Are Brain Waves the Key to
Fibromyalgia Syndrome (FS) is a common chronic pain disorder that effects approximately one million Canadians— mostly women.
Common symptoms of FS are: chronic wide-spread or all-over-body pain with numerous painful tender points in specific locations on the body, disturbed and nonrestorative sleep, morning stiffness, persistent fatigue and exercise intolerance, and reduced ability to think clearly (mental clouding or “fibro-fog”). Other health problems frequently associated with FS include: depressed and irritable mood, irritable bowel and bladder, headaches, dysmenorrhea, multiple allergies and chemical sensitivities, and cold hands and feet.
To see an excellent presentation on pain called, "Understanding Pain and What to Do About It in Less Than 5 Minutes" GOTO: www.youtube.com/watch?v=4b8oB757DKc
Fibromyalgia is especially confusing and often misunderstood because almost all its symptoms are also common to other conditions. There is no single test or laboratory finding that is uniquely diagnostic for FS. In addition, FS probably has more than one cause. It can develop over a few months as a result of a traumatic muscle injury from a fall or minor motor vehicle accident, or it can start with a viral illness like the flu or mononucleosis. In some women it appears to develop after sudden hormonal change such as occurs after a hysterectomy, child birth or menopause. While FS can be associated with irritable and depressed mood and is frequently made worse by psychological stress, most research does not support the notion that FS is a psychological disorder.
Moreover, FS and chronic fatigue immune deficiency syndrome (CFIDS) are closely related conditions often confused in diagnosis. It has been estimated that approximately 65% of persons with FS also meet all diagnostic criteria for CFIDS and, similarly, nearly 85% of those with CFIDS also have FS.
Common medical and physical therapy treatments for chronic body pain have not proven very successful in alleviating FS. Commonly prescribed low dose antidepressant drugs, painkillers, and aerobic exercise generally help only a minority of FS sufferers to obtain minimal to moderate remission of symptoms.
Recent research increasingly points to the brain as key to understanding FS. Physiological arousal is under the management of the brain, which also regulates the sleep-wake cycle and modulates the pain response. When the brain and central nervous system are presented with a constant barrage of pain signals, over the course of time a number of physical and chemical changes occur within the brain centres that process bodily sensations to increase their sensitivity to stimulation and decrease their sensitivity to location. More and more, the brain interprets previously nonpainful stimulation as painful and loses its ability to pinpoint exactly where stimulation is coming from. There is growing consensus among neurological researchers that FS patients show abnormalities in brain blood flow and electrical activity (EEG) that appear to be associated with a number of core symptoms. These changes include evidence of reduced blood circulation (hypoperfusion) in various areas of the brain and excessive amounts of low frequency electrical activity from primarily central and frontal areas of the cortex.
“What we believe happens in FS is that the continued bombardment of the brain by the pain stimulus in the periphery causes the brain to shift patterns.” (Dr. Stuart Donaldson, Director of Myosymmetries in Calgary, 1997)
A promising new therapy for FS uses EEG neurotherapy to train the brain to reduce low frequency EEG activity and increase the amount of higher frequency activity. This training appears to normalize the brain’s functioning and results in increased mental clarity and energy, improved mood, deeper and more restful sleep, decreased physical fatigue, and a reduction in “all-over-body” pain. Once these changes begin, FS patients are able to benefit from specific physical therapy treatments that focus on decreasing activity of painful myofascial trigger points and obtaining myofascial release, reinstating muscle balance, gentle muscle stretching, correcting poor posture and movement patterns, and increasing physical stamina.
