious oils are not to be cooked.
  9. Drink at least eight glasses of pure water daily.
  10. Substitute herbal and naturally decaffeinated teas for caffeinated beverages and sodas (including chemical containing 'diet' drinks).

Exercise: A healthy life is an active one. Regular exercise is essential for maintaining optimal health. The long-term success of any health care program is diminished if you do not exercise at least to a moderate degree on a regular basis. Exercise increases the body's metabolic rate and therefore helps you achieve your ideal weight, although that is not the main reason for exercising. Exercise increases circulation and improves the delivery of nutrients to the cells in our body that need them.

Exercise improves the removal of metabolic waste products from the body's cells and the elimination of toxins from your body. It improves your heart's strength and performance, and cause the production and release of chemicals in your brain that make you feel good, also known as the so-called "runner's high" produced by endorphins. Exercise has multiple positive benefits, should be included in your regular schedule, and should become a part of your life.

To get the most benefit from an exercise program, you must bring your heart rate up to approximately two-thirds of its maximum, and keep it there for a minimum of 15 minutes at least three times a week. Exercising daily will produce results much faster than every other day and 30 minutes is better than 15! Be sure to listen to your body and do not overdo it.

Remember: Inch by inch, anything is a cinch! Just about any form of activity that will meet the above criteria is fine – walking, jogging, swimming, dancing, bicycling, etc. Since all of these fit nicely into the category of "aerobic exercise," you do not need to buy a color-coordinated outfit and join an aerobic dance class to get your exercise. Of course, if you want take up aerobics, it is also great exercise. Good shoes with a strong arch support and loose, comfortable clothes work fine. The most important thing is to make exercise enjoyable, so that it becomes a regular part of your life, just like eating and sleeping. You must use it, or you will lose it!

Rest and Relaxation: Let us define what is meant by proper rest. Ideally, proper rest means freedom from work or physical activity, freedom from disturbance of mind or spirit, peace of mind. The purpose of proper rest is to restore, to bring back to a former or original condition. Presently, many theories exist as to why we require rest or sleep, what happens mentally and physiologically while we sleep, and even how much sleep each individual really needs. Based on the information that we have, a rational approach serves to unravel some of the mystery surrounding sleep and the essentials of proper or adequate rest. When individuals are deprived of sleep, their most common complaints are mental fatigue or confusion and musculoskeletal discomfort. Subsequent rest relieves these conditions. Therefore, we may extrapolate that sleep is essential to maintaining mental clarity and neutralizing structural stress. The physiology behind the restoration of mental capacity is not yet well understood; however, it appears to be associated with renewing neurotransmitting chemicals and cell membrane potentials throughout our bodies. In turn, these processes depend, at least in part, on the length of rest, the quality of one's nutrition, and the state of one's mind.

Rest provides time for your logical, analytical left brain to relax its dominance and thus allow the emotional and imaginative right brain valuable time for creative expression. One of the keys to effective rest is learning how to turn down the volume of your left brain while you tune into your right! Regular use of an exceptional guided imagery tape can be very useful. Structural recuperation, the physiology behind the other major function of rest and sleep, is more important.

The constant and relentless force of gravity acts on our physical structure, day by day, week after week. The more effectively one learns to be aware of this force and to deal with it intelligently, the less destructive its influence. Failure to pay heed to and effectively reduce the effect of this downward pull on our bodies often results in chronic and recurrent musculoskeletal discomfort (stiff, sore shoulders, neck, and back; hip, knee, and ankle distress), degenerative disc and joint disease, myofascial problems, and even headaches.

How then do we better cope with these stresses, especially those related to the earth's gravity? While most of us are aware of the need for a good night's sleep, too few of us recognize the need for proper rest and relaxation. People engaged in heavy physical labor as well as business executives and white-collar workers are subjected to a variety of physical stressors throughout their 'working hours.' There is mounting evidence that people who manage to obtain some rest and more resourceful postures during the day not only live more comfortably and work more effectively, they also live longer! Once convinced of the benefits, how does one go about obtaining proper rest during business hours? Proper rest refers to "inactivity that serve to aid restoration of optimal mental and physical function" (i.e. good health).

