Fibromyalgia

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Fibromyalgia. Is it another medical dumpster?

When doctors cannot explain your aching, chronic pain, and ongoing flu-like symptoms they might label you as having fibromyalgia.

So what is it and what can you do?

If you have fibromyalgia, this story may be familiar to you. You are in pain and you decide it is time to visit the doctor. The pain didn’t happen overnight; it started with some dull aches (as if you overdid your exercise the day before), soon enough, though, the pain is full-time. Some people describe the pain as if they have a bad flu; others describe it as overwork or exhaustion. Either way, your doctor scratches her head, runs a bunch of tests, and when all the tests come back negative, she declares that you must have fibromyalgia.

Fibrositis, fibromyalgia, or fibromyositis are the names giving to a chronic widespread pain condition with heightened and painful responses to pressure and specific points of pain called trigger points. Your doctor has progressed in awareness more than most given that she gave you the diagnosis, because there are many doctors who question whether fibromyalgia exists at all.1

Strange that there is so much confusion about a disease that affects an estimated ten million people in the United States (and an estimated 3-6 percent of the world population).2 While fibromyalgia affects mostly women (over 75 percent of people with the disease are women), it also occurs in men and children. There is a strong family association, meaning you are more likely to have fibromyalgia if your mother had it.

Symptoms of Fibromyalgia
Deciding exactly who has fibromyalgia and who doesn’t is a bit tricky as there are large overlaps with other conditions such as chronic fatigue syndrome and multiple chemical sensitivities. 3

According to The American College of Rheumatology for a diagnosis of fibromyalgia, the following must be present:4 Widespread pain in combination with tenderness at eleven or more of the eighteen specific tender point sites (trigger points).

In addition, many people with fibromyalgia suffer from other conditions:

  • Brain problems: Sufferers complain of “brain fog,” which includes poor concentration and memory (both short-term and long-term), cognitive overload, reduced attention span.5
  • Mood: Anxiety and depression are common symptoms, as are panic attacks and post-traumatic stress disorder.6
  • Digestive: Most people with fibromyalgia suffer from digestive complaints. Irritable bowel syndrome is a very common co-disease.7
  • Other: Other common symptoms/diseases include insomnia, headaches, low-grade fever, abdominal pain, muscle and joint pain.

What Causes Fibromyalgia?
bodyWhile uncovering the cause of fibromyalgia has proved difficult, people with the disease generally report similar experiences, such as a severe accident (a car wreck or other injury), a surgery, a traumatic event, or a sickness (like flu) that marked the beginning of the disease.

In addition, the following are thought to be perceptive events:

  • Stress: Stress and fibromyalgia are closely related. Research has shown changes in the hypothalamic-pituitary-HPA (HPA) axis (the body-hormonal-system that responds to stress) and that the changes are not physical, but functional. The authors of a study suggest that the changes in the HPA axis are the body’s adaptation to chronic stress.8 Other authors suggest that chronic widespread pain is a hallmark of abnormalities of HPA axis function. 9 All studies aside, basic science tells us that your HPA axis will break down when under stress.
  • Dopamine dysfunction: Dopamine, a neurotransmitter, has been shown to be in low supply in people with fibromyalgia. Dopamine helps control our perceptions of pain. Patients who were treated with Pramipexole (a drug that stimulates dopamine production) reported less pain after using the drug.10
  • Serotonin dysfunction: Serotonin, another neurotransmitter, has been shown to be low in people with fibromyalgia.11 To date, though, treatments with drugs that increase serotonin have only limited success.12
  • Psychological factors: There is a strong link between fibromyalgia and depression and anxiety.13 While too many people who have fibromyalgia have been told that the condition is only in their heads, one cannot deny the strong connection between psychological factors. The question is often which came first, the disease or the anxiety/depression?

What to do about Fibromyalgia
Medical Approach
Treatments for fibromyalgia are difficult precisely because the underlying cause of the disease remains a mystery. The medical approach, in its tendency to just cover up symptoms, includes the following:

  • Antidepressants: These medications are thought to help with sleep problems and depression. Examples include: Monoamine oxidase inhibitors (MAOs): Nardil, Parnate, and Marplan; Tricyclic antidepressants (TCAs): Elavil, Norpramin, Tofranil, and Pamelor; Selective serotonin reuptake inhibitors (SSRIs): Celexa, Lexapro, Paxil, Prozac, Zoloft; Aminoketones: Wellbutrin.
  • Muscle relaxants: Various muscle relaxants have been tried (Carisoprodol, Metaxalone, Methocarbamol).
  • Anti-seizure medications: These medicines were originally used for people with seizures and are sometimes used in fibromyalgia (Neurontin Pregabalin).
  • Anti-inflammatories: various anti-inflammatories have been tried from over-the-counter medications (Tylenol, Ibuprofen and others) to steroids.

