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Fibromyalgia

Introduction

What should I know about Fibromyalgia?

If you find yourself confused about fibromyalgia, you are not alone. Patients, physicians, and researchers alike have been perplexed by this complex condition. Even as few as ten years ago, there was little discussion about this syndrome within the medical community. With the wide array of symptoms associated with it, fibromyalgia was often confused with the symptoms which accompanied it, and consequently was misdiagnosed or thought to be "in the mind." Today science has recognized fibromyalgia as a rheumatic autoimmune disorder affecting between 3 and 6 million Americans each year. What was once thought of a psychosomatic complaint has turned out to be a complex disorder which is only now beginning to be understood.

Your health care professional may use other names for this condition including fibromyositis, fibrositis, periarticular fibrositis, muscular rheumatism, chronic muscle pain syndrome, musculoskeletal pain syndrome, and tension myalgia. However, fibromyalgia, which means pain of the muscles and other fibrous tissue, is now the acknowledged term. It is now accepted that the following two criteria must be met for a diagnosis of fibromyalgia: widespread musculoskeletal pain in all four quadrants of the body for at least three months duration, in combination with tenderness at 11 or more of the 18 specific "tender point" sites. (1)

What causes this disorder? We simply do not know yet. However, the medical community has begun to develop theories about how certain life events can act as triggers which somehow relate to its onset. While these triggers do not necessarily cause fibromyalgia, it is thought that they might somehow awaken some underlying abnormality which then leads to the onset of the disorder. Some of these triggers include such things as infections and physical traumas like an automobile accident. Illnesses such as lupus, "leaky gut" syndrome, and rheumatoid arthritis are being looked at as possible triggers as well.

Part of the confusion over fibromyalgia is that it mimics, or looks like, many other diseases or conditions. That is why, in the past, it was so often misdiagnosed. For years, the diagnosis of fibromyalgia was difficult because objective signs, such as inflammation and joint deformity, are not associated with the condition. In fact, many clinicians initially thought that fibromyalgia was a psychiatric illness. Today, several well-designed studies have disproved this theory. (2) , (3) Fibromyalgia is now accepted as a physical illness.

Other conditions that may commonly mimic, or look like, fibromyalgia include hypothyroidism, lupus, Lyme disease, rheumatoid arthritis, and infections. We now know that there is a very close relationship between fibromyalgia and chronic fatigue syndrome. (4) Still again, some patients have absolutely no underlying or related disorder. No wonder this condition is so difficult to diagnose with absolute certainty!

The good news is that medical science is taking this disorder seriously now. That means that there will be more studies conducted which will give us some of the answers to the complexity of this condition. Studies published in medical journals offer information to the healthcare professional which assist them in making diagnostic and treatment decisions. In the meantime, there are lifestyle and nutritional changes that patients with fibromyalgia may make which may help with the many symptoms associated with FM. Listed below is information which covers what has been reported in these journals about how to treat FM. This information is useful for the patient and healthcare professional alike and covers both conventional and alternative treatments.

Connection to "Leaky Gut" Syndrome: Epidemiological studies have confirmed that patients with functional gastrointestinal disorders such as irritable bowel syndrome (IBS) frequently overlap with fibromyalgia (FM). Fibromyalgia occurs in up to 60 percent of patients with functional bowel disorders. Up to 50 percent of patients with a diagnosis of FM syndrome complain of symptoms characteristic of functional dyspepsia, and 70 percent have symptoms of IBS. (5) These digestive problems can cause a leaky gut, which can cause multiple food allergies, weakened immunity, increased toxicity, psychological disturbances, nutrient depletions, and low energy.

Statistic

American College of Rheumatology, 2000.

    Fibromyalgia is common, affecting approximately two percent of the U.S. population. It occurs seven times more frequently in women than in men. It occurs most frequently in women of childbearing age.

National Institute of Arthritis and Musculoskeletal and Skin Diseases, 1999.

    Fibromyalgia primarily occurs in women of childbearing age, but children,the elderly, and men can also be affected.

Fibromyalgia Network, 1999.

    90% of fibromyalgia patients have jaw and facial tenderness that could produce symptoms of TMJD. 50% of all fibromyalgia patients suffer from sensitivities to odors, noise, bright lights, medications, and various foods.

Signs and Symptoms

The following list does not insure the presence of this health condition. Please see the text and your healthcare professional for more information.

Several symptoms must be present in order to confirm a fibromyalgia diagnosis. The first is widespread muscle and skeletal pain. Widespread is defined as pain occurring on the right and left sides of the body, above and below the waist, and along the spine. Localized pain also must occur in a majority of identified "tender points" all over the surface of the body.

