Fibromyalgia

Fibromyalgia syndrome (FMS) is characterized by pain in the muscles and bones trouble sleeping (or waking up feeling tired) and multiple tender points on the body. FMS while different for everyone who has it tends to come and go throughout life. It is not deforming degenerative life-threatening or imaginary.

Signs and Symptoms

• Fatigue
• Morning stiffness
• Paresthesia (tingling)
• Raynaud's phenomenon
• Skin sensitivity
• Headaches
• Psychological disturbances
• Pain after exertion
• Memory lapses
• Sleep disorders
• Restless leg syndrome
• Dizziness
• Irritable bowel syndrome
• Joint pain and swelling

What Causes It?

The tendency to get FMS may be inherited. Illness or physical trauma such as an accident often precedes FMS symptoms. Many patients report a history of psychological problems such as depression or anxiety.

What to Expect at Your Provider's Office

Although FMS does not show up in laboratory and imaging tests your provider must perform them to rule out other causes of your symptoms. Your provider will also perform a physical examination of your joints. Be sure to tell your provider about all of your symptoms.

Treatment Options

Treatment Plan

The goal of treatment is to help you function as well as possible on a day-to-day basis. It probably will not be possible to get rid of all of your symptoms. However various drugs are available to relieve many of the symptoms.

Drug Therapies

Prescription

Sleep disturbances:

• Tricyclic antidepressants—for example amitriptyline or cyclobenzaprine; can be helpful in low doses; it may take some time to find the specific tricyclic antidepressant that works for you; various side effects
• Benzodiazepines—used when tricyclic antidepressants are not effective; you can become dependent on these drugs; various side effects

• Tricyclic antidepressants—for example fluoxetine; various side effects
• Sedative-hypnotics— for example alprazolam; various side effects

• Lidocaine or procaine—injected into trigger points (points of greatest pain)
• Opiates—for example tramadol; potentially addictive limit use to flare-ups only
• Capsaicin—a cream that is rubbed on the skin at the area of pain

Over the Counter

• Ibuprofen—may briefly reduce some pain; can help in relieving depression insomnia and pain when used with some of the tricyclic antidepressants; various side effects

Complementary and Alternative Therapies

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

Nutrition

• Eliminate all food allergens from the diet. Common allergenic foods are dairy soy citrus peanuts wheat fish eggs corn and tomatoes. Try an elimination trial: Remove suspected allergens from the diet for two weeks. Reintroduce one food every three days. Watch for reactions such as gastrointestinal upset mood changes flushing fatigue and worsening of symptoms. A rotation diet in which the same food is not eaten more than once every four days may reduce sensitivities.
• Decrease carbohydrate intake; increase protein; fats in moderation.
• Eliminate inflammatory foods such as refined foods sugar saturated fats (meat and dairy products) alcohol and caffeine.
• Eat whole foods such as vegetables whole grains fruits protein and essential fatty acids (cold-water fish nuts and seeds).
• Vitamin C (1 000 mg three to four times per day) reduces swelling and helps your immune system function better.
• Coenzyme Q10 (50 to 100 mg one to two times per day) improves oxygen delivery to tissues and has antioxidant activity.
• Chromium picolinate (200 mcg with meals) may reduce reactive hypoglycemia which may make your symptoms worse.
• Magnesium (200 mg two to three times per day) with malic acid (1 200 mg one to two times per day) relieves pain and fatigue.
• 5-Hydroxytryptophan (100 mg three times per day) may help with depression and insomnia.
• B vitamins help reduce the effects of stress: B-complex (50 to 100 mg per day) niacinamide (100 mg per day) and B₆ (100 mg per day).
• Melatonin (0.5 