A recent clinical outcomes study of 30 FS patients1 treated with EEG neurotherapy followed by trigger point massage and myofascial physical therapies reported that the majority (84%) of patients obtained significant improvements in mood (mean 65% improvement), mental clarity (66%), restorative sleep (135%), and pain (54%). Whereas all 30 patients fully met the American College of Rheumatology (1990) classification criteria for FS at the start of their treatment (average 15 ± 2 positive tender points), none met the full criteria at their discharge from treatment (average 8 ± 3 positive tender points). At follow-up, an average of nearly 8 months posttreatment, these ex-patients reported an average three-fold increase in the number of nights per week they “slept well” and a four-fold increase in the number of days per week they “felt good”. At follow-up, on average, these ex-patients reported themselves to be just over 60% improved overall (range = 20% - 90%).
Only a small number of pioneering clinicians in the United States and Canada are currently using EEG neurotherapy with fibromyalgia and chronic fatigue syndrome patients. However, as their positive clinical outcomes become more broadly reported and research on the connection between brain wave patterns and various physical disorders continues, EEG neurotherapy will become a relatively common form of treatment.
For more information on treating FS and CFIDS with neurotherapy, search the internet using the following search terms: “fibromyalgia” AND/OR “chronic fatigue syndrome” AND “EEG neurofeedback”.
Billiot, K., Budzynski, T., & Andrasik, F. (1997). EEG patterns and chronic fatigue. Journal of Neurotherapy. Volume 2, Issue 2, Pages: 20-30.
Donaldson, C.C.S., Sella, G.E., & Mueller, H.H. (1998). Fibromyalgia. A retrospective study of 252 consecutive referrals. Canadian Journal of Clinical Medicine. Volume 5, Issue 5, Pages: 116-127.
Donaldson, C.C.S., Sella, G.E., & Mueller, H.H. (2001). Neural Plasticity Model of Fibromyalgia – Theory, Assessment and Treatment. Parts 1-4. Practical Pain Management, Volume 1, Issues 3-4.
Donaldson, M., Mueller, H.H., Donaldson, C.C.S., & Sella, G.E. (2003). QEEG patterns, psychological status and pain reports of fibromyalgia sufferers. American Journal of Pain Management. Volume 13, Issue 2, Pages: 60-73.
1Mueller, H., Donaldson, C.C.S., Nelson, D.V., & Layman M. (2001). Treatment of fibromyalgia incorporating EEG-Driven Stimulation: A Clinical Outcomes Study. Journal of Clinical Psychology. Volume 57, Issue 7, Pages: 933-952.
Simons, P. (1998). City researcher offers hope for chronically fatigued. Edmonton Journal, April 24, 1998.
Tansey, M.A. (1993). EEG neurofeedback and chronic fatigue syndrome: New findings with respect to diagnosis and treatment. The CFIDS Chronicle Physician’s Forum, Fall 1993.
Clinical Outcomes of Myosymmetries’ Treatment of Fibromyalgia Patients.
A Brief Overview of Results.
Patients Treated October 1996-2000.
Dr. Horst H. Mueller, RPsych, CRHSPP, FBCIA(EEG)
Recent research increasingly points to the brain as key to understanding fibromyalgia. There is growing consensus amongst researchers that fibromyalgia is a pain amplification syndrome in which central nervous system plasticity plays a major role in symptom onset and maintenance. Neural plasticity refers to the way the neurological systems (sensory, motor and central) react and adapt over time to repeated stimulation of chronic pain.
The overall effectiveness of combining treatment modalities that focus on both the central and peripheral nervous systems in alleviating the complex psychological and somatic complaints associated with fibromyalgia is demonstrated by a recent clinical outcomes study of a series of 30 consecutive fibromyalgia patients treated at the Myosymmetries Edmonton clinic (Mueller, Donaldson, Nelson & Layman, 2001). Between October 1996 and October 2000, clinical data was obtained on a total of 46 consecutive fibromyalgia patients treated at Myosymmetries.
All patients (27 female, 3 male; aged 50.7 ± 12.0 years) included in this study had been previously diagnosed with fibromyalgia by a treating physician, fully met the American College of Rheumatology 1990 classification criteria for fibromyalgia as determined by both their history and a physical examination with tender point palpation and dolometry, and were actively symptomatic at the time of their intake to treatment. Disease chronicity averaged 5.7 ± 4.9 years.
