January 14, 2006
Q: What is fibromyalgia and what natural remedies help? - Layperson
A: Fibromyalgia (FM or FMS) is a debilitating chronic syndrome (constellation of signs and symptoms) characterized by diffuse pain, fatigue, and a wide range of other symptoms. It is not contagious, and recent studies suggest that people with fibromyalgia may be genetically predisposed. It affects more females than males, with a ratio of 9:1 by ACR (American College of Rheumatology) criteria. Fibromyalgia is seen in 3-10% of the general population, and is most commonly diagnosed in individuals between the ages of 20 and 50. The nature of fibromyalgia is not well understood, and there is no cure.
Fibromyalgia has been studied since the early 1800s and referred to by a variety of former names, including muscular rheumatism and fibrositis. The term fibromyalgia was coined in 1976 to more accurately describe the symptoms, from the Greek my-, meaning muscle, and algia, meaning pain.
Fibromyalgia was once considered an autoimmune disorder, but laboratory results reveal no disturbance of the immune system although reactivated viral infection has been identified in a subset of patients. It was also once reclassified as a psychosomatic disorder by psychiatrists at the Institute of Psychiatry at Kings College in London and by Harvard psychiatrist Jonathan Barsky, although few rheumatological specialists classified it as such. Because the understanding of this disorder has grown so rapidly in the 1990s and 2000s, many texts on the subject are out of date. Many of the outdated texts link this rheumatological disorder (ICD-10 M79) with depression and mood disorders as a result of psychiatric studies that failed to use psychiatric tests valid for organically ill patients. The actual rate is no higher than for most chronic organic diseases.
The primary symptom of fibromyalgia is widespread, diffuse pain, often including heightened sensitivity of the skin (that may make the touch of clothing painful), achiness around joints, and nerve pain. Chronic sleep disturbances are also characteristic of fibromyalgia, and some studies suggest that these sleep disturbances are the result of a sleep disorder called alpha wave interrupted sleep pattern, a condition in which deep sleep is frequently interrupted by bursts of brain activity similar to wakefulness. Many patients experience "brain fog," which is objectively proven abnormally slow brain waves and objectively proven cognitive deficits. Many experts feel that "brain fog" is directly related to the sleep disturbances experienced by sufferers of fibromyalgia. Other symptoms often attributed to fibromyalgia (possibly due to another comorbid disorder) are physical fatigue, irritable bowel syndrome, genitourinary symptoms such as those associated with the chronic bladder condition interstitial cystitis, dermatological disorders, headaches, and symptomatic hypoglycemia. Although it is common in people with fibromyalgia for pain to be widespread, it may also be localized in areas such as the shoulders, neck, back, hips, or other areas. Not all patients have all symptoms.
Fibromyalgia can start as a result of some trauma (such as a traffic accident) or illness, but there is no strong correlation between any specific type of trigger and the subsequent initiation of fibromyalgia. Symptoms can have a slow onset, and many patients have mild symptoms beginning in childhood such as growing pains. Symptoms are often aggravated by unrelated illness or changes in the weather. They can become more tolerable or less tolerable throughout daily or yearly cycles, however, many people with fibromyalgia find that, at least some of the time, the condition prevents them from performing normal activities such as driving a car or walking up stairs. The syndrome does not cause inflammation as is presented in arthritis, nor are there any diagnostically abnormal laboratory findings. Symptoms may present periodically or may be continual.
When making a diagnosis of fibromyalgia, a practitioner would take into consideration the patient's case history and the exclusion of other conditions such as endocrine disorders, arthritis, and polymyalgia rheumatica. There are also two criteria established by the American College of Rheumatology for diagnosis:
A number of other disorders can produce essentially the same symptoms as fibromyalgia. Other organic disorders known to produce some similar symptoms are:
Like many other soft tissue and rheumatolgical organic disorders there is no cure for fibromyalgia, but some treatment options are available. A patient may try many routes of treatment under the guidance of a physician to find relief. Treatments range from prescription medication to alternative and complementary medicine.
Studies have found gentle exercise, such as warm-water pool therapy, improves fitness and sleep and may reduce pain and fatigue in people with fibromyalgia. Mild aerobic exercise is often prescribed. Patients should begin slowly and build their activity level gradually so as to avoid pain. However, exercise may be poorly tolerated in more severe cases with abnormal post-exertional fatigue.
