Hacking the nervous system

http://mosaicscience.com/story/hacking-nervous-system

One nerve connects your vital organs, sensing and shaping your health. If we learn to control it, the future of medicine will be electric. By Gaia Vince.

 

When Maria Vrind, a former gymnast from Volendam in the Netherlands, found that the only way she could put her socks on in the morning was to lie on her back with her feet in the air, she had to accept that things had reached a crisis point. “I had become so stiff I couldn’t stand up,” she says. “It was a great shock because I’m such an active person.”

It was 1993. Vrind was in her late 40s and working two jobs, athletics coach and a carer for disabled people, but her condition now began taking over her life. “I had to stop my jobs and look for another one as I became increasingly disabled myself.” By the time she was diagnosed, seven years later, she was in severe pain and couldn’t walk any more. Her knees, ankles, wrists, elbows and shoulder joints were hot and inflamed. It was rheumatoid arthritis, a common but incurable autoimmune disorder in which the body attacks its own cells, in this case the lining of the joints, producing chronic inflammation and bone deformity.
Waiting rooms outside rheumatoid arthritis clinics used to be full of people in wheelchairs. That doesn’t happen as much now because of a new wave of drugs called biopharmaceuticals – such as highly targeted, genetically engineered proteins – which can really help. Not everyone feels better, however: even in countries with the best healthcare, at least 50 per cent of patients continue to suffer symptoms.

Like many patients, Vrind was given several different medications, including painkillers, a cancer drug called methotrexate to dampen her entire immune system, and biopharmaceuticals to block the production of specific inflammatory proteins. The drugs did their job well enough – at least, they did until one day in 2011, when they stopped working.

“I was on holiday with my family and my arthritis suddenly became terrible and I couldn’t walk – my daughter-in-law had to wash me.” Vrind was rushed to hospital, where she was hooked up to an intravenous drip and given another cancer drug, one that targeted her white blood cells. “It helped,” she admits, but she was nervous about relying on such a drug long-term.

Luckily, she would not have to. As she was resigning herself to a life of disability and monthly chemotherapy, a new treatment was being developed that would profoundly challenge our understanding of how the brain and body interact to control the immune system. It would open up a whole new approach to treating rheumatoid arthritis and other autoimmune diseases, using the nervous system to modify inflammation. It would even lead to research into how we might use our minds to stave off disease.
And, like many good ideas, it came from an unexpected source.

The nerve hunter

Kevin Tracey, a neurosurgeon based in New York, is a man haunted by personal events – a man with a mission. “My mother died from a brain tumour when I was five years old. It was very sudden and unexpected,” he says. “And I learned from that experience that the brain – nerves – are responsible for health.” This drove his decision to become a brain surgeon. Then, during his hospital training, he was looking after a patient with serious burns who suddenly suffered severe inflammation. “She was an 11-month-old baby girl called Janice who died in my arms.”

These traumatic moments made him a neurosurgeon who thinks a lot about inflammation. He believes it was this perspective that enabled him to interpret the results of an accidental experiment in a new way.
In the late 1990s, Tracey was experimenting with a rat’s brain. “We’d injected an anti-inflammatory drug into the brain because we were studying the beneficial effect of blocking inflammation during a stroke,” he recalls. “We were surprised to find that when the drug was present in the brain, it also blocked inflammation in the spleen and in other organs in the rest of the body. Yet the amount of drug we’d injected was far too small to have got into the bloodstream and travelled to the rest of the body.”

After months puzzling over this, he finally hit upon the idea that the brain might be using the nervous system – specifically the vagus nerve – to tell the spleen to switch off inflammation everywhere.
It was an extraordinary idea – if Tracey was right, inflammation in body tissues was being directly regulated by the brain. Communication between the immune system’s specialist cells in our organs and bloodstream and the electrical connections of the nervous system had been considered impossible. Now Tracey was apparently discovering that the two systems were intricately linked.

The first critical test of this exciting hypothesis was to cut the vagus nerve. When Tracey and his team did, injecting the anti-inflammatory drug into the brain no longer had an effect on the rest of the body. The second test was to stimulate the nerve without any drug in the system. “Because the vagus nerve, like all nerves, communicates information through electrical signals, it meant that we should be able to replicate the experiment by putting a nerve stimulator on the vagus nerve in the brainstem to block inflammation in the spleen,” he explains. “That’s what we did and that was the breakthrough experiment.”

The wandering nerve

Ups and downs in the nervous system The vagus nerve starts in the brainstem, just behind the ears. It travels down each side of the neck, across the chest and down through the abdomen. ‘Vagus’ is Latin for ‘wandering’ and indeed this bundle of nerve fibres roves through the body, networking the brain with the stomach and digestive tract, the lungs, heart, spleen, intestines, liver and kidneys, not to mention a range of other nerves that are involved in speech, eye contact, facial expressions and even your ability to tune in to other people’s voices. It is made of thousands and thousands of fibres and 80 per cent of them are sensory, meaning that the vagus nerve reports back to your brain what is going on in your organs.

