Living with Fibromyalgia
 

HEALTH INFORMATION SERIES

DEFINITION

This chronic, debilitating condition may also be called Myofascial Pain Syndrome, Muscular Rheumatism or Fibromyositis. It refers to a group of non-articular rheumatic disorders characterized by pain, tenderness and stiffness of muscles and of the areas of tendon insertion and adjacent soft tissues. 

The term 'myalgia' properly refers to muscle pain while 'myositis' refers to muscle inflammation but as these symptoms so often occur concurrently the terminology has some overlap. To be absolutely correct, fibromyalgia is not an inflammatory disease per se, as heat, redness and swelling are rarely present. Rather, it is a condition of muscle tenderness and stiffness with focal points of more acute actual inflammation (trigger points).
 

CAUSES

This condition may occur in any age group and affects both men and women although, like its close relative Chronic Fatigue Syndrome, women are much more frequently affected than men. Also like CFS, it is more likely to affect younger women who are very hard working, career oriented, tense, depressed or perfectionist in nature. It is both induced and intensified by physical or mental stress, chronically disturbed sleep, trauma (especially after car accidents or other injuries) and exposure to damp or cold. It may occasionally occur secondary to a viral or bacterial infection. 

People with FM commonly also have a tendency to suffer from allergies and / or Candida. Flaring up of either of these conditions can be a trigger for the appearance or aggravation of FM. Presumably this points to an overload on the immune and eliminatory systems and an overwhelming of the bodies defenses. The whole system begins to shut down and we call it FM.

A theory which is currently gaining popularity in natural health circles is that, when an impact trauma is the triggering factor (e.g. car accident and whiplash), there is a torsion (twisting) of the meningeal layers that wrap the spinal cord and brain. This cause a disruption to the flow of cerebro-spinal fluid which normally bathes the brain and spinal cord and provides them with nutrients and a waste-disposal system. The pineal gland lying deep in the brain tissue, is also bathed by this fluid, and several of the symptoms of FM such as disturbed sleep and reduced energy and controlled and governed by this gland. This may be one of the reasons why a bodywork techniques called Cranio-sacral therapy is so effective in treating FM (see lifestyle for more details).
 

CLINICAL FEATURES

Symptoms generally begin as diffuse aching and stiffness which slowly worsen over a period of weeks or even months. This may be associated with general flu-like symptoms of lethargy and torpor, low grade fevers and swollen glands. Eventually the muscle stiffness and pain become chronic and constant and there are frequently 'trigger points' in the muscles which are exquisitely tender nodules that are palpable. The actual diagnosis is made by the presence of up to 18 pairs of these trigger points in specified places on the body. There is local muscle spasm and a low grade inflammation which may be felt as a burning, aching or shooting pain in the affected part. Frequently there will be poor sleep, usually manifesting as a difficulty falling asleep at night and great difficulty waking in the morning. There is a variable degree of fatigue that can become very sever or even overwhelming. Another common symptom is 'brain fog' or cotton wool brain - a feeling of walking around in a bit of a stupor, awake but not present. Memory loss and impaired ability to concentrate are frequent. There may be difficulty comprehending words, whether written or spoken and the patients own speech may become slurred or confused. 

Other common symptoms include irritability, anxiety, depression, bladder and urethral irritation leading to frequency of micturition and dysuria, irritable bowel symptoms and general malaise. No abnormal blood pictures are usually present, except occasionally a slightly raised ESR. 
 

ALLOPATHIC TREATMENT OF FIBROMYALGIA

Almost nowhere in medical literature is fibromyalgia mentioned. It is such a 'new' phenomenon that it has not yet been accepted into mainstream medicine. Similarly, little is known about how to treat this condition. Amitriptyline (a.k.a. Elavil), a tricyclic anti-depressant is used to promote deeper sleep despite being, paradoxically, a sympathomimetic. This means that it gives a very 'drugged' sleep and the person frequently misses REM sleep patterns and wakes feeling groggy and hungover the next day. Other anti-depressants and tranquillizers may be used as well. For muscle pain and spasm, Cyclobenzeprine (Flexeril) is used frequently and long term, despite the fact that it increases the action of tricyclic anti-depressants and is recommended not to be used for longer than 2 - 3 weeks.