Cognitive behavioral therapy has been shown to improve quality of life and coping in fibromyalgia patients and other sufferers of chronic pain
Many patients find temporary relief by applying heat to painful areas. Those with access to physical therapy and/or massage may find them beneficial.
Treatment for the "brain fog" has not yet been developed, however biofeedback and self-management techniques such as pacing and stress management may be helpful for some patients.
Unfortunately, as with many difficult-to-treat disorders, a large number of opportunistic practitioners are attracted to the treatment of fibromyalgia, and many treatments of dubious validity are often offered to the unsuspecting (and desperate).
Fibromyalgia can affect every aspect of a person's life. While it cannot cause death in itself, the chronic pain associated with Fibromyalgia and resulting depression puts its sufferers at risk for suicide, although it is unclear whether there is an increased risk. FMS can severely curtail social activity and recreation, and many people with fibromyalgia are unable to maintain a full-time job. Like others with disabilities, individuals with FMS often need accommodations to fully participate in their education or remain active in their careers.
Theories on the cause of fibromyalgia
The cause of fibromyalgia is currently unknown. Over the past few decades many theories have been presented, and the understanding of the disorder has changed dramatically. Most current theories explain only a few symptoms of the disorder and are thus incomplete.
The sleep disturbance theory postulates that fibromyalgia is related to sleep quality. Electroencephalography (EEG) studies have shown that people with fibromyalgia lose deep sleep. Circumstances that interfere with "stage 4" deep sleep (such as drug use, pain, or anxiety) appear to be able to cause or worsen the condition.
According to the sleep disturbance theory, an event such as a trauma or illness causes sleep disturbance and, possibly, some sort of initial chronic pain. These initiate the disorder. The theory supposes that "stage 4" sleep is critical to the function of the nervous system, as it is during that stage that certain neurochemical processes in the body "reset". In particular, pain causes the release of the neuropeptide substance P in the spinal cord, and substance P has the effect of amplifying pain and causing nerves near the initiating ones to become more sensitive to pain. Under normal circumstances this just causes the area around a wound to become more sensitive to pain, but if pain becomes chronic and body-wide then this process can run out of control. The sleep disturbance theory holds that deep sleep is critical to reset the substance P mechanism and prevent this out-of-control effect.
An interesting aspect of the sleep disturbance/substance P theory is that it explains "tender points" that are characteristic of fibromyalgia but which are otherwise enigmatic, since their positions don't correspond to any particular set of nerve junctions or other obvious body structures. The theory posits that these locations are more sensitive because the sensory nerves that serve them are positioned in the spinal cord to be most strongly affected by substance P. The theory also explains some of more general neurological features of fibromyalgia, since substance P is active in many other areas of the nervous system.
Critics of the theory argue that it does not explain slow-onset fibromyalgia, fibromyalgia present without tender points, or patients without heightened pain symptoms, and a number of the non-pain symptoms present in the disorder.
Also of interest is a possible connection between this theory and the theory that chronic fatigue syndrome and post-polio syndrome are due, at least in part to damage to the ascending reticular activating system of the reticular formation. This area of the brain, in addition to apparently controlling the sensation of fatigue, is known to control sleep behaviors and is also believed to produce some neuropeptides, and thus injury or imbalance in this area could cause both CFS and sleep-related fibromyalgia, explaining why the two disorders so often occur together.
Another theory involves phosphate and calcium accumulation in cells that eventually reaches a level to impede the ATP process, possibly caused by a kidney defect or missing enzyme that prevents the removal of excess phosphates from the blood stream. This theory posits that fibromyalgia is an inherited disorder, and that phosphate build up in cells is gradual (but can be accelerated by trauma or illness). Calcium is required for the excess phosphate to enter the cells. The additional phosphate slows down the ATP process; however the excess calcium prods the cell to continue producing ATP.
Diagnosis is made with a specialized technique called mapping that is a gentle palpitation of the muscles to detect lumps and areas of spasm that are thought to be caused by an excess of calcium in the cytosol of the cells. This mapping approach is specific to deposition theory, and is not related to the trigger points of myofascial pain syndrome.
While this theory does not identify the causative mechanism in the kidneys, it proposes a treatment known as guaifenesin therapy. This treatment involves administering the drug guaifenesin to a patient's individual dosage, avoiding salicylic acid in medications or on the skin, and, if the patient is also hypoglyemic, a diet designed to keep insulin levels low.