Other general, common symptoms include aching, disturbed sleep patterns, fatigue, morning stiffness, depression, recurrent headaches, tender lymph nodes, bowel or bladder disturbances, sensitivity to heat or cold, anxiety, gastrointestinal disturbances, dizziness, occasional racing heart beats, decreased coordination, and environmental allergies. The presence of certain diseases is also common with a fibromyalgia diagnosis. Three of the most common diseases are irritable bowel syndrome (IBS), Raynaud’s disease, and temporal mandibular joint dysfunction (TMJ).

General

  • Whole body muscle and skeletal pain
  • Aching
  • Disturbed sleep patterns
  • Fatigue
  • Morning stiffness
  • Specific tender and painful areas of the body when pressure is applied
  • Depression
  • Recurrent headaches
  • Tender lymph nodes
  • Bowel or bladder disturbances
  • Sensitivity to heat or cold
  • Anxiety
  • Gastrointestinal disturbances
  • Dizziness
  • Occasional racing heart beats
  • Decreased coordination
  • Allergies
  • Irritable bowel syndrome
  • Raynaud’s syndrome
  • Temporal mandibular joint dysfunction

Treatment Options

Conventional

Unfortunately, fibromyalgia generally does not respond well to the anti-inflammatory drugs that are used to treat other rheumatic conditions such as NSAIDS, aspirin, and corticosteroids. (6) Other medications, called tricyclic antidepressants such as alprazolam (7) and amitriptyline, (8) have been used with some degree of success by improving sleep patterns and by inducing a certain level of analgesia, or pain relief.

Nutritional Suplementation


S-Adenosylmethionine (SAMe)

S-adenosylmethionine is a compound with anti-inflammatory, analgesic, and antidepressant effects. A six-week double-blind trial with 44 patients receiving 800mg/day reported the improvements in clinical disease activity, pain, fatigue, morning stiffness, and mood in the actively treated group compared to placebo. (9) In an earlier double-blind crossover trial with 17 patients, SAMe reportedly reduced levels of depression as the amount of pain and number of trigger points decreased, which prompted the researchers to state that SAMe, "seems to be an effective and safe therapy in the management of primary fibromyalgia." (10)


Creatine

Creatine plays a role in energy production by helping the body convert adenosinediphosphate (ADP) to ATP. In order for this cycle to be complete, the creatine must remain stable and not break down into creatinine. There appears to be evidence supporting the use of a bicarbonate effervescent buffer in creatine products to assist in maintaining active form. (11)


5-Hydroxytryptophan (5-HTP)

Studies have reported that a substantial number of patients with fibromyalgia have abnormalities in the normal serotonin-melatonin metabolic pathways. Two natural substances can be used to stimulate the body’s ability to synthesize serotonin and melatonin. These substances are the essential amino acid tryptophan and 5-hydroxytryptophan (5-HTP). When these precursors are used in the treatment of fibromyalgia, patients report improvements in symptoms of depression, anxiety, insomnia, and body pains. (12) In one double-blind study, 50 patients were given 100mg of 5-HTP three times daily for 30 days. At this dosage level, the patients reported significant clinical improvement in all of their symptoms. (13)


Melatonin

One study reported that patients with fibromyalgia syndrome had nighttime melatonin levels that were 31 percent lower than placebo controls. (14) This may contribute to impaired sleep at night, fatigue during the day, and altered pain perception. In a therapeutic trial, patients were given 3mg of melatonin daily at bedtime. After one month, patients reported significant improvement in sleep, tender point count, and severity of pain at selected points. (15)


Digestive Enzymes

Digestive enzymes are often beneficial for patients whose disease state involves gastrointestinal problems. Since a significant number of patients with fibromyalgia fall into this category, supplementation with a full range digestive enzyme may provide relief from bloating and other GI symptoms.


Magnesium, Malic Acid

Many patients with fibromyalgia report significant reductions in pain using a combination of magnesium hydroxide (300-600mg/day) and malic acid (1,200-1,400 mg/day). There are reports which indicate that pain levels are reduced and that the symptoms of fatigue may improve within two weeks. (16) , (17) Both magnesium and malic acid have oxygen-sparing effects, and a deficiency of either may contribute to the hypoxia, or lack of cellular oxygen, commonly found in the muscle tissue of fibromyalgia patients. In general, the combination of magnesium and malic acid is thought to increase energy production and reduce lactic acid, a source of the muscular tenderness and pain that patients experience.

If you suffer from Irritable Bowel Syndrome (IBS) consult your healthcare professional before using magnesium and malic acid as they might contribute to gastric distress.


