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Fibromyalgia

Introduction:

Fibromyalgia is a chronic condition characterized by pain in the muscles, ligaments, and tendons; fatigue, and multiple tender points on the body. While no one knows what causes fibromyalgia, there is evidence that people with the condition may be more sensitive to pain because something is wrong with the body's usual pain perception processes. More women than men have fibromyalgia. Fibromyalgia, while different for everyone who has it, tends to come and go throughout life. It also tends to coexist with sleep disorders, anxiety, depression, and irritable bowel syndrome. Although fibromyalgia can be debilitating for some people, it is not degenerative or life threatening, and you can manage your symptoms and improve your quality of life with professional and self care.

Signs and Symptoms:

  • Widespread pain and stiffness
  • Fatigue or trouble sleeping
  • Paresthesia (tingling)
  • Irritable bowel syndrome
  • Skin sensitivity
  • Heightened sensitivity to noises, bright lights, smells
  • Depression
  • Headaches
  • Pain after exertion
  • Memory lapses or difficulty concentrating
  • Restless legs syndrome
  • Dizziness
  • Anxiety
  • Hemorrhoids

It is not uncommon for people with fibromyalgia to have other conditions, including temporomandibular joint disorder and bladder problems.

What Causes It?:

No one knows what causes fibromyalgia, although there are several theories, and multiple factors may bring on the condition.

  • Changes in brain chemicals -- Some people with fibromyalgia have abnormal levels of brain chemicals called neurotransmitters. Specifically, they have low levels of serotonin, which affects mood, promotes sleep, and helps reduce the perception of pain. They often have high levels of substance P, which transmits the "pain message" to the brain.
  • Disregulation of the autonomic nervous system -- The autonomic nervous system releases hormones that affect how you react to stress. Some doctors think people with fibromyalgia release these hormones differently when they experience stress, and the hormones affect the perception of pain.
  • Sleep problems -- The majority of people with fibromyalgia report sleep problems, and especially have trouble with stage 4 sleep, the most restful stage in which the body repairs itself. Some doctors believe that the lack of restful sleep means that the muscles of people with fibromyalgia are not able to repair the tiny tears and trauma that occur everyday, leading to muscle pain and fatigue. Other doctors believe that sleep problems are a result, not a cause, of fibromyalgia.
  • Injury and infection -- Fibromyalgia can be triggered by an injury, especially to the upper spine or neck, or an infection caused by a virus or bacteria.
  • Genetics -- The tendency to get fibromyalgia may sometimes be inherited.
  • Having another rheumatic disease -- You may be more likely to get fibromyalgia if you have a disease such as rheumatoid arthritis or lupus.

What to Expect at Your Provider's Office:

There is no laboratory test for fibromyalgia, but your doctor may order several tests, including blood tests and x-rays to rule out other diseases. Your doctor may also press firmly on specific "tender points" on your head and body to see which ones are abnormally sensitive under pressure. Be sure to tell your health care provider about all of your symptoms. You may be referred to a rheumatologist, who specializes in treating rheumatic conditions like fibromyalgia and arthritis.

Treatment Options:

The goal is to help you function as well as possible on a daily basis. While it is probably not possible to completely relieve all of your symptoms, medication and certain complementary and alternative therapies may help reduce symptoms.

Drug Therapies

Your health care provider may prescribe the following drugs:

  • Sleep disturbances are often treated successfully with low doses of tricyclic antidepressants, such as amitriptyline (Elavil), doxepin (Sinequan), and nortriptyline (Pamelor, Aventyl). Sometimes doctors may prescribe sleeping pills for short term use.
  • Analgesics treat pain. Your doctor may recommend nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen sodium (Aleve), ibuprofen (Advil, Motrin), or prescription NSAIDs. Sometimes these drugs may lessen pain, but they are not effective for everyone. Your doctor may also prescribe tramadol (Ultram), which is often used to treat fibromyalgia pain.
  • Muscle relaxants, such as cyclobenazaprine (Flexeril), can help treat muscle spasms.
  • A technique called "spray and stretch" is sometimes used. A prescription spray coolant is applied to a painful muscle while the muscle is stretched.
  • Pain in specific spots in muscles can be treated with lidocaine or procaine (injected into points where pain is greatest), or with capsaicin (used topically).
  • Ibuprofen may also help briefly reduce muscle pain.
  • Depression can be treated with antidepressants, such as fluoxetine (Prozac) and sertraline (Zoloft).
  • Armour Thyroid, a natural thyroid hormone medication, may be helpful if tests show abnormal thyroid function. People with fibromyalgia may want to have their tests examined by both conventional and holistically oriented physicians because levels of thyroid hormone in the blood are often interpreted differently. Specifically, people with fibromyalgia may want to ask for an assessment of T3 levels, a lab test that is rarely ordered by conventional doctors.