Although there was some individual variation, patients were generally treated 3-5 times per week with EEG-Driven Stimulation (EDS) (Flexyx LLC, Walnut Creek, California) exclusively until their in-session self-reports began to reveal a positive change in perceived mental clarity, mood, and restorative sleep as well as a shift from experiencing “all-over-body” pain to more localized aches and pains. Once this shift in self-reported symptoms began to become apparent (i.e., mean of 16 ± 6 weeks; range 6-29 weeks), the number of EDS sessions per week were gradually reduced and 2-3 sessions per week of physical therapies were added.
Physical therapies included some combination of trigger point massage, myofascial and positional release, stretch and spray, sEMG-assisted neuromuscular retrain-ing, prescribed muscle stretching and strengthening exercises, dependent on each patient’s individual needs. As a group, these patients averaged 37.3 ± 15.6 hours of EDS and 14.7 ± 8.0 hours of physical therapies over the course of approximately 3-5 months of treatment.
Significant pre- versus post-treatment changes were obtained on the Symptom Check List 90-R (SCL-90-R) (Derogatis, 1994), the Fibromyalgia Impact Questionnaire (FIQ) (Burckhardt, Clark, & Bennett, 1991), repeated patient self-reports of selected key symptoms using a 10 cm visual analog scale (VAS), spectral EEG bandwidth power, number of positive tender points, mean pain threshold over tender points, and total percent of body perceived as painful. Patients rated themselves as an average of 62% ± 22% improved overall (range 20%-90%) at the time of their follow-up an average of 8.2 ± 4.3 months after treatment was terminated. Fully three-quarters of the patients were 50% or more improved at follow-up.
Treatment was associated with significant improvement in SCL-90-R Global Severity Index scores, as well as 7 of 9 subscales; with greatest change in those symptoms included within the Somatization, Obsessive-Compulsive, Depression, and Anxiety subscales. Broadly, SCL-90-R profiles shifted from clinical to normal levels. Similarly, patient VAS ratings for sleep quality, pain intensity, level of fatigue, level of cognitive clouding, level of depression, and level of anxiety improved significantly from intake to discharge (i.e., 135%, 69%, 40%, 66%, 65%, and 68% improved, respectively).
EDS therapy was associated with a significant decrease in average levels of cortical delta (1-4 Hz), theta (4-8 Hz), and alpha (8-12 Hz) activity as measured in pre- versus post-treatment brain maps (i.e., 31%, 29%, and 19% reductions, respectively). Changes in low beta (12-18 Hz) and mid beta (18-24 Hz) activity were not significant.
Treatment also resulted in a significant decrease in the average percent of the body perceived as painful, from a mean of 33% ± 12% at intake to 10% ± 11% at discharge. Similarly, treatment resulted in a significant reduction in number of positive tender points (from 15 ± 2 at intake, to 8 ± 3 at discharge) for the group; with all patients meeting the ACR 1990 criteria of at least 11 of 18 tender points positive for pain at less than 4.0 kg/cm2 of pressure on intake and only 4 (13%) patients still meeting this criteria on discharge. As a group, the mean pain threshold over the 18 fibromyalgia tender point locations increased significantly; from 2.6 ± 0.5 kg/cm2 to 3.8 ± 0.9 kg/cm2 of pressure (46% increase).
Finally, there were significant increases in patients’ “activities of daily living” (50% increase), average days per week in which patients “felt good” (from 1.1 days at intake to 4.4 days at follow-up), and average number of nights per week patients “slept well” (from 1.8 nights at intake to 5.2 nights at follow-up) as reported on the FIQ at treatment intake versus at follow-up, an average of 8 months post-treatment.