The phosphate build-up theory explains many of the symptoms present in fibromyalgia and proposes an underlying cause. The guaifenesin treatment, based on this theory, has received mixed reviews, with some practitioners claiming many near universal success and others reporting no success. Only one controlled clinical trial has been conducted to date, and it showed no evidence of the efficacy of this treatment protocol. This study was criticized for not limiting the salicylic acid exposure in patients, and for studying the only effectiveness of guaifenesin, not the entire treatment method. As of 2005, further studies to test the protocol's effectiveness are in the planning stages, with funding for independent studies largely collected from groups which advocate the theory.
Other theories relate to various toxins from the patient's environment, viral causes such as the Epstein-Barr Virus, growth hormone deficiencies, neurotransmitter disruptions in the central nervous system, and erosion of the protective chemical coating around sensory nerves. Due to the multi-systemic nature of illnesses such as fibromyalgia and chronic fatigue syndrome (CFS/ME), an emerging branch of medical science called psychoneuroimmunology (PNI) is looking into how the various theories fit together.
Cutting across several of the above theories is a theory that proposes that fibromyalgia is almost always a comorbid disorder, occurring in combination with some other disorder that likely served to "trigger" the fibromyalgia in the first place. This concept fits especially well with the sleep disturbance theory.
By this theory, some other disorder (or trauma) occurs first, and fibromyalgia follows as a result. In some cases the original disorder abates on its own or is separately treated and cured, but the fibromyalgia remains. In other cases the two disorders coexist. This theory would explain why such a wide variety of symptoms are often ascribed to fibromyalgia, since there are potentially a wide variety of comorbid disorders. It also helps explain why fibromyalgia is so hard to treat, since the fibromyalgia is unlikely to abate while the comorbid condition is untreated.
Commonly proposed comorbid/trigger disorders are:
Serenitol, containing the following ingredients:
has been found extremely helpful. Serenitol attacks the disorder at three levels; 1) pain relief through reversion instead of signal blocking; 2) Hormonal balancing for low melatonin and other essentials; 3) Anti-anxiety and stress suppressants.
Freederm AC, containing the following ingredients:
Emu Oil: Non-pore-clogging substance... reduces inflammation in joints... penetrates skin due to its non-phosphorous composition... proven treatment for muscle aches and pains.
Glucosamine: Maintains integrity of joints... inhibits cartilage destroying enzymes... repairs and rebuilds worn joints and cartilage... increases joint flexibility.
MSM: Essential dietary element... prime source of bio-available sulfur... improves health problems such as arthritis and circulation... helps build healthy new cells.
Chondroitin Sulfate: Proven anti-inflammatory... more effective than non-steroidal, anti-inflammatory drugs (NSAID's)... protects cartilage from premature degeneration... works with glucosamine to stimulate cartilage production.
Collagen Type II: Powerful anti-inflammatory, rebuilds cartilage in arthritic joints, 60% of cartilage is Collage Type II, reduces cholesterol in blood, cardio-protective agent, lowers risk of heart attacks.
Vitamin E: Biological anti-oxidant, protects cells against free radical damage, may help prevent onset of cardiovascular disease and cancer.
Vitamin C: Necessary for manufacture of collagen, water soluble antioxidant, protects body against oxidative damage, neutralizes harmful reactions in blood and fluid inside and surrounding cells, protects the heart and other tissues
There is some evidence that a systemic candida albicans yeast infection may be one cause of fibromyalgia. ThreeLac Candida Defense containing the following ingredients: Spore Forming Lactic Acid Bacteria (Lactobacillus Sporogenes), Lemon Juice Powder, Refined Yeast Powder, Castor Oil, Spore Forming Bacteria (Bacillus Subtilis), Lactic Acid Bacteria (Streptococcus Faecalis-not the species of streptococcus that causes strep infections, is naturally found in the intestinal flora in small amounts and is also in very small amounts in ThreeLac) kills the Candida Albicans infection and helps maintain an alkaline condition necessary for good immune function.
As usual, consult a healthcare proessional knowledgeable in the above, but especially those with immune system conditions, the elderly, the pregnant, and those on any kind of medications.
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DISCLAIMER: The information in this column, is NOT intended to diagnose and/or treat any health related issues and is provided solely for informational purposes only. Consult the appropriate healthcare professional before making any changes to your healthcare regime. Even what may seem like simple changes in the diet for example, can interact with, and alter, the efficiency of medications and/or the body's response to the medications. Many herbs and supplements exert powerful medicinal effects. Neither the author, nor the website designers, assume any responsibility for the reader's use or misuse of this information.