Integrative Approach to Fibromyalgia

  • Diet: A diet for someone with fibromyalgia should include plenty of fruits and vegetables. Since all manner of digestive problems are associated with fibromyalgia (including irritable bowel syndrome)14 it has been suggested that diet may play a strong role in the disease. Some health professionals suggest a diet free of gluten or an allergy elimination diet as the best approach.
  • HPA Hormone Balancing: When the HPA glands are performing at their best, the HPA axis has a better chance of retaining its feedback loops and healthy function. The body’s systems are conducted efficiently and behave in a way that prevents fibromyalgia from developing. With saliva based lab tests that measure cortisol and DHEA patterns, natural therapies for hormone balance can be developed.
  • Functional Lab Testing: As with any health condition or prevention plan, one should devote resources towards doing as much lab testing as possible to identify dysfunction. Get tested.
  • Exercise: While often hard to perform, exercise (see related products) has been shown to help reduce the pain and increase physical capacity of fibromyalgia as are stretching.15
  • Acetyl-L-Carnitine: This amino acid derivative has been shown to be helpful in reducing pain and improving the mental health of patients with fibromyalgia.16
  • Other: Massage, acupuncture, biofeedback, relaxation therapies, aromatherapy have all been tried with varying success.Relaxation aids.

1 Goldenberg DL. Fibromyalgia: why such controversy? Ann Rheum Dis. 1995 Jan;54(1):3-5.
2 National Fibromyalgia Association: Fibromyalgia, Prevalence. http://www.fmaware.org/site/PageServer?pagename=fibromyalgia_affected Accessed 7/31/2009
3 Buchwald D, Garrity D. Comparison of patients with chronic fatigue syndrome, fibromyalgia, and multiple chemical sensitivities. Arch Intern Med. 1994 Sep 26;154(18):2049-53.
4 Wolfe F, Smythe HA, Yunus MB, et al. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum. 1990 Feb;33(2):160-72.
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6 Buskila D, Cohen H. Comorbidity of fibromyalgia and psychiatric disorders. Curr Pain Headache Rep. 2007 Oct;11(5):333-8.
7 Reitblat T, Zamir D, Polishchuck I, et al. Patients treated by tegaserod for irritable bowel syndrome with constipation showed significant improvement in fibromyalgia symptoms. A pilot study. Clin Rheumatol. 2009 May 26
8 Tanriverdi F, Karaca Z, Unluhizarci K, Kelestimur F. The hypothalamo-pituitary-HPA axis in chronic fatigue syndrome and fibromyalgia syndrome. Stress. 2007 Mar;10(1):13-25.
9 McBeth J, Chiu YH, Silman AJ, et al. Hypothalamic-pituitary-HPA stress axis function and the relationship with chronic widespread pain and its antecedents. Arthritis Res Ther. 2005;7(5):R992-R1000.
10 Holman AJ, Myers RR. A randomized, double-blind, placebo-controlled trial of pramipexole, a dopamine agonist, in patients with fibromyalgia receiving concomitant medications. Arthritis Rheum. 2005 Aug;52(8):2495-505
11 Russell IJ, Michalek JE, Vipraio GA, et al. Platelet 3H-imipramine uptake receptor density and serum serotonin levels in patients with fibromyalgia/fibrositis syndrome. J Rheumatol. 1992 Jan;19(1):104-9.
12 Arnold LM. Biology and therapy of fibromyalgia. New therapies in fibromyalgia. Arthritis Res Ther. 2006;8(4):212
13 Arnold LM. Management of fibromyalgia and comorbid psychiatric disorders. J Clin Psychiatry. 2008;69 Suppl 2:14-9
14 Wallace DJ, Hallegua DS. Fibromyalgia: the gastrointestinal link. Curr Pain Headache Rep. 2004 Oct;8(5):364-8.
15 Busch A, Schachter CL, Peloso PM, Bombardier C. Exercise for treating fibromyalgia syndrome. Cochrane Database Syst Rev. 2002;(3):CD003786.
16 Rossini M, Di Munno O, Valentini G, et al. Double-blind, multicenter trial comparing acetyl l-carnitine with placebo in the treatment of fibromyalgia patients. Clin Exp Rheumatol 2007;25:182–8.