Appropriate exercise, local applications of heat, gentle massage and occasionally NSAID's may also be employed. 
 

HOLISTIC TREATMENT OF FIBROMYALGIA

All those who are experienced at working with fibromyalgia will agree that the single most important facet of the treatment plan is rest. Just as fibromyalgia has been considered a type of Chronic Fatigue Syndrome, so rest is paramount. Beyond that, diet, herbs, massage, flower remedies, visualizations and various other holistic healing modalities may be usefully employed. Detoxification, tissue cleansing and allergy and Candida management are vitally important. 

Diet

Very many patients with fibromyalgia suffer from an accumulation of toxins, especially acid wastes and which tend to aggravate muscle inflammations and spasms as well as ultimately often leading to arthritic changes in the joints. Initially a cleansing and detoxification program will ease the load on the immune system and liver and remove acid wastes. A short fast should be undertaken, the best method being a mono-food fast on white/green grapes or vegetable juice (carrot, beet, celery, parsley). This should be followed for as long as can be tolerated, at least 3 days and preferably 1 week. 

The main toxins which accumulate in the body are acidic and nitrogen-containing (urea, uric acid, pyrimidines & purines). The acids and nitrogen-containing substances are formed from the digestion of animal proteins (all meats, sea food & dairy products). Certain foods seems to be worse than others e.g.. pork is worse than chicken, milk and cheese are worse than yoghurt or butter. Other acid forming foods are wheat (especially refined flour products), sugar, tea and coffee, alcohol, vinegar (except apple cider), pickles, processed and tinned foods, tomatoes, rhubarb, gooseberries, red and black currants, cooked spinach, margarine and all processed fats, eggs, chocolate, cod liver oil and peanuts.

Thus a maintenance diet will avoid all of the above foods and concentrate on fresh fruits and vegetables with limited amounts of cereal/grain, occasional fish and chicken and no processed or artificial foods at all.

Bernard Jensen recommends the following foods in particular: sesame seeds, kale, celery, green beans, artichoke, okra, collards, watercress, lettuce, garlic, onions, turnip greens, barley, almonds, black mission figs, cherries, pineapple, limes, raw goats milk, goats whey and olive oil. 

The following juices have been found to also be beneficial as part of a maintenance diet: black cherry; celery & parsley; celery & apple; cucumber, endive, & goats whey; fig and goats milk. 

Supplements 

Niacinamide

High doses of niacinamide (900 - 4000 mg. daily in divided doses) has proven to be significant in reducing musculo-skeletal inflammations. However, doses this high can cause serious side effects including glucose intolerance and liver damage and should not be taken without medical supervision.

Lipotropic factors

These are a combination of phosphatidyl choline (lecithin), inositol and methionine which enhance liver function and aid the cleansing and detoxification process. Methionine is a sulphur-containing amino acid which is incorporated into cartilage and can thus act to improve the strength and integrity of the joint tissues as well. The lipotropic factors are best taken in combination to a dose of 1 gram of each per day. 

Superoxide dismutase

This is free radical scavenger and powerful anti-oxidant that is especially useful musculoskeletal inflammations. It has been suggested that the orally administered form is poorly absorbed and that it is best taken intra-venously,

Vitamin E

This vitamin has an anti-inflammatory action due to its effect on prostaglandin and leukotrine formation and it acts synergistically with other anti-oxidants as a free radical fighter. It inhibits the enzymatic breakdown of cartilage and stimulates cartilage synthesis. It should be taken in the form of d-alpha-tocopherol to a dose of 400 - 800 iu./day.

Vitamin C

As an essential nutrient for tissue repair, any deficiency of vitamin C will lead to poor healing. In combination with vitamin E, this vitamin will enhance the stability of the sulfated proteoglycans that make up cartilage and strengthen the tissue. It should be taken to bowel tolerance.

Eicosapentaenoic acid (EPA)

Supplementing the diet with fish oils that provide EPA enhances the formation of anti-inflammatory prostaglandins and inhibits the formation of the inflammatory leukotrines. Clinical trials have shown that 1.8 grams per day was an effective dose.