Our goals here include assisting the nervous system in its ability to cope with the stresses that it faces and assisting the physical body in compensating for the wear and tear of manual activities and the effects of gravity. All that is normally required is 15 to 20 minutes, twice daily (in addition to your usual night sleep) to counteract the onslaught of stress-related fatigue and wear and tear. One of the most effective practices involves getting off your feet and laying supine on your back on a firm surface. Any carpeted floor will do nicely. The knees should be bent up toward your chest until your thighs are at right angles to your trunk, perpendicular to the floor, with your lower legs resting on a chair seat, couch, or even a box with padding on top.

Stress: Stress can be very damaging to your health. While it is true that we cannot function without some stress, excessive stress ultimately wears you down and makes you sick. Dr. Hans Selye studied the effects of stress throughout his life, and identified "dis-stress" as the most damaging. He stated that this harmful stress has a distinct effect on health and can eventually cause a variety of body systems to deteriorate. Drs Holmes and Rahe, in a series of studies done on military personnel, showed that stress can have a cumulative effect. They catalogued many different stressors, ranging from mild ones such as traffic tickets to the profound stress associated with the loss of a loved one. They showed that people subjected to multiple stresses over a two-year period had a much higher likelihood of becoming seriously ill than those not under such stress. This illustrates the importance of eliminating "dis-stress" whenever possible.

How can you reduce stress? Sometimes it is difficult. Perhaps the stress comes from the type of work you do, and changing your job is not economically feasible. You can, however, change the way you deal with that stress. Learning to deal with stressful events in a positive manner can minimize their harmful effects. Relaxation tapes, meditation techniques, and biofeedback can all help. Regular exercise has the additional benefit of helping you rid your body of the negative effects of stress (please refer to the section on exercise for more information). A relaxing walk in the park or along a beach can work wonders! If you would like more help in this area, just ask.

Structural Care/Chiropractic Treatment: The body requires two forms of energy to function: biochemical, provided by the food we eat, and electrical, provided by the brain and nervous system. One cannot function without the other. You can improve the biochemical part by being careful about what you eat, taking your supplements to fill in "gaps" in your diet or to overcome unique metabolic, environmental or genetic circumstances, and to ensure that digestion and absorption are functioning optimally.

The electrical component, however, depends on structural integrity. The brain acts as a control center, producing the energy that flows out through the spinal cord to the rest of the body via the network of nerves. Every function of the body, from the contraction of muscles allowing movement, to the digestive processes, to the production and repair of cells, to our immune function – literally everything depends on the proper supply of electrical energy from the brain through the nerves. Chiropractic is the science of making sure that these nerve signals reach their destination with maximum impact and value. Your personalized, multifaceted chiropractic program will work to ensure that no structural problem impedes optimal electrical energy flow throughout the body. The nutritional program outlined in this report helps ensure that your biochemical energy needs are also being met. The two depend on one another!

Weight Management and Detoxification: Your questionnaire responses and our assessment may indicate that you could benefit from a comprehensive weight management program. In our office, we utilize a program that emphasizes a proper and healthy weight loss regimen. This is an exciting program for us to recommend because of its exceptional results and the simplicity of its design. Unlike many weight management programs, it involves less time spent in food preparation by providing an easy-to-use, single-meal-replacement drink as well as a predetermined food shopping list. Included is a comprehensive patient guide in addition to this report. We have found the results extraordinary and often include the resolution of other symptoms, such as bloating, mood swings, and fatigue spells. Our hope is that you experience a noticeable increase in your energy, endurance, and overall well-being.

Toxins exist everywhere and can lead to serious health problems. They are in food and the environment, and persist because of our insufficient metabolic ability to rid the body of all that we are exposed to on a daily basis. They can drain the body of energy and make you more susceptible to disease and infection. Toxins tend to concentrate in the liver and gastrointestinal tract, both places responsible for eliminating toxins from the body. Since everyone is exposed to toxins, everyone can benefit from a detoxification treatment on a regular basis.