Because all patients received differing amounts of the different therapy modalities, it was not possible to determine which therapy accounted for the majority of the patients’ improvements. However, it was noted that reductions in EEG delta and theta amplitudes correlated significantly with improvements in SCL-90-R Global Severity Index, Somatization, Depression, and Anxiety scores as well as with improved ability to perform activities of daily living, increased number of days in which patients felt good, and increased number of nights patients slept well as indicated on the FIQ. Number of sessions of EDS therapy correlated most strongly with patients’ self-report of reduced pain and improved sleep over the course of treatment sessions. Time spent in physical therapies was most strongly correlated with reductions in patients’ number of positive tender points, increased pain threshold, and decreased percent of the body experienced as painful.
These outcomes based on a relatively small group of fibromyalgia patients seen for therapy at Myosymmetries Edmonton are broadly consistent with observations on a larger number of such patients seen at Myosymmetries Calgary (see Donaldson, Sella & Mueller, 1998).
Chaudhuri, B., Holden, W., Donaldson, C.S., & Ochs, L. (1996). Electroencephalogram (EEG) Driven Stimulation (EDS) to Improve Fibromyalgia Pain Symptoms. Poster presented at the National Congress of Neurological Scientists, 31st Annual Meeting, June 25-29, 1998, London, Ontario.
Donaldson, C.S. (1999). The pain of fibromyalgia: A message to the practitioner. Biofeedback, 27(3), 11-12.
Donaldson, C.S., MacInis, A., Snelling, L., Sella, G., Mueller, H.H. (2002). Characteristics of diffuse muscular coactivation (DMC) in persons with fibromyalgia— Part 2. Neurorehabilitation, 17(1): 41-48.
Donaldson, C.S., Sella, G.E., & Mueller, H.H. (1998). Fibromyalgia: A retrospective study of 252 consecutive referrals. Canadian Journal of Clinical Medicine, 5(6), 116-127.
Donaldson, C.S., Snelling, L., MacInnis, A., Sella, G., Mueller, H.H. (2002). Diffuse muscular coactivation (DMC) as a potential sourse of pain in fibromyalgia— Part 1. Neurorehabilitation, 17(1): 33-39.
Donaldson, M.., Mueller, H.H., Donaldson, C.S., Sella. G.E. (2003). QEEG patterns, psychological status and pain reports of fibromyalgia patients. Clinical findings. American Journal of Pain Management, 13(2), 60-73.
Mueller, H.H. (1998). Brain waves. The key to curing fibromyalgia? Feel Good Magazine, March/April 1998, 24.
Mueller, H.H., Donaldson, C.S., Nelson, D., & Layman, M. (2001). Treatment of fibromyalgia incorporating EEG-driven stimulation: A clinical outcomes study. Journal of Clinical Psychology, 57(7), 933-52.
Mueller, H.H., Holden, W., & Layman, M. (2000). EEG neurotherapy: New kid on the block. PAA Psymposium, 9 (5), 26-28.
EEG Stimulation: Neurotherapy and Fibromyalgia
Dr. Mary Lee Esty
Dr. Mary Lee Esty believes fibromyalgia (FMS) is misnamed because the dysfunction is in the brain, not in the muscle fibers. Trauma-induced changes in the central nervous system (CNS) perpetuate FMS symptoms. The CNS ability to filter and process signals is modified, leaving increased perception of pain. Dr. Esty has found that most FMS patients seen in her clinic have a history of mild or moderate brain trauma. When brain cells are damaged by physical or biochemical trauma, imbalances appear, regardless of the cause of damage. The first 2 grades of concussion do not involve loss of consciousness and many people remain unaware that they have sustained a concussion. Brain trauma is cumulative. Minor brain traumas through life can culminate in a variety of major dysfunctions. The majority of FMS patients have had brain trauma that is sufficient to affect functioning.
Improvements and enhancements to older equipment and treatment protocols have resulted in Neurosymmetries, a treatment device that can be used in treatment once or twice a week. In treatment the EEG signals are recorded through surface electrodes held on the scalp with a conductive paste by a standard EEG system that records brainwave activity while the gentle stimulation of Neurosymmetries is taking place. Neurosymmetries uses an invisible and imperceptible pulsed electromagnetic signal and direct current radiating to the scalp. Signal power is approximately the same as normal brainwave activity (a trillionth of a watt). During treatment the exposure length of stimulation is modified according to the specific needs and responses of the individual patient.