Selenium

This is a powerful free radical scavenger and anti-oxidant that appears to work synergistically with vitamin E and is a co-factor for glutathione peroxidase. It also inhibits the production of leukotrines. Serum levels of selenium may be low in people with fibromyalgia and this suggests that it is useful to supplement with 200 mcg./day.

Zinc

This is another anti-oxidant that may be low in people with fibromyalgia. It is also essential for tissue repair. A supplement of 25 - 50 mg./day may be helpful.

Manganese

This is a co-factor for SOD and is often low in people with musculoskeletal diseases. Supplementing with manganese at a dose of 15 mg./day increases SOD activity and thus minimizes free radical damage.

Pycnogenol or Grape seed extract

These are very powerful natural antioxidants and may help to reduce pain and stiffness and improve energy and mental alertness. Typical doses are 1 mg / lb body weight / day.

Co-enzyme Q 10

This serves to improve energy production in the mitochondria of the cells and may enhance the ability of muscles to work normally and increase stamina.

Green foods (chlorella, spirulina, wheat grass, barley greens etc)

These are rich in natural vitamins and minerals and also provide a high level of chlorophyll. They tend to support detoxification of the cells and improve oxygenation of the tissues which will lead to improved energy levels. 

Melatonin

This is a controversial newcomer to the supplement scene, classified in Canada as an 'experimental new drug' and available through GP's only by a special release from Ottawa. It is an extract, frequently now synthetic, from the pineal gland and is given orally at night to induce deep and restful sleep. It is also reputed to retard the aging process, contribute to tissue repair and to inhibit cancer. It is actually a hormone and so there is legitimate concern about the long term side-effects. At the present time it has not been in use long enough to judge the long term effects. The body naturally produces 0.5 mg each night. The usual dose is 3 - 6 mg nightly, but recent introduction of 0.5 mg capsules have given equally good results. It should be taken ½ hour before bed. 

Lifestyle

It is very important to exercise regularly. Stretching and warm up should always precede any more vigorous exercise although, at least at first, you probably won't have the stamina or energy to work out very much. Swimming, yoga, Tai Chi and walking are the preferred exercises. 

Rest and relaxation is very important. Even if sleep is poor the person should be encouraged to lie down at intervals during the day and, if amenable to the idea, meditation and visualization is helpful. When we are at rest our parasympathetic nervous system is predominant and the sympathetic nervous system is less active. It is during parasympathetic dominance that most tissue healing, recuperation and repair occur - hence we must take time to relax in order to heal. 

Massage therapy can be very helpful, especially trigger point therapy, although this is also very painful!

Heat applications (heating pads or a hot water bottle) are soothing for the pain and stiffness. Hot sulphur or other mineral baths may be very soothing and somewhat anti-inflammatory. A mineral bath may also be taken at home using Epsom salts. This will help to draw toxins out of the tissues and enhance peripheral circulation. 

Epsom salt bath

Put 2 cups of Epsom salts (Magnesium Sulphate) in a bath of water as hot as can be borne. Soak in it for 10-15 minutes. Get out of the bath and, still wet, wrap up in an old sheet. Go to bed with a hot water bottle and lots of blankets. This will promote diaphoresis and in the morning the sheet can be stained yellow with drawn out toxins. The regime can be repeated fortnightly until the sheet remains clean. 

Hot herbal baths may also be helpful in the treatment of fibromyalgia. Herbs to consider using would include Lavender., Hops or Chamomile for pain relief and general relaxation; Oregano, Rosemary, or Yarrow for circulatory stimulation. 

There are many herbal combinations that can be used to reduce muscle aching and stiffness, improve circulation, reduce brain fog, and, indeed to moderate or alleviate the multiple symptoms of this distressing condition. The accomplished herbal prescriber will build customized formulations for each individual person with their own unique set of symptoms. The general underlying principle will be the same, strengthen, tonify, cleanse, support, manage pain etc, but the specifics will be different for each person. No cures are expected but appropriate management can make it much more bearable. 
 

Fibromyalgia Association of BC
PO Box 15455 
Vancouver, BC, 
V6B 5B2