Possible Causes of Toxicities and Risks Include: Aging, alcohol, bacterial toxins, burns, cigarettes, constipation, drugs, food additives, food allergies, fried foods, heavy metals, intestinal infections, silicone implants, stress, toxic chemicals, metabolites, and pesticides.

Purification: Purification (also known as detoxification or cleansing) is the process of addressing the natural toxins in the body. The liver, digestive tract, kidneys, bladder, lymphatic system, lungs, and skin are the major systems/organs involved in the neutralization and elimination of toxins.

Because we are exposed to high levels of foreign substances and over consume chemically treated, synthetically produced food, we need extra purification. The program we use at our clinic utilizes whole food supplements, pure food, and water to give the body the resources it needs to purify and rebuild itself naturally. Our programs emphasize the liver and colon because these two organs play a major role in supporting the digestive system.

Many people completing our purification program experience increased energy, better digestion, less bloating, clearer skin, shinier hair and a disappearance or lessoning of past conditions such as PMS, digestive problems, fibromyalgia, and chronic fatigue, to name just a few.

Helpful Lifestyle Changes: Breathe. Avoid stress and seek out ways to relax and resolve stressful conditions in your life. Get sufficient sunlight, exercise, and sleep. Counseling, meditation, and other therapies are proactive ways to relieve stress.

Helpful Dietary Changes: Drink green tea, a dietary source of catechin. Eat a well-balanced diet rich in fresh fruits and vegetables. Eat artichokes, which help detox the liver. Eat foods in the Brassica family (cabbage, cauliflower, brussels sprout). Increase your intake of berries. Keep a food diary to detect individual patterns of sensitivity to foods. Fast regularly.

Supportive Nutritional Supplements: As many nutritional supplements exist on the market today, and a great deal of misinformation is being disseminated in magazines and infomercials, the average consumer can be "sold" on almost any concoction for almost any condition he has, or thinks he may have. Starting a "health regeneration program" means more than just grabbing the next vitamin bottle seen on the shelf or on television. Be an informed consumer and get tested by a reputable and knowledgeable practitioner. The following list will provide you with a sampling of vitamins and minerals that may be prescribed as part of your treatment protocol, along with their physiological effects on the body:

  • Coenzyme Q 10 (Ubiquinone) is an antioxidant that carries oxygen to the tissues and strengthens the immune system.
  • Copper assists in body detoxification.
  • Folic acid strengthens immunity.
  • Magnesium helps reduce stress and is used with calcium metabolism.
  • The B-complex vitamins aid in improving general health, help relieve stress, and aid liver function.
  • Vitamin C antioxidant.
  • Vitamin E antioxidant.
  • Zinc is an antioxidant that strengthens immunity (should be taken with copper).

Supportive Herbs Properties/Function:

  • Acacia catechu is a source of catechin and fights free radical formation.
  • Dandelion provides blood and liver support and has a diuretic effect. It can help in the treatment for liver damage and is a mild laxative.
  • Garlic is well known for its antibiotic and antimicrobial effects. It is also an antioxidant, inhibits infection, and strengthens immunity.
  • Gingko biloba neutralizes free radicals often produced during stress.
  • Goldenseal is a very potent detoxifier and strengthens immunity.
  • Hawthorn berries increase circulation and are a great source of vitamin C.
  • Milk thistle (Silybum) is an antioxidant and blood and liver detoxifier. It also supports and neutralizes free radicals often produced during stress.
  • Turmeric aids liver function and is a tremendous anti-inflammatory agent.
  • Uncaria is a source of catechin and fights free radicals.
  • Pharmacological Considerations

Pain relief, improved sleep, and improved mood are examples of goals that prescription medicines can help you reach. Generally, patients with fibromyalgia and chronic pain do not tolerate medicines well. Side effects such as nausea, drowsiness, or lightheadedness often occur. One person may tolerate a particular medicine, but it will make the next person sick. Prescribed medicines can provide great benefits to many; however, they should not be used in lieu of natural forms of treatment and treating the "cause" of the problem.