Operating far below the level of our conscious minds, the vagus nerve is vital for keeping our bodies healthy. It is an essential part of the parasympathetic nervous system, which is responsible for calming organs after the stressed ‘fight-or-flight’ adrenaline response to danger. Not all vagus nerves are the same, however: some people have stronger vagus activity, which means their bodies can relax faster after a stress.

The strength of your vagus response is known as your vagal tone and it can be determined by using an electrocardiogram to measure heart rate. Every time you breathe in, your heart beats faster in order to speed the flow of oxygenated blood around your body. Breathe out and your heart rate slows. This variability is one of many things regulated by the vagus nerve, which is active when you breathe out but suppressed when you breathe in, so the bigger your difference in heart rate when breathing in and out, the higher your vagal tone.

Research shows that a high vagal tone makes your body better at regulating blood glucose levels, reducing the likelihood of diabetes, stroke and cardiovascular disease. Low vagal tone, however, has been associated with chronic inflammation. As part of the immune system, inflammation has a useful role helping the body to heal after an injury, for example, but it can damage organs and blood vessels if it persists when it is not needed. One of the vagus nerve’s jobs is to reset the immune system and switch off production of proteins that fuel inflammation. Low vagal tone means this regulation is less effective and inflammation can become excessive, such as in Maria Vrind’s rheumatoid arthritis or in toxic shock syndrome, which Kevin Tracey believes killed little Janice.

Having found evidence of a role for the vagus in a range of chronic inflammatory diseases, including rheumatoid arthritis, Tracey and his colleagues wanted to see if it could become a possible route for treatment. The vagus nerve works as a two-way messenger, passing electrochemical signals between the organs and the brain. In chronic inflammatory disease, Tracey figured, messages from the brain telling the spleen to switch off production of a particular inflammatory protein, tumour necrosis factor (TNF), weren’t being sent. Perhaps the signals could be boosted?

He spent the next decade meticulously mapping all the neural pathways involved in regulating TNF, from the brainstem to the mitochondria inside all our cells. Eventually, with a robust understanding of how the vagus nerve controlled inflammation, Tracey was ready to test whether it was possible to intervene in human disease.

Stimulating trial

In the summer of 2011, Maria Vrind saw a newspaper advertisement calling for people with severe rheumatoid arthritis to volunteer for a clinical trial. Taking part would involve being fitted with an electrical implant directly connected to the vagus nerve. “I called them immediately,” she says. “I didn’t want to be on anticancer drugs my whole life; it’s bad for your organs and not good long-term.”

Tracey had designed the trial with his collaborator, Paul-Peter Tak, professor of rheumatology at the University of Amsterdam. Tak had long been searching for an alternative to strong drugs that suppress the immune system to treat rheumatoid arthritis. “The body’s immune response only becomes a problem when it attacks your own body rather than alien cells, or when it is chronic,” he reasoned. “So the question becomes: how can we enhance the body’s switch-off mechanism? How can we drive resolution?”

When Tracey called him to suggest stimulating the vagus nerve might be the answer by switching off production of TNF, Tak quickly saw the potential and was enthusiastic to see if it would work. Vagal nerve stimulation had already been approved in humans for epilepsy, so getting approval for an arthritis trial would be relatively straightforward. A more serious potential hurdle was whether people used to taking drugs for their condition would be willing to undergo an operation to implant a device inside their body: “There was a big question mark about whether patients would accept a neuroelectric device like a pacemaker,” Tak says.
He needn’t have worried. More than a thousand people expressed interest in the procedure, far more than were needed for the trial. In November 2011, Vrind was the first of 20 Dutch patients to be operated on.
“They put the pacemaker on the left-hand side of my chest, with wires that go up and attach to the vagus nerve in my throat,” she says. “I waited two weeks while the area healed, and then the doctors switched it on and adjusted the settings for me.”

She was given a magnet to swipe across her throat six times a day, activating the implant and stimulating her vagus nerve for 30 seconds at a time. The hope was that this would reduce the inflammatory response in her spleen. As Vrind and the other trial participants were sent home, it became a waiting game for Tracey, Tak and the team to see if the theory, lab studies and animal trials would bear fruit in real patients. “We hoped that for some, there would be an easing of their symptoms – perhaps their joints would become a little less painful,” Tak says.

At first, Vrind was a bit too eager for a miracle cure. She immediately stopped taking her pills, but her symptoms came back so badly that she was bedridden and in terrible pain. She went back on the drugs and they were gradually reduced over a week instead.

And then the extraordinary happened: Vrind experienced a recovery more remarkable than she or the scientists had dared hope for.

“Within a few weeks, I was in a great condition,” she says. “I could walk again and cycle, I started ice-skating again and got back to my gymnastics. I feel so much better.” She is still taking methotrexate, which she will need at a low dose for the rest of her life, but at 68, semi-retired Vrind now plays and teaches seniors’ volleyball a couple of hours a week, cycles for at least an hour every day, does gymnastics, and plays with her eight grandchildren.

