Fibromyalgia and Allyship in Herbal Care and Practice

Originally written in early 2013 while attending Wild Seed School of Herbal Studies located on Tsawout Territories, this piece focuses on the physiological, emotional and social aspects of approaching Fibromyalgia (and by extension, chronic pain) care from a clinical western herbalism perspective. Included are thoughts and considerations for all care providers, friends, family, and community members when interacting with folks living with Fibromyalgia and chronic pain, as well as starting points for discussion surrounding the reader's personal relationship to wildcrafting medicines on Turtle Island, and engaging in the practice of traditional medicines in a general context. We all come to herbal medicine and form relationships to plants and the land from various experiences. May we be thoughtful of our privileges and our intersecting his/herstories on this land as we strive to provide wellness care and in our community/s.

Contained in this writing are profiles of plants that can be used as allies for folks living with Fibromyalgia. Much plant usage information written here comes from the years of clinical experience held by herbalist, teacher, and mentor, Jasmyn Clift

*Please consult your health care provider before introducing any medicines into your wellness routine.*


 

Fibromyalgia

  

Fibro- “fibrous tissues” (Latin)

Myo- “muscle” (Greek)

Algos- “pain” (Greek) 

Fibromyalgia: Muscle and connective tissue pain

 


What is Fibromyalgia?
 

Fibromyalgia is a syndrome* and/or dis/ease** characterized by, yet not limited to, chronic and widespread musculoskeletal pain and allodynia (which is a heightened and painful response to pressure). Other symptoms such as fatigue, sleep disturbances, joint stiffness, difficulty swallowing, bowel and bladder abnormalities, numbness and tingling and cognitive dysfunction occur as well. Folks with fibromyalgia often are also living with depression, anxiety, and/or stress-related disorders such as post traumatic stress disorder. Not everyone with Fibromyalgia experiences the same collection of symptoms.

 Biomedicine states that its exact cause is unknown, but believe that there are psychological, genetic, neurobiological and environmental factors. Research has found that fibromyalgia amplifies painful sensations by affecting the way your brain and spinal cord process pain signals, and that there are physiological and neurochemical actions taking place. Folks may notice their symptoms beginning after a physical trauma, surgery, infection or marked psychological stress. In other cases, symptoms gradually accumulate over time with no single triggering event.

Both historically, and to some degree, currently, there has been a slow progression towards considering Fibromyalgia as “real”. Many folks living with Fibromyalgia have been told that their symptoms are “in their heads”, imagined, purely psychosomatic, or that there is no known cause for their complaints. While today's research (and therefore current biomedical thought) confirms that this is a “real” syndrome/dis/ease, many people still hold previous mindsets.

*Syndrome: a group of symptoms that consistently occur together or a condition characterized by a set of associated symptoms.
** Some may self-identify


BIOMEDICINE centers their Fibromyalgia diagnoses on these  two criteria:
 

             1.)    Widespread pain occurring in all four quadrants of the body for at least three months

2.)    Pain is felt when pressure is applied to at least eleven out of eighteen tender points

These eighteen tender points (see diagram) are found concentrated around the neck, head, shoulders and collarbone, as well as the hips and lower back, elbows, and knees. For those with Fibromyalgia, pain is felt when just enough pressure is applied with one's finger tips to “blanch the nailbed” (cause it to turn white) when pressed against these tender points.
 

Tender points are found along these sites on the body: the inner knee, the side of the hip, where the top of the hip meets the small of the back, the shoulder blades, the top of the shoulders, the elbows, the collarbone, as well as the top and side of the neck.

Tender points are found along these sites on the body: the inner knee, the side of the hip, where the top of the hip meets the small of the back, the shoulder blades, the top of the shoulders, the elbows, the collarbone, as well as the top and side of the neck.


Tender Points and Trigger Points:
 

 Concerning fibromyalgia, tender points are the 18 specific locations on the body where when pressure is applied, pain is felt at the location of the isolated tender point. Trigger points are also tender points, however when pressure is applied pain is felt not only in the location of the trigger point, but is referred to elsewhere in the body as well, often described as shooting pain.

         Sometimes a tender point is simply a tender point: pain is felt solely at the site of the tender point
         Tender points can also be trigger points.
         Trigger points are always tender points: pain is felt at the site of the trigger point + referred pain is felt throughout the body    

Ninety percent of the eighteen tender points are also myofascial trigger points (MYO is muscle: FASCIA is the connective tissue that holds us together). Myofascial trigger points are nodules within bands of rope like muscles, otherwise described as “... hyper irritable spots in skeletal muscle that are associated with palpable nodules in taut bands of muscle fibers.”