Complementary and Alternative Therapies

Nutritional support, exercise, herbs, and mind-body techniques may help reduce symptoms.

Nutrition and Supplements

These nutritional tips may help reduce symptoms:

  • Eliminate potential food allergens, including dairy, wheat (gluten), corn, soy, preservatives, and food additives. Your health care provider may want to test for food sensitivities.
  • Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as kale, spinach, and bell peppers).
  • Avoid refined foods, such as white breads, pastas, and sugar.
  • Eat fewer red meats and more lean meats, cold water fish, tofu (soy, if no allergy) or beans for protein.
  • Use healthy cooking oils, such as olive oil or vegetable oil.
  • Reduce or eliminate trans fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
  • Avoid alcohol, tobacco, and caffeine, and limit foods that are high in sugar, salt, and fat. Avoid foods with additives such as monosodium glutamate (MSG).
  • Drink 6 - 8 glasses of filtered water daily.

You can address nutritional deficiencies with the following supplements:

  • Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 - 2 tablespoons of oil daily, to help decrease inflammation and improve immunity. Talk to your health care provider before taking omega-3 supplements if you are taking blood thinning medications, such as aspirin or warfarin (Coumadin).
  • A multivitamin daily, containing the antioxidant vitamins A, C, D, E, the B-vitamins, and trace minerals, such as magnesium, calcium, zinc, and selenium.
  • Vitamin C, 500 - 1,000 mg daily, as an antioxidant and for immune support.
  • Alpha-lipoic acid, 25 - 50 mg twice daily, for antioxidant support.
  • L-carnitine, 500 - 2,000 mg daily, for muscular support.
  • Magnesium, 200 mg 3 times daily, with malic acid 1,200 mg 3 times daily, for symptoms of fibromyalgia. If you have kidney disease, talk to your doctor before taking magnesium.
  • S-adenosylmethionine or SAMe, 800 mg daily, for mental and immune support. People who have manic or bipolar disorder should not take SAMe.
  • Probiotic supplement (containing Lactobacillus acidophilus), 5 - 10 billion CFUs (colony forming units) a day, when needed for maintenance of gastrointestinal and immune health. Some acidophilus products may need refrigeration -- check labels carefully.
  • Calcium/vitamin D supplement, 1 - 2 tablets daily, for support of muscle and skeletal weakness.
  • Coenzyme Q10, 100 - 200 mg at bedtime, for antioxidant, immune, and muscular support.
  • Chlorella (Chlorella pyrenoidosa), a blue-green algae, may help lessen symptoms. Participants in a clinical study took a specific dose of 10 g of Sun chlorella tablets and 100 ml of the liquid chlorella extract Wasaka Gold and showed significant improvement in symptoms. More studies are needed.
  • NADH (nicotinamide adenine dinucleotide), 5 - 20 mg daily, for energy. People who have anxiety should start NADH at a lower dose and work up slowly.
  • Melatonin, 0.5 - 3 mg, once daily before bed, for sleep and immune support. Talk to your doctor first if you are using any anti-depressants or other neurological or psychiatric medications.

Exercise

It may seem odd to suggest exercising when your muscles are sore and you are in pain, but a number of studies show that regular, low intensity exercise is one of the most effective treatments for fibromyalgia. Although you may experience a slight increase in pain and soreness when you start, as you continue you will help lessen muscle tension and stiffness, improve sleep quality, and raise serotonin and endorphin levels, helping to reduce pain. Exercise programs should include multiple dimensions, including strength, endurances, flexibility, and balance. Many people with fibromyalgia find warm water aquatic exercises to be helpful. Talk to your doctor or physical therapist to design an exercise program that is best for you.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to diagnose your problem before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. of herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

Herbal therapies aim to reduce the symptoms of fibromyalgia, or those of common conditions associated with fibromyalgia.

