(also referred to as...) FM
Description Fibromyalgia (FM) is a syndrome characterized by diffuse muscular pain throughout the body. A number of tender points are also present and occur in specific sites set out by the American College of Rheumatology (see diagram under Symptoms and Signs, below). FM occurs most frequently among women between the ages of twenty and fifty. The specific cause for the syndrome is yet to be discovered. FM is a relatively common, yet somewhat controversial, syndrome. Part of the controversy lies in the fact that most of the possible symptoms of fibromyalgia are the same as those for chronic fatigue syndrome and multiple chemical sensitivities. In fact, studies show that whether or not a person suffering from certain symptoms is diagnosed as having fibromyalgia is dependent upon what type of doctor s/he is diagnosed by. A rheumatologist, for example, may be more prone to diagnosing someone as having fibromyalgia, whereas the same person may be diagnosed with chronic fatigue syndrome by another specialist. Thus, the theory holds that they are different manifestations of the same condition. Some still believe that both fibromyalgia and chronic fatigue are purely psychological ailments.
Symptoms and Signs: The most notable symptoms of fibromyalgia are generalized aching or stiffness that seem to be all over the body for at least three consecutive months and tenderness upon palpation of at least 11 of 18 characteristic tender points (see diagram, below).
Other symptoms include fatigue, chronic headache, sleep disturbances, joint swelling, irritable bowel syndrome, and neurological or psychological complaints. You might also experience depression, PMS, or restless leg syndrome. Some people experience what is called Raynaud's Phenomenon/Syndrome, a condition in which your hands turn very white and cold. Yet others may experience anxiety, dry eyes or mouth, memory lapses, inability to concentrate, and arthritis. Severity of symptoms may depend on your stress level, your activity level, and weather changes.
Pain The main cause of fibromyalgia pain is low levels of serotonin (a neurotransmitter). A decrease in serotonin levels can amplify pain sensations. Serotonin is also important in the regulation of sleep. Serotonin is referred to as a monoamine and low levels of this class of neurotransmitters have been associated with clinical depression. Mood states have also been shown to have an affect on pain sensation. The better you emotionally feel, the better equipped you are to deal with pain. The sensation of pain is associated with quality of sleep. That is, if you sleep well, you will feel less pain than if you have poor sleep. Also, increasing levels of pain leads to poorer and poorer sleep. This positive feedback creates a vicious cycle of ever greater pain sensitivity. People suffering from fibromyalgia often have poor sleep. In fact, studies show that people with fibromyalgia, while sleeping, spend less time in the deeper stages of sleep than healthy individuals. This lack of deep sleep results in waking up feeling tired even though you may have slept for an adequate number of hours. The presence of substance P (a type of neurotransmitter that relays sensory information to the brain) is also associated with pain. People suffering from FM have an increased level of substance P in their bodies.
Causes: The cause of fibromyalgia is still unknown. However, it is often preceded by an injury, usually mild, or a particularly stressful or traumatic event.
What to Expect: It is difficult to say what to expect. The syndrome can manifest quite differently in different people. For some it can be quite debilitating. Sometimes, it can clear up of its own accord. Others may live with it as a chronic condition. Some people have alternating periods of flare-up and remission of symptoms.
Remedies
Amino Acids A free-form amino acid complex can be beneficial. It will help with the repair and rebuilding of muscle tissue. It will also contain amino acids that can help regulate brain function. Take as directed on the label. Alternatively, one may supplement with a lactose-free whey protein powder. You may also supplement with tryptophan, the precursor for serotonin, at 100mg daily before bed. Some sources suggest supplementing with blue-green algae (Spirulina) to increase serotonin levels. Work up to taking 2 to 4 capsules three times daily with meals. 5-HTP is an intermediate between tryptophan and serotonin and some suggest that supplementing with 5-HTP is better than supplementing with tryptophan. It may be easier to convert 5-HTP into serotonin than tryptophan. There may also be better absorption and less conversion to other unusable compounds of 5-HTP. It has been shown to improve symptoms of fatigue, sleep disturbances, and depression. It has also been shown to decrease sensitivity to pain. Take 100mg three times daily. Take with St. John's Wort and magnesium to further enhance function. Do not use if taking a MAO inhibitor or a Selective Serotonin Reuptake Inhibitor (SSRI).
Food Supplements If candidiasis is a problem, Acidophilus and Bifidus supplementation will restore beneficial bacteria counts and help keep harmful bacteria at bay. It is essential that these bacteria be restored to the body, particularly after the use of antibiotics. Look for a dairy-free formulation with at least 2.5 billion viable cultures per capsule and keep refrigerated. Take 2 or 3 capsules daily on an empty stomach, preferably in the morning or right before bed. Supplements with Fructooligosaccharides (FOS) provide a beneficial "bed" and initial food source for the bacteria. If dairy allergies have been ruled out, you can also eat yogurt that has had either bacterial culture added. Eicosapentainoic acid (EPA) is an essential fatty acid that has anti-inflammatory properties. It is found in most fish oils. The suggested dose is two 500mg capsules of fish oil (not fish liver oil), 3 times per day.