Categories of drugs used in the treatment of fibromyalgia and chronic pain include:

  • Analgesics
  • Anti-inflammatory medicines
  • Antidepressant medicines (tricyclics and selective serotonin reuptake inhibitors)
  • Muscle relaxants
  • Sleep modifiers
  • Anti-anxiety medicines

Other medicines used to treat chronic pain

  1. Analgesics: Analgesics are pain killers and include over-the-counter medicines such as aspirin and acetaminophen, or prescription-strength pain pills like narcotics (opiates), codeine, Vicodin, Darvocet, Oxycontin, and Percocet. Ultram is a pain reliever that differs from narcotics in its action on the central nervous system. These medications do not alter fibromyalgia, but they can help take the edge off the pain. Narcotic medications have the potential for adverse side effects, including drowsiness, difficulty with concentrating, and addiction, and should be used carefully.

    Many people with fibromyalgia and chronic pain are sensitive to codeine medicines, which can cause nausea or an allergic reaction. Ultram can cause allergic reactions in people sensitive to codeine, and a small number of people taking Ultram have seizures.
  2. Anti-Inflammatory Medicines: Anti-inflammatory medicines include aspirin, nonsteroidal anti-inflammatories (NSAIDs) such as ibuprofen, Naprosyn, Lodine, Daypro, and Cox-II inhibitors, and corticosteroids such as prednisone or dexmethasone. These medications are both anti-inflammatory and analgesic. Some of them, such as ibuprofen, are available both over-the-counter and by prescription. Because fibromyalgia is not a true inflammation, these drugs may be less effective in reducing pain. However, they can help reduce the pain that flares up with excessive physical activity, tendonitis, or bursitis, and should be used only as needed.

    The major side effect of the anti-inflammatories is bleeding from gastrointestinal ulcers. This problem is more common the longer the medicine is taken. However, a medication class of drugs called Cox-II inhibitors is available, and includes Celebrex (Searle Pharmaceuticals), Bextra, and Vioxx (Merck). Cox-II inhibitors are now under scrutiny, with Vioxx recently being pulled off the shelf. Post-market studies confirm that Vioxx raises the risk of serious cardiovascular events, including heart attack and stroke. About two million people worldwide were on the drug at the time of its withdrawal. As with any medication, caution should be taken when using any Cox-II inhibitor.
  3. Antidepressant Medicines: The antidepressant medicines include tricyclics (for example, amitriptyline, nortriptyline, doxepin, and trazodone), and selective serotonin reuptake inhibitors (Prozac, Zoloft, Paxil, Effexor, Serzone, and Celexa). These medicines can treat pain and alter sleep and mood disturbances seen in fibromyalgia. The tricyclic medicines are effective, but frequent side effects include dry mouth and drowsiness.
  4. Muscle Relaxants: Muscle relaxants can decrease pain in people with fibromyalgia. Medicines in this family include Flexeril, Soma, Skelaxin, and Robaxin. The most common side effect is drowsiness, although Soma and Skelaxin cause less of these effects.

    Medicines in the antispasticity category have been used to treat muscle spasms. Two of these medicines, Zanaflex and Baclofen, have been shown to help reduce back muscle spasms and pain.
  5. Sleep Modifiers: Various medicines including those already mentioned are used to treat insomnia (analgesics, antidepressants, and muscle relaxants). True sleep modifiers include benzodiazepines like Restoril and the hypnotic nonbenzodiazepines, such as Ambien. The most common reported concern over using sleep modifiers, especially benzodiazepams, is their habit-forming potential. Ambien is reported to be less habit-forming but can cause rebound insomnia when stopped.
  6. Anti-Anxiety Medicines: Anxiety is a common problem in fibromyalgia and contributes to pain, muscle tension, and irritability. It can worsen depression and insomnia. Various medicines including antidepressants and muscle relaxants are used to treat anxiety. Benzodiazepines such as Klonopin, Ativan, and Xanax, are commonly used. They also cause sedation and can improve sleep. Possible side effects include depression and decreased memory. Sometimes determining whether symptoms are due to fibromyalgia or are side effects of medication is difficult.
  7. Other Medicines Used to Treat Chronic Pain: Other medicines can be used to treat pain. Some pain medicines were originally developed for a different purpose. For example, antiseizure medicines known as neuroleptics (including Neurontin, Dilantin, Depakote, and Tegretol) were later found to be helpful in treating pain, particularly neuropathic pain. People with fibromyalgia who have a lot of burning or sensations of electric shock in their hands and feet may improve from a trial of neuroleptic medicines.