The initial evaluation includes a history, a brain map, and a treatment. The maps are painless measures of brain function that reveal EEG patterns. Imbalances in energy distribution are indicators of types of dysfunction and predictors of treatment response. In a healthy person, brain waves are relatively smooth. When healthy adults are awake the slower brain waves (1-4 cycles/second) should have relatively low power and be equal in energy and smoothness. EEG activity in FMS patients is excessive in the front of the head, indicating an imbalance consistent with energy, mood, restless mind, sleep, cognitive, loss of libido, dysautonomia, and pain problems. This inefficient energy state reflects the very real life problems of people with FMS. When the brain functions efficiently, effects of body therapies provide lasting results.
As the electroencephalogram (EEG) amplitudes begin to lower and to smooth, FMS patients experience a reduction of symptoms. Dr. Esty has found that patients with FMS are able to delete or reduce medications substantially. As FMS "fibrofog" lifts, some patients become aware of sharper, localized myofascial TrP pain. These TrPs are then treated with appropriate bodywork, and localized symptoms are relieved. The majority of people without chronic infection who complete EEG stimulation treatment have achieved virtual remission of FMS symptoms. The researchers found that some FMS patients concentrate with their eyes closed because this cuts down on sensory stimuli. This may be useful for us to remember in times of fibrofog. A study using one form of EEG stimulation, SyNAPs, is in progress in Flint, MI, with patients who have both FMS and myofascial pain.
EEG stimulation treatment is effective for traumatic brain injuries. Gentle stimulation "tickles" the brain and is thought to activate symptomatic change by enhancing neural plasticity, the capacity of the brain to change. Mechanisms that may be activated by this stimulation include increased blood flow, changes in glucose metabolism, stimulation of neuron healing, and a change in cell inhibitory/excitatory potentials.
For information contact Mary Lee Esty, Ph.D., LCSW-C, President of the Neurotherapy Center of Washington and Washington DC, 5480 Wisconsin Avenue, Suite 221, Chevy Chase, MD 301-652-7175, www.neurotherapycenters.com For video information, see www.fm-research.com
The Effect of EEG Neurofeedback Training in a Clinical Sample of Patients With Fibromyalgia
Earl Franklin Winter, PhD
Scope of Study: This study evaluated EEG neurofeed-back training (neurotherapy) as a possible treatment option for patients with fibromyalgia. The neurotherapy treatment protocol consisted of a sensing electrode placed on the midline of the head of the patient, directly over the sensory motor cortex. The training protocol required the patient to inhibit theta waves, augment SMR waves, and inhibit high beta waves in order for the patient to be rewarded. In addition, TOVA tests of variables of attention were administered to the patients after completion of every 10 sessions of neurotherapy.
Data was obtained from 15 fibromyalgia patients who received a minimum of 40 sessions of neurotherapy. The average number of sessions for the group was 58, with a range of 40-98 sessions. This treatment protocol was attempted only after other medical treatment protocols had failed to relieve patient symptoms.
Data from these 15 patients was compared to another group of 63 fibromyalgia patients who had not received EEG neurofeedback training. For that comparison group, symptoms changed very little: global pain decreased 6%, fatigue decreased 5%, anxiety increased 4%, and depression increased 3%.
Findings and Conclusions: This neurotherapy protocol appears to offer a significant improvement for patients with fibromyalgia: 93% felt improved, there was a 74% average reduction in tender point pain, a 39% average reduction in global pain, and a 40% average reduction in fatigue in amounts that were statistically significant. Also, there was a reduction in stiffness and mood/depression scores, but the amount was not statistically significant. In addition, the TOVA tests did not give results that were reliable as monitors of neurotherapy treatment progress.