Common Fibromyalgia Symptoms
 

•         Pain
      ◦         Often described as a deep, throbbing ache, a shooting or stabbing sensation, or intense burning pain.
      ◦         Muscles /muscle groups which are used more frequently often are most affected
  
•         Fatigue
      ◦         Exhaustion
      ◦      “Limbs weighted down as though concrete blacks were attached”
      ◦      Drained of energy to the point of everyday tasks ranging from difficult to unmanageable

•         Sleep Difficulties
      ◦         Repeat arousals preventing one from achieving a deep, restorative sleep
      ◦         Described as “non-restorative sleep” as folks often awaken feeling as though they had not slept at all

•         Brain Fog/Fibro Fog
      ◦         Concentration and memory are affected
      ◦         Trouble with “word-finding” and retaining new information
      ◦         Brain/Fibro Fog symptoms often increase in tandem with pain levels

•         Morning Stiffness
      ◦         Increased muscle soreness and stiffness is often seen upon awakening

•         Muscle Knots, Cramping, Weakness
      ◦         Myofascial trigger points can lead to muscle weakness and cramping
      ◦         The pain of fibromyalgia itself may lead to muscle weakness

•         Digestive Disorders
      ◦         Constipation, diarrhea, abdominal pain, etc. are found in 40-70% of folks living with Fibromyalgia
      ◦         Also common: Acid reflex and slowed digestion.

•         Headaches, Migraines
      ◦         50-70% of folks experience severe tension headaches, often multiple times per week
      ◦      Most headaches have a migraine component.

•         Balance Problems 
      ◦         Walking patterns tend to be adjusted, and therefore decreased balance can occur
      ◦         Falls may be more likely for some individuals

•         Itchy/Burning Skin
      ◦         Itchy, red bumps that are similar to hives may occur
      ◦         Burning pain, similar to a sunburn is not uncommon

•         Sensory Related Symptoms- “Sensory Overload”
      ◦         Sensitivity to sounds, odours, tastes, or bright lights
      ◦         Dry/burning eyes, burning skin
      ◦         Numbness, tingling, and/or swelling sensations in limbs.
 


Who develops Fibromyalgia/Who receives a Fibromyalgia diagnosis?
 

It is estimated that 2-4% of the population has fibromyalgia with a 9:1 female (sex) to male (sex) incidence ratio. Hormones have been theorized by some as a reason for this occurrence.

•         Age as a Factor:
      ◦         Diagnosis often occurs between the ages of 20-55, though elderly folks can develop Fibromyalgia as well
      ◦         It is possible for children to develop Fibromyalgia, however, due to its pattern of slower onset, diagnosis in children is rare

•         Genetics as a Factor:
      ◦         Female sex folks, with a close relative living with Fibromyalgia and also of female sex, are more likely to develop                                   Fibromyalgia

•         Those with Lupus, Osteoarthritis, Ankylosing Spondylitis, and sleep disorders can be at a higher risk for developing                               Fibromyalgia

•         Post-traumatic Fibromyalgia:
      ◦         Fibromyalgia can occur after a physical trauma
      ◦         Typically pain begins in the neck, head, and/or shoulder reign
      ◦         Medication, physiotherapy, among other treatments does not dissipate the pain
      ◦         Pain increases, and tender points develop alongside other Fibromyalgia symptoms


Points to consider as an herbalist providing care:
 

•         The gendering of Fibromyalgia:
       ◦         Why are instances of Fibromyalgia higher among folks who are female and/or have been socialized as female?
       ◦         Does patriarchy, cissexism*, mothering work, and capitalism interact with Fibromyalgia? If so, how?
            ▪         If yes, how do we disrupt/resist/unlearn this as care providers?
            ▪         How might Fibromyalgia affect mothering/reproductive work? Consider breastfeeding, single mother parenting, care of                                           both young and older children, financial concerns, etc.
            ▪         Does capitalism influence how we view ability?

•       The history of Fibromyalgia as an unrecognised dis/ease and biomedicine as prominent health culture:
        ◦      Whose voices holds power, and how those voices shape folks access to care, and the care that they may/may not receive?
        ◦         How does this culture affect the way we experience, view, and care for our bodies, minds and health?
        ◦         Does this culture affect the way that families, friends, care providers and communities of those living with                                                                    Fibromyalgia perceive their lived experiences with their pain, fatigue and ability stemming from their Fibromyalgia?
             ▪         If so, how do we move towards allyship* as friends, family members, care providers, and/or community membe

•         Mental Health is often affected by Fibromyalgia:
        ◦         Can this be cyclic? Is there a connection between living with chronic pain and mental health?         
        ◦         How do we provide full spectrum care and support as herbalists? As friends, family members, mentors,                                                                   and community members?
 