Other conditions associated with fibromyalgia such as irritable bowel syndrome can cause pain from severe cramping and may require separately prescribed medications. Medicines used to treat irritable bowel syndrome include Metamucil, Levsin, and Levbid.

Medications can play a very important part in the treatment protocol for any patient dealing with issues associated with chronic pain and fatigue. However, if at all possible, the role of medication should not be as a substitute for correcting the cause of the problem.

Referral and Co-Treatment

Patients with fibromyalgia, chronic fatigue, and chronic pain often have complex presentations, and may require management by more than one practitioner. The proper combination of therapeutic approaches may have a synergistic effect. The Doctor of Chiropractic may be in a unique position to facilitate or coordinate the referral and co-treatment process.

The following are resources to consider, using clinical judgment and the patient's history.

Chiropractic is a branch of the healing arts concerned with human health and disease processes. Doctors of Chiropractic are physicians who consider man as an integrated being and give special attention to the physiological and biochemical aspects, including structural, spinal, musculoskeletal, neurological, vascular, nutritional, emotional, and environmental relationships.

The practice and procedures employed by Doctors of Chiropractic are based on the academic and clinical training received in and through accredited chiropractic colleges. They include, but are not limited to, using current diagnostic and therapeutic procedures. Specifically, such procedures include the adjustment and manipulation of the articulations and adjacent tissues of the human body, particularly of the spinal column, as well as the treatment of intersegmental aberrations for alleviation of related functional disorders.

Chiropractic is a drug-free, nonsurgical science and, as such, does not utilize pharmaceuticals or incisive surgery. Due regard is given to the state laws, as well as the nation's antitrust laws, that may allow Doctors of Chiropractic to utilize ancillary health care procedures commonly referred to as in the common domain.

Medical, M.D./D.O. A good primary care provider, one knowledgeable in complementary and alternative treatment, as well as in functional medicine, can provide tremendous support for a patient requiring the regulation of medications. Psychotherapist, counselor, or a similar related professional is essential in assisting the patient with chronic pain and stress reduction utilizing biofeedback, visualization, guided imagery, and meditative techniques.

Naturopathic Medicine is a distinctively natural approach to health and healing that recognizes the integrity of the whole person. Naturopathic Medicine is heir to the vitalistic tradition of medicine in the Western world, and emphasizes the treatment of disease through the stimulation, enhancement, and support of the inherent healing capacity of the person. Methods of treatments are chosen to work with the patient's vital force and respect the intelligence of the natural healing process. The practice of Naturopathic Medicine emerges from six underlying principles of healing. These principles are based on the objective observation of the nature of health and disease, and are continually reexamined in light of scientific analysis.

Acupuncturist/ Oriental Medicine. The distinct methods used by oriental medicine have long posed problems of understanding and accreditation for Western practitioners seeking to verify the efficacy of acupuncture. Western allopathic medicine treats diagnoses, and diagnoses are often established by fairly objective impersonal standards. The conventional Western medical model of treating specific and "objective" diagnoses can design studies that permit statistical inferences about the benefits of a treatment.

This approach contrasts with traditional acupuncture models in which an individual, not a diagnosis, is treated. Treatment is based not only on diagnostic evaluations derived from subjective signs and symptoms but on an accurate assessment of a patient’s nature/constitution. In a medical model such as traditional oriental medicine, where optimal treatment requires individualization, Western statistical analyses and study design must challenge a sole reliance on "standard" approaches to be meaningful.

Therein lies the problem. It is human nature to want the best medical care according to established standards, which in this country are based on the traditional scientific model. Average Westerners, having been exposed to a fairly homogeneous group of medical practitioners, tend to assume that there is an optimal treatment regimen for any given condition. Most medical doctors ask similar questions, do similar exams, order similar tests, and recommend similar therapies for a given problem, this approach being based on similar research, teaching, and experience. Therefore, people assume that a physician who deviates from the norm is either ignorant or incompetent. (The exception is physicians exploring new treatment regimes in research settings.)