Herbs Astragalus can be used to stimulate your immune system. If using capsules, take 6g three times daily. If using a tincture, take 20 to 30 drops three times daily. Cayenne has been shown to help decrease pain and inflammation in people with FM, while also reducing the amount of substance P in your body. Substance P is associated with the sensation of pain and inflammation. You may purchase a cream containing capsaicin (the active ingredient in cayenne) and massage it into tender points three times daily. Echinacea can also be used to stimulate the immune system. However, do not use echinacea over the long term as it will confuse your immune system into action and thus weaken its ability to fight an actual infection. If using a tincture, take 20 to 40 drops in a glass of water three times daily. If using a supplement, take 300mg powdered extract three times daily. If preparing a tea/decoction, bring 2 teaspoons echinacea root and 1 cup of water to a boil. Simmer 15 minutes. Drink up to 3 cups a day. The taste may be initially sweet, then bitter. People over 65 should start with a low strength preparation and increase as required. Garlic is good for detoxification, for generalized immune support, and also will help to eradicate any yeast or parasites that may be present. Add it to your favourite meal and enjoy the numerous benefits. If you prefer to go "sans aroma", you may also take odourless garlic capsules. If eating whole cloves, take 2 to 4 daily. If using capsules, take 600 to 1,200mg once or twice daily with meals. If using a tincture, take 2 to 4mL three times daily. Ginkgo biloba helps improve brain function and circulation. This herb enhances blood flow to the brain and results in increased oxygen availability and an overall improvement in mental function. It also helps relieve pain of muscular origin. Take 100 to 200mg three times daily in liquid or capsule form. Goldenseal has strong antibacterial properties. NOTE: This delicate, wild herb is becoming increasingly rare as its popularity grows. Use only after you have exhausted other possible courses of antibacterial treatment. To prepare a tea, use 1/2 to 1 tsp. powdered root per cup of boiling water. Let steep for 10 minutes. Drink up to 2 cups daily. Add honey or lemon to reduce the bitter flavour. If using a tincture, take 10 to 40 drops two times daily. If using capsules, take 250 to 500mg of powdered extract. Do not take internally for more than one week at a time and avoid completely if you are pregnant or have high blood pressure. St. John's Wort is beneficial in treatment of the symptom of depression. It has also been shown to enhance the action of 5-HTP. Take 300mg daily (with 0.3% hypericin content). Some find that Essiac tea/Floressence is beneficial, likely as a result of its detoxification abilities. For the pain and inflammation itself, devil's claw and willow bark are helpful. Passionflower and valerian teas may be taken throughout the day to promote muscle relaxation.
Lifestyle One study with FM patients suggests that massage can help to decrease pain, stiffness, stress levels, and fatigue, and improve muscle function and sleep. Massage has also been shown to help with depression and can improve the activity of serotonin in the brain (perhaps causing the decrease in pain and the amelioration of depression). Stress management is essential. Find ways to reduce your stress levels. Some suggestions have already been given. You can also try meditation or join a FM support group in your area. Many people with FM suffer from chemical or food sensitivities. Consider seeing your naturopath or other health practitioner to have yourself tested. Avoiding such allergens if you are sensitive can bring relief of many symptoms. Epsom salt baths provide a source of magnesium to the muscles and is very detoxifying. Add two cups of salts to warm bathwater.
Minerals Low levels of magnesium is a common finding among sufferers of fibromyalgia. This mineral is essential for energy production and serotonin function. It is best to take magnesium along with malic acid. Take 150 to 250mg three times daily. Do not exceed 1,000mg daily from all sources. Magnesium can act as a laxative and you may experience diarrhea at doses above 600mg. You should also increase your dietary intake of magnesium by consuming magnesium-rich foods. Studies show that selenium levels tend to be low in people with FM. Selenium works with vitamins E and C to reduce inflammation. Supplementation may be beneficial. Take 200mcg daily or eat brazil nuts. Zinc is required for tissue repair. Take 25 to 50mg daily.
Miscellaneous People with FM are often deficient in dehydroedianrosterone (DHEA) hormone, produced by the adrenal glands. Supplementation can prove beneficial if a deficiency is confirmed. Take 50mcg three times daily. DHEA Therapy can also be considered. Discuss this option with your naturopath or other health practitioner.
Therapies, Healing Aids, and More Many people find relief from pain through acupuncture. Consult your local alternative health services directory or visit your local health food store to find a clinic in your area. The use of a Transcutaneous Electric Nerve Stimulation (TENS) unit can also decrease pain.
Vitamins Vitamin A supports the immune system and also has potent antioxidant properties. Take 15,000 IU daily. Vitamin B Complex helps increase energy levels and is important for normal brain and nervous system function. Take 50mg two to three times daily. You may also require injections. You must discuss this option with your naturopath or other health practitioner. Vitamin C is an antioxidant that is important for tissue repair. It can also your increase energy and has anti-viral properties. Take 3,000 to 10,000mg daily, in divided doses. Start at the lower dosage and increase up to bowel tolerance. Vitamin E has antioxidant properties and promotes immune system function. It also has anti-inflammatory properties and slows the breakdown of cartilage while enhancing cartilage growth. Take 800 IU daily for the first month, then reduce to a maintenance dosage of 400 IU daily.
Actions and Remedy Listings
For More Information ... Goldberg, Burton. Chronic Fatigue, Fibromyalgia & Environmental Illness. Tiburon: Future Medicine Publishing, 1998.
Web Links: Shelter in the Storm Medical Links www.ashelter.org/links.html Fibromyalgia Syndrome Resources www.muhealth.org/~fibro/
See also Chronic Fatigue Syndrome
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