*Cissexism refers to beliefs and behaviours influenced by the idea that those who are transgender, non gendered, twospirit, gender variant or gender queer are inferior to those who are cisgendered. Cisgender describes a gender identity where an individual's self-identity and experience of their gender matches the sex they were assigned at birth

*Allyship/Ally: “An ally works to end a form of oppression from which they receive privilege. Allies align themselves with the people over whom they hold privilege and work to dismantle the system of oppression that gives them those privileges.” Allyship/being an ally is something you do, not something you are. It is an active set of behaviours, words, and thought patterns, not an identity.


A Brief Primer of Herbal Allies for Fibromyalgia

 

  •  Hypericum perforatum (St. John's Wort)
    •         “Tincture...not capsules, not the tea - is a powerful ally for women with fibromyalgia. It is one of the best muscle relaxers I have ever used. A 25-30 drop dose not only stops but also prevents muscle aches. I have used it as frequently as every twenty minutes (for ten doses) when the occasion has necessitated it.” (Susan S. Weed)
    •         Topical pain relief in combination with Populus balsamifera as an oil. 
    •         Depression and topical/internal uses for pain, helps change relationship to pain. 
     
  • Urtica dioica (Nettle) and Avena sativa (Oat straw)
    •         “Magnesium is a critical nutrient for preventing pain in muscles and connective tissues. Legumes, whole grains, leafy greens and nourishing herbal infusions - like nettle and oatstraw - are the best sources.” (Susan S. Weed)
     
  • Populus balsamifera (Balsam Poplar, Cottonwood)
    •         “The salicylates, relatives of aspirin found in Balsam Poplar act topically as anti-inflammatory agents; and the aromatic resins act as vasodilators, antimicrobial and stimulants to skin proliferations...It is helpful for pain from inflammation or congestion (hot or cold)...a simple, reliable, and predictable pain and swelling treatment.” (Michael Moore) 
     
  • Pedicularus spp. (Betony)
    •         “By itself, it is one of our safest and most effective skeletal muscle relaxants...if muscle twitches jolt you awake when you are trying to sleep, try Betony.” (Michael Moore)
    •         Preventative. In general, knocks down pain/irritability levels.
     

  • Melissa officinalis (Lemon Balm)
    •        Restorative  
    •        To deepen and improve the quality  sleep
    •      To elevate mood
     

  • Passiflora spp. (Passion Flower)
    •        To change your relationship to pain, particularly concerning musculoskeletal pain   
    •      Classic sedative for latent insomnia   

  • Eschscholtzia californica (California Poppy)
     •         Pain: tonic or acute
     •         Insomnia: particularly when kept awake by pain
     •         Slight opioid effect
     •         Can potentate opiates by 10-15%
     
  • Ginkgo biloba (Ginkgo)
     •         Fibrofog
     •         Ongoing dose as a preventative
     
  • Ocimum sacrum (Tulsi, Holy Basil)
     •         Fibrofog
     •         To deepen sleep
     •         Essential oil for muscle aches

Herbal Care and wildcrafting on turtle island:

 

•         Whose voices hold power? Who holds knowledge, traditional or otherwise, and to whom is it accessible to? Concerning herbal medicine, who shapes narratives and holds influence over academic information, current standards and practices, and who forms “the norm” concerning avenues in which we attain knowledge?

•         Given our own individual and collective experiences, herstories and histories, how do we interact with both Turtle Island's colonial past and present? What does our personal relationship to the land look like, and how does that intersect with others?

•         What does decolonization look like in our everyday lives? In terms of herbal medicine? In terms of relationships between indigenous folks, people of colour settlers, mixed heritage folks, and/or white settlers? In terms of migration and access to land?

•         How does colonization affect health and wellness of ours' and others' communities? To whom is herbal medicine accessible to? As herbalists and care providers, what are our roles and responsibilities?

•         As herbalists and wildcrafters, who do we take leadership from? Who are our mentors? What are their relationships to the plants? To the land? If not of the indigenous community where they wildcraft, what is their relationship to that community?

•         Does capitalism affect our relationship to land? Do settlers/migrants have responsibilities to the land and/or indigenous communities/people where they wildcraft?

•         Can medicine and health practices be appropriated? In a global context, what happens when folks who hold power over another community, culture, nation or people practice the marginalized group's medicine? What does transnational solidarity look like in terms of herbal medicine?