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April 19,2ooo Newsletter

Chiari Malformation, Cervical Spinal Stenosis and Fibromyalgia

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Special Edition on Chiari Malformation, Cervical Spinal Stenosis and
Fibromyalgia. 

Dr. Lamb comments on the ABC 20/20 Television 
Program.

Many of our readers have asked for my opinion about the recent reports of
Chiari malformation, cervical spinal stenosis , fibromyalgia and fatigue
syndromes. It is estimated that there are ten million or more people in
North America suffering from a pain condition commonly named fibromyalgia
and/or chronic fatigue syndrome. 

Recently, on ABC News, Dr. Tim Johnson reported that a neurosurgical
procedure being performed on sufferers of fibromyalgia and chronic fatigue
had improved in their pain and fatigue. Dr. Rosner states that “ the
degree of disability you see in some people is way in excess of what you
see (on the scans). Unless you’re looking for this, or you have a high
degree of suspicion, you say there is nothing wrong with the patient.”
“Some doctors rely too much on scans and don’t do adequate physical exams.”

Dr. Charles Lapp, a Charlotte physician who specializes in treating
patients with CFS and Fibromyalgia, agreed there is “great potential”, but
claims he has seen patients relapse later after surgery.

Dr. Lamb’s Opinion

My first thoughts are of great excitement. Finally there is some medical
recognition of this problem called fibromyalgia. It has always been my
opinion that the major abnormality of most fibromyalgics is a compression
neuropathy, typically involving the cervical spine and other parts of the
spine. I suspect that the Chiari Malformation is present at birth but
that symptoms probably mostly occur in people after cervical spinal
compression from injury, repetitive work or progressive spinal
degeneration. Dr. Rosner emphasizes much upon cervical spinal stenosis and
less upon the actual Chiari malformation. 

I have seen high cervical lesions (C1 to C4) contribute to sleep
disruption, fatigue, headache, sinus congestion, vertigo and decreased
hearing. I have seen middle to low neck lesions (C4 to T1) contribute to
carpal tunnel syndrome, tennis elbow, golfer’s elbow, headache and sleep
disruption. Some of the explanation is directly obvious- that is a C5 to
C6 nerve root compression will cause pain and numbness radiating down into
the neck, shoulder, arm and forearm. Some of the explanation is a little
more perplexing- that is the exact neurology patterns of the human body
are a little more complicated than we have traditionally thought and may
sway slightly from strict dermatomes and straight forward nerve pathways.
For example, it seems that some of the cranial nerves in the brainstem may
derive part of their nerve supply from the cervical spine. Hence cervical
spondylosis may “refer” pain or dysfunction into a cranial nerve area
causing referred headache or even dysfunction such as vertigo.

I am excited, yet watchful of the surgical cervical decompression
procedure for fibromyalgia and like conditions. Historically, in the
sixties, we began operating on lower backs for back pain. Many individuals
have had back surgery and some had successes but many have had terrible
post-operative back pain. As a result, since the sixties, most surgeons
have greatly reduced their lower spinal surgeries and require strict
abnormalities on scanning before operating on the lower back. I suspect
cervical decompression surgery will develop similar guidelines eventually.

My final points are not on the treatment but on the prevention of
fibromyalgia and other pain syndromes. Early recognition of neuropathic
symptoms are sleep disruption, restless limbs, joint crepitus and
stiffness, minor limb numbness and tingling and itchy body parts,
especially at rest or bed-time. I have incorporated early recognition and
treatment into my practice and seminars and this has helped many from
progressing into a chronic pain syndrome.

For the complete commentary from Dr. Lamb, please go to
www.drlamb.com/chiari.htm.

Consult your doctor and keep long and strong.

G. Blair Lamb MD, C.C.F.P.
Pain and Rehabilitation Consultant
pain@drlamb.com
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The information contained in this newsletter is the opinion of Dr. G.
Blair Lamb M.D. C.C.F.P. and should not be used as personal medical
advice. Everyone is encouraged to see their own healthcare professional to
review what is best for them.  For further details, please visit
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