Vitamin B1

The active form of thiamine, known as thiamine pyrophosphate (TPP), is involved in the production of energy in the Krebs cycle. The symptoms of thiamine deficiency are similar to many of the symptoms of fibromyalgia such as fatigue, depression, apathy, confusion, numbness or burning in the hands and feet, low blood pressure, low metabolism, and shortness of breath. A dose of 10mg twice daily is a usual dose. Your health professional may recommend diagnostic testing to determine the most appropriate dosage for you.

Herbal Suplementation


Turmeric

Reports from laboratory and clinical research indicate that turmeric has unique antioxidant and anti-inflammatory properties. (18) Chemicals called curcuminoids reportedly inhibit enzymes, which participate in the synthesis of inflammatory substances. It is claimed that they are comparable in activity to the NSAIDs (non-steroidal anti-inflammatory drugs such as ibuprofen). (19) , (20) In a double-blind study of individuals with rheumatoid arthritis, curcuminoids produced significant improvement in all of the subjects who were studied. (21) Turmeric has been reported to be anti-rheumatic, anti-inflammatory, and an antioxidant. (22)


Astragalus

The Chinese have valued astragalus for centuries for its immune-enhancing and adaptogenic properties. As an adaptogen, it may modify and improve the body’s response to stress through action on the adrenal cortex. Astragalus enhances the effects of interferon, and may increase cellular oxygenation of the heart and cerebrovascular tissue and improve stamina and endurance. (23) , (24) , (25)


Cordyceps

Cordyceps is a unique black mushroom that extracts nutrients from and grows only on a caterpillar found in the high altitudes of Tibet and China. Cordyceps has been used in humans for centuries as a tonic for improving performance and vitality. Cordyceps may modulate immune function and optimize endocrine systems, increasing physical strength and endurance. (26) , (27)

Cordyceps has traditionally been used for its improvement in respiration (28) and has been reported to have certain anticancer effects. (29) , (30) , (31) Cordyceps is also known to be an effective antioxidant.


St. John's Wort

St. John’s wort has gained a great deal of attention for its use in minor depression. Its popularity has stemmed from its extensive use by physicians in Europe as the first agent of choice in the treatment of mild to moderate depression. There are a variety of studies which are claimed to support the use of St. John’s wort in treating depression. (32) , (33) , (34)


Kava

Kava preparations are approved medicines in several European countries for the treatment of nervous anxiety and restlessness. (35) , (36) Studies have reported that kava preparations compare favorably to certain prescription medications in controlling symptoms of anxiety and minor depression, while increasing vigilance, sociability, memory, and reaction time. (37) , (38) It is thought that kava may promote relaxation, sleep, and to produce skeletal muscle relaxation (comparable to mephenesin), a benefit in fibromyalgia. (39)

Homeopathic

Rhus toxicondedron

Typical Dosage: In one study, patients were given homeopathic treatment Rhus toxicodendron 6x under double-blind, placebo-controlled, crossover conditions for one month. The FM patients under the active treatment did better on all of the variables as compared to the FM control patients. (40)

Acupunture & Acupressure

Some 70 patients with fibromyalgia were randomly assigned to receive either electroacupuncture or a placebo treatment. The parameters of this study included pain threshold, number of analgesic tablets used, regional pain score, pain recorded on visual analogue scale, sleep quality, morning stiffness, and the patient’s and evaluating physician’s appreciation. The results indicated that seven of the eight outcome parameters reported a significant improvement in the active treatment group, whereas none were improved in the placebo treatment group. This study suggests that electroacupuncture may be effective in relieving symptoms of fibromyalgia. (41) However, the authors of this study stress that electroacupuncture’s potential in long term management needs further study.

Diet & Lifestyle

It is important to eat a diet consisting of plenty of fresh fruits and vegetables and limiting refined foods and sugars. Include good sources of dietary magnesium such as:

    Soybean products Whole wheat flour (not in hypersensitive individuals) Buckwheat flour Almonds Cashews Rice Most legumes
Relaxation techniques such as aromatherapy, yoga, and meditation all help in relieving stress, which has been suggested to worsen the symptoms of fibromyalgia. Taking time out during a hectic day to reflect on the positive aspects of life is essential. Learning to relax and calming the mind will allow the body to do the same.
    Hypoallergenic diet: Although the connection between diet and fibromyalgia has not been well researched, the following information suggests that hypoallergenic diets, in which food and chemical allergic agents are removed, can help many patients. In one study, researchers placed a group of patients with fibromyalgia on a vegetarian diet for three weeks. Numerous biochemical parameters improved, and 70 percent of the volunteers reported significant improvement in feelings of well being. (42)

References

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