  • Green tea (Camelia sinensis) standardized extract, 250 - 500 mg daily, for antioxidant and immune effects. Use caffeine-free products. You may also prepare teas from the leaf of this herb.
  • Cat's claw (Uncaria tomentosa) standardized extract, 20 mg 3 times a day, for inflammation, immune, and antifungal activity.
  • Bromelain (Ananus comosus) standardized extract, 40 mg 3 times a day, for pain and inflammation. Bromelain can have a blood thinning effect and increase the effectiveness of blood thinning medications, such as aspirin and Coumadin. People with peptic ulcers should not take Bromelain. Bromelain can affect the absorption of certain antibiotics, 5-fluoracil and vincristine, and medications that cause drowsiness, such as benzodiazepines lorazepam (Ativan) or diazepam (Valium), some antidepressants, and narcotics, such as codeine, and barbituates, such as phenobarbitol.
  • Turmeric (Curcuma longa) standardized extract, 300 mg 3 times a day, for imflammation. Turmeric can have a blood thinning effect and can increasethe effectiveness of blood thinning medications, such as aspirin and Coumadin.
  • Rhodiola (Rhodiola rosea) standardized extract, 100 - 600 mg daily, for antioxidant, antistress, and immune activity.
  • Capsicum or capsaicin (Zostrix), as a cream containing .025% capsaicin, applied topically (on the skin) 1 - 3 times daily.

Homeopathy

Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual. Some of the homeopathic remedies used for fibromyalgia are below.

  • Arnica, for someone who feels sore and bruised, and does not want to be touched. Laying down is difficult, and the patient is restless when trying to find a comfortable position. Soreness stays after gentle exercise.
  • Bryonia, used when the slightest movement aggravates pain. The person is usually very thirsty. Pain is worse at night and upon waking in the morning.
  • Calcarea carbonica, for people who tend to move slowly, look pasty, and are always chilly. Exertion leaves them weak and breathless. They feel better when lying down. Being warm relieves symptoms.
  • Rhus toxicodendron, for joint stiffness, worse when starting to move, then easing with more movement. Stiffness is worse in the morning and in cold or damp weather.
  • Ruta graveolens, for sore, bruised pain in the joints and tendons that feel worse when lying on the affected area.

Mind-Body Therapies

Stress makes symptoms of fibromyalgia worse, so mind-body therapies including meditation and biofeedback can be helpful in learning relaxation techniques.

Physical Medicine

Using 2 - 4 cups of Epsom salts in a warm bath can soothe aching muscles.

Acupuncture

The National Institutes of Health recommends acupuncture as a treatment for fibromyalgia. Acupuncturists treat people with fibromyalgia based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. In fibromyalgia, a qi deficiency is usually detected in the spleen or kidney meridians. Moxibustion (a technique in which the herb mugwort is burned over specific acupuncture points) is used to strengthen the entire energy system. Qualified practitioners may also advise people with fibromyalgia on lifestyle and diet, and provide recommendations on the use of herbal medicines.

Chiropractic

Because fibromyalgia generally includes low back pain or neck pain (for which spinal manipulation is beneficial), chiropractors commonly treat people who have this condition. In one small study, women with fibromyalgia reported that they experienced a 77% reduction in pain intensity, 63% improvement in sleep quality, and 75% improvement in fatigue level after receiving 30 chiropractic treatments. Symptom relief continued for 1 month after treatment ended.

Massage

Massage may reduce stress, improve circulation, and soothe sore muscles. Find a massage therapist who has experience working with fibromyalgia.

Following Up:

Education and support groups may help you manage your condition.

  • Reviewed last on: 2/4/2010
  • Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

Supporting Research

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Bennett R. Clinical Manifestations and Diagnosis of Fibromyalgia. Rheumatic Diseases Clinics of North America. 2009;35(2).

Chakrabarty S, Zoorob R. Fibromyalgia. Am Fam Physician. 2007;76(2):247-54.

Firestein: Kelly's Textbook of Rheumatology, 8th ed. Philadelphia, PA: Saunders. 2008.

McBeth J, Jones K. Epidemiology of chronic musculoskeletal pain. Best Pract Res ClinRheumatol. 2007;21(3):403-25.

Müller W, Schneider EM, Stratz T. The classification of fibromyalgia syndrome. Rheumatol Int. 2007;27(11):1005-10.

Reiter RJ, Acuna-Castroviejo D, Tan DX. Melatonin therapy in fibromyalgia. Curr Pain Headache Rep. 2007;11(5):339-42.

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Targino RA, Imamura M, Kaziyama HH, Souza LP, Hsing WT, Furlan AD, Imamura ST, Azevedo Neto RS. A randomized controlled trial of acupuncture added to usual treatment for fibromyalgia. J Rehabil Med. 2008;40(7):582-8.

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