Positional cervical compression and fibromyalgia – a possible connection
Positional cervical (neck) compression, or PC3, as a possible primary cause of fibromyalgia
I wrote this article for ProHealth Magazine a few years ago, but they’ve recently overhauled their publication and deleted it. I thought I’d go ahead and freshen it up for re-posting here.
Fibromyalgia is one of those diagnoses that can leave patients confused as to the root cause of their symptoms, in which case any clue as to possible underlying causes may be welcome! Positional cervical compression is one possible root cause. As an aside, Lyme disease can also be an underlying cause of fibromyalgia and neck pain. Make sure you choose a doctor willing to go the distance to help you find the real root cause.
Fibromyalgia affects mostly women
Maya Dusenbery writes in Doing Harm, The Truth About How Bad Medicine and Lazy Science Leave Women Dismissed, Misdiagnosed and Sick, that many diseases that affect primarily women have been considered “purely psychological” by medicine, just because the physical origins of the conditions aren’t yet understood. As medicine and diagnostic ability evolve, the origins of seemingly psychological conditions become apparent, treatments are developed, and patients’ complaints are more validated – especially when the patients are women.
Fibromyalgia – a condition causing chronic musculoskeletal pain as well as fatigue, sleep disturbances, and issues with memory and mood – may be one of these conditions. It affects primarily women: according to the National Fibromyalgia Association, 75% to 90% of fibromyalgia patients are female. And, before the 1990s, fibromyalgia was widely believed to be a psychological phenomenon, with no organic, physical cause.
Recent evolution in fibromyalgia diagnosis
In 1990, the American College of Rheumatology Research Classification Criteria (ACR RCC) for fibromyalgia was published, giving criteria for fibromyalgia diagnosis for the first time. In order to receive a diagnosis of fibromyalgia, a patient needed to report widespread pain for at least 3 months, and to present at least 11 of 18 tender, soft tissue trigger points.
Later in the 1990s, causative factors were proposed, including a hyper-functional autonomic nervous system, which could trigger tachycardia, fatigue, insomnia, depression, hyperthermia, and widespread pain. At this point, the necessity of displaying specific painful trigger points was discarded.
In the last few years, research initially presented by neurosurgeon Dan Heffez has convinced some doctors that fibromyalgia may not be a primary condition at all, but rather a secondary condition. Dr. Heffez posited that in significant numbers of fibromyalgia cases, both autonomic hyper-function and its resulting symptoms, including widespread pain, can be caused by positional compression of the cervical spinal cord (referring to the spinal cord within the 7 vertebrae of the neck), or PC3.
What is positional cervical compression (PC3)
Positional cervical compression occurs when parts of the spinal cord in the neck are compressed in certain positions. In cases of PC3, the cervical spinal cord is most often compressed during neck extension, when the patient tilts their head backward, say, to look up at the sky. In cases of PC3, a number of structures can compress the cervical cord when the neck is in extension, including displaced discs from trauma or degenerative disc disease, an injured ligamentum flavum (a series of ligaments connecting vertebral lamina close to the spinal cord), or the Chiari 1 malformation (a congenital disorder that compresses brain and spinal cord structures).
Dr. Heffez believes PC3 has been overlooked as a possible cause of fibromyalgia due to the fact that diagnositc MRIs are almost always taken with the cervical spine in a neutral position. In order to see PC3 in an MRI, the neck has to be in positions other than neutral; primarily in extension. (There are many examples comparing cervical MRIs in different positions online.)
Symptoms of PC3
PC3 causes widespread, referred pain, due to the compression of the cervical cord. This pain is typically worse when the neck is in extension. Dr. Andrew Holman writes that many fibromyalgia patients find extending their necks very painful – noticed in situations such as getting their hair washed at a salon, or riding a bicycle (non-recumbent).
Light or intermittent pressure on the cervical cord can cause changes in blood pressure and heart rate – in other words, can affect the autonomic nervous system, or ANS. Similar pressure on the thoracic or lumbar cord does not have the same effect. Some doctors believe that PC3 could contribute to the hyper-function of the ANS seen in fibromyalgia patients, contributing to insomnia, tachycardia, hyperthermia, depression, poor balance, neurological symptoms, and fatigue. (All of these symptoms will sound awfully familiar to people healing Lyme disease as well.)
Testing for PC3
Unfortunately, MRI imaging of the spine in multiple positions is expensive, and still unlikely to be reimbursed by most insurance companies. This is the primary reason PC3 has been overlooked as a possible cause of fibromyalgia – the necessary images just weren’t taken. However, if you suspect PC3 may have bearing on your symptoms, discuss a diagnosis with your doctor. They may be able to request the necessary MRIs, or to diagnose you clinically.
Physical therapy or surgery can both help resolve pain from PC3
Some clinics have developed physical therapy programs to treat PC3. Dr. Andrew J. Holman writes that clinics in Seattle and Portland have physical therapy programs that first aim to improve proprioception (the awareness of where the body is in space), and second to stabilize and support the ligamentum flavum in the cervical spine. According to Holman, success is determined in part by how narrow the cervical spinal canal is in PC3 patients. If the canal is too narrow (from 4-6mm), patients typically respond better to surgery. If you have a diagnosis of PC3 and can’t access a physical therapy clinic that specializes in it, you may have success with a good Pilates teacher well trained in anatomy. Many Pilates exercises focus on strengthening the core muscles of the neck, which in turn support deep ligaments.
PC3 in conclusion
Dr. Forest Tenant writes in Practical Pain Management that fully two-thirds of his fibromyalgia patients have PC3. The last third developed fibromyalgia either after an infectious disease (often mononucleosis), head trauma, a peripheral nerve injury, or endometriosis. In all cases, he believes fibromyalgia to be a secondary diagnosis, and treats his patients accordingly. If none of these underlying diagnoses feel right to you, be sure to test for Lyme disease as well.
These developments are heartening for people, mostly women, suffering from fibromyalgia – who may have felt dismissed and condescended to by previous doctors (again, an experience very familiar to Lyme patients as well). Talk to your doctor about possible primary causes of fibromyalgia, and be sure they help you research treatment options accordingly. A good doctor will look below the surface, and find solutions that work for you personally. These doctors can be hard to come by, but are worth their weight in gold.
Thank you for reading!
You are a star in the vast sky,
Shona
Sources:
Andrew J. Holman, M.D. Why You Should Be Thinking About Positional Cervical Cord Compression. Fibromyalgia Frontiers. 2012 (Volume 20, Number 2)
Maya Dusenbery. Doing Harm: The Truth about How Bad Medicine and Lazy Science Leave Women Dismissed, Misdiagnosed, and Sick. 2018 March, New York. Harper Collins Publisher.
Forest Tennant, MD, DrPH. Editor's Memo: Fibromyalgia: Time To Be a Secondary Diagnosis? Practical Pain Management. 2014, May 30.
Sarkozi J. Fibromyalgia, chronic widespread pain, and the fallacy of pain from nowhere. Practical Pain Management. 2011;11(1):74-77.
Holman AJ. Using dynamic MRI to diagnose neck pain: the importance of
positional cervical cord compression (PC3). Practical Pain Management. 2012;12(11):51-55.