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Fibromyalgia

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 it, there is evidence that people with fibromyalgia may be more sensitive to pain because something is wrong with the body's usual pain perception processes.

More women than men have fibromyalgia. While different for everyone who has it, fibromyalgia tends to come and go throughout life. Although it 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 leg syndrome
  • Dizziness
  • Anxiety

It is not uncommon for people with fibromyalgia to have other conditions, including restless legs syndrome, irritable bowel syndrome, temporomandibular joint disorder (TMJ), 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 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.

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.

Diagnosis
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 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 day-to-day basis. While it is probably not possible to completely relieve all your symptoms, medication and certain complementary and alternative therapies may help reduce symptoms.

Naturopathic Treatments include:

Nutritional Therapy
Eat a healthy diet. Eat fewer carbohydrates and more protein. Consume unsaturated fats in moderation. Eat plant-based foods such as vegetables, whole grains, fruits, plus essential fatty acids (cold-water fish, nuts, and seeds). Some people see an improvement by following a vegan diet (no animal products).

Avoid alcohol and caffeine, and limit foods that are high in sugar, salt, and fat. Avoid foods with additives such as monosodium glutamate (MSG).

If your symptoms seem worse after eating specific foods, try an elimination diet: Remove suspected allergens from the diet for 2 weeks. Reintroduce one food every 3 days. Watch for reactions such as gastrointestinal upset, mood changes, flushing, fatigue, and worsening of symptoms. Common allergenic foods are dairy, soy, citrus, peanuts, wheat, fish, eggs, corn, and tomatoes.

Magnesium with malic acid may relieve pain and fatigue.

S-adenosylmethionine or SAMe is often used as a therapy for depression, but the chemical may also have an effect on how the body uses energy. Some people report that taking SAMe helps decrease fatigue, stiffness, and pain, and improve mood. If you take a prescription anti-depressant, Ultram, St. John's wort or 5-HTP, talk to your doctor before taking SAMe.

5-hydroxytryptophan or 5-HTP may help with depression and insomnia. People with fibromyalgia often have low levels of serotonin, a brain chemical that influences mood and pain perception, and 5-HTP may increase serotonin levels. If you take a prescription anti-depressant, Ultram, St. John's wort, or SAMe, talk to your doctor before taking 5-HTP.

Essential fatty acids, such as those found in fish oil (may also help reduce fatigue.

NADH, a naturally occurring chemical involved in energy production in the body, may help lessen fatigue.

Coenzyme Q10 may help the body use energy and lessen fatigue.

DHEA, a hormone produced by the body that may improve energy levels. DHEA is a precursor to testosterone and estrogen. It is truly a hormone rather than a supplement, and should never be taken without a doctor's prescription. Do not use DHEA if you have or are at risk for breast cancer, prostate cancer, or any other hormonally-influenced illnesses.

Melatonin may help sleep. Talk to your doctor first if you are using any anti-depressants or other neurological or psychiatric medications.

Zinc is essential for proper immune function. Taking zinc may make it harder for your body to absorb magnesium, so talk to your doctor before taking a zinc supplement.

Quercetin, a bioflavonoid found in many plants, may help reduce symptoms of pain and fatigue, but the evidence is anecdotal. Do not take quercetin if you take blood-thinning medication.

Thiamin or vitamin B1 helps the body use energy. People with fibromyalgia sometimes have low levels of thiamin.

For people who also experience restless legs syndrome, taking vitamin E, folic acid, and magnesium may help.

Exercise
It may seem odd to suggest exercising when your muscles are sore and you are in pain, but a number of studies have shown 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.

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 get your problem diagnosed before starting any treatment.

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

Muscle pain

  • Capsicum or capsaicin, applied topically as a cream containing .025% capsaicin
  • Devil’s claw (Harpagophytum procumbens), 750 mg three times per day
  • Pycnogenol (Pinus pinaster)
  • Ginger (Zingiber officinale)
  • Cat’s claw (Uncaria tomentosa)

Fatigue

  • Ginseng (Panax ginseng)

Homeopathy
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 they are 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.

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.

Page Last Updated: October 25, 2009

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