Attempts have been made to "standardize" acupuncture approaches. The Chinese government under communist rule created a model of acupuncture called Traditional Chinese Medicine. This is the model taught in most acupuncture schools in the West. Although based on traditional models of Oriental medicine, particularly herbal approaches, it only partially reflects the wealth of acupuncture models used historically and today.

Ayurveda is one of the oldest systems of natural health care, originating in the ancient traditions of India. Now considered one of the leading forms of holistic medicine available in the West, Ayurveda addresses all factors that influence our quality of life.

The principles of Ayurveda state that nothing exists in isolation. Everything you interact with – your diet, family, work, or relationships – has an effect on your health and well-being. One guiding principle of Ayurveda is that mind and body are connected and that the mind has a profound influence over our health and well-being. While conventional Western medicine remains grounded in the paradigm of separation of the mind and body, Ayurveda holds that health is more than the absence of disease; it is a dynamic state of balance and integration of body, mind, and spirit.

Physical Therapy. Although the use of certain physical therapy techniques go back to ancient times, the modern profession of physical therapy developed in the twentieth century, in the wake of World War I. The very first modern American physical therapists were trained to work with soldiers returning from war, and several groups of "reconstruction aides," as they were then called, were sent to military hospitals in France to institute early rehabilitation with wounded veterans.

Today's physical therapist is a direct descendant of these brave women (and a few men). Physical therapists now practice in a wide variety of settings, with patients from all age groups. Many people are familiar with physical therapists' work helping patients with orthopedic problems, such as low back pain or knee surgeries, to reduce pain and regain function. Others may be aware of the treatment that physical therapists provide to assist patients recovering from a stroke in learning to use their limbs and to walk again. If you are old enough to remember the mid-century polio epidemics, you might be aware of the important role that physical therapists played in helping people minimize or overcome the paralyzing effects of this disease. Each of these recollections captures the essence of physical therapists. In today's health care system, physical therapists are the experts in the examination and treatment of musculoskeletal and neuromuscular problems that affect the ability of people to move the way they want and function as well as they want in their daily lives.

Functional medicine is anchored in an examination of the core clinical imbalances that underlie various disease conditions. These imbalances arise when environmental inputs, such as diet, nutrients (including air and water), exercise, and trauma, are processed by one’s body, mind, and spirit through a unique set of genetic predispositions, attitudes, and beliefs. The core clinical imbalances arising from malfunctions within this complex system include:

  • Hormonal and neurotransmitter imbalances
  • Oxidation–reduction imbalances
  • Detoxification imbalances
  • Immune imbalances
  • Inflammatory imbalances
  • Digestive, absorptive, and microbiological imbalances
  • Structural imbalances from cellular membrane function to the musculoskeletal system.

Imbalances such as these are precursors to the signs and symptoms by which we detect and label (diagnose) organ system disease. Improving balance is the precursor to restoring health, and involves much more than treating the symptoms. Functional medicine is dedicated to improving the management of complex, chronic disease by intervening at multiple levels to address these core clinical imbalances and to restore each patient's functionality and health.

Functional medicine is not a unique and separate body of knowledge. It is grounded in scientific principles and information widely available in medicine today, combining research from various disciplines into highly detailed yet clinically relevant models of disease pathogenesis and effective clinical management.

Functional medicine is a science-based field of health care grounded in the following principles:

  • Biochemical individuality describes the individual variations in function that come from genetic and environmental differences among individuals.
  • Patient-centered medicine emphasizes "patient care" rather than "disease care."
  • Dynamic balance of internal and external factors.

Web-like interconnections of physiological factors. The human body functions as an orchestrated network of interconnected systems rather than individual systems functioning autonomously and without effect on each other. For example, we now know that immunological dysfunctions can promote cardiovascular disease, that dietary imbalances can cause hormonal disturbances, and that environmental exposures can precipitate neurological syndromes such as Parkinson's disease.