Other patients on the trial had similar transformative experiences. The results are still being prepared for publication but Tak says more than half of the patients showed significant improvement and around one-third are in remission – in effect cured of their rheumatoid arthritis. Sixteen of the 20 patients on the trial not only felt better, but measures of inflammation in their blood also went down. Some are now entirely drug-free. Even those who have not experienced clinically significant improvements with the implant insist it helps them; nobody wants it removed.

“We have shown very clear trends with stimulation of three minutes a day,” Tak says. “When we discontinued stimulation, you could see disease came back again and levels of TNF in the blood went up. We restarted stimulation, and it normalised again.”

Tak suspects that patients will continue to need vagal nerve stimulation for life. But unlike the drugs, which work by preventing production of immune cells and proteins such as TNF, vagal nerve stimulation seems to restore the body’s natural balance. It reduces the over-production of TNF that causes chronic inflammation but does not affect healthy immune function, so the body can respond normally to infection.
“I’m really glad I got into the trial,” says Vrind. “It’s been more than three years now since the implant and my symptoms haven’t returned. At first I felt a pain in my head and throat when I used it, but within a couple of days, it stopped. Now I don’t feel anything except a tightness in my throat and my voice trembles while it’s working.

“I have occasional stiffness or a little pain in my knee sometimes but it’s gone in a couple of hours. I don’t have any side-effects from the implant, like I had with the drugs, and the effect is not wearing off, like it did with the drugs.”

Raising the tone

A nervy way to lose weight Having an electrical device surgically implanted into your neck for the rest of your life is a serious procedure. But the technique has proved so successful – and so appealing to patients – that other researchers are now looking into using vagal nerve stimulation for a range of other chronic debilitating conditions, including inflammatory bowel disease, asthma, diabetes, chronic fatigue syndrome and obesity.

But what about people who just have low vagal tone, whose physical and mental health could benefit from giving it a boost? Low vagal tone is associated with a range of health risks, whereas people with high vagal tone are not just healthier, they’re also socially and psychologically stronger – better able to concentrate and remember things, happier and less likely to be depressed, more empathetic and more likely to have close friendships.

Twin studies show that to a certain extent, vagal tone is genetically predetermined – some people are born luckier than others. But low vagal tone is more prevalent in those with certain lifestyles – people who do little exercise, for example. This led psychologists at the University of North Carolina at Chapel Hill to wonder if the relationship between vagal tone and wellbeing could be harnessed without the need for implants.

In 2010, Barbara Fredrickson and Bethany Kok recruited around 70 university staff members for an experiment. Each volunteer was asked to record the strength of emotions they felt every day. Vagal tone was measured at the beginning of the experiment and at the end, nine weeks later. As part of the experiment, half of the participants were taught a meditation technique to promote feelings of goodwill towards themselves and others.

Those who meditated showed a significant rise in vagal tone, which was associated with reported increases in positive emotions. “That was the first experimental evidence that if you increased positive emotions and that led to increased social closeness, then vagal tone changed,” Kok says.

Now at the Max Planck Institute in Germany, Kok is conducting a much larger trial to see if the results they found can be replicated. If so, vagal tone could one day be used as a diagnostic tool. In a way, it already is. “Hospitals already track heart-rate variability – vagal tone – in patients that have had a heart attack,” she says, “because it is known that having low variability is a risk factor.”

The implications of being able to simply and cheaply improve vagal tone, and so relieve major public health burdens such as cardiovascular conditions and diabetes, are enormous. It has the potential to completely change how we view disease. If visiting your GP involved a check on your vagal tone as easily as we test blood pressure, for example, you could be prescribed therapies to improve it. But this is still a long way off: “We don’t even know yet what a healthy vagal tone looks like,” cautions Kok. “We’re just looking at ranges, we don’t have precise measurements like we do for blood pressure.”

Bioelectric dreams What seems more likely in the shorter term is that devices will be implanted for many diseases that today are treated by drugs: “As the technology improves and these devices get smaller and more precise,” says Kevin Tracey, “I envisage a time where devices to control neural circuits for bioelectronic medicine will be injected – they will be placed either under local anaesthesia or under mild sedation.”

However the technology develops, our understanding of how the body manages disease has changed for ever. “It’s become increasingly clear that we can’t see organ systems in isolation, like we did in the past,” says Paul-Peter Tak. “We just looked at the immune system and therefore we have medicines that target the immune system.

“But it’s very clear that the human is one entity: mind and body are one. It sounds logical but it’s not how we looked at it before. We didn’t have the science to agree with what may seem intuitive. Now we have new data and new insights.”

And Maria Vrind, who despite severe rheumatoid arthritis can now cycle pain-free around Volendam, has a new lease of life: “It’s not a miracle – they told me how it works through electrical impulses – but it feels magical. I don’t want them to remove it ever. I have my life back!”


This story first appeared on Mosaic and is republished here under a Creative Commons licence.

Fibromyalgia and Meningeal Compression, Dr Paul Whitcomb

https://whitcombpaul.wordpress.com/2012/12/27/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.

2. 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.

3. 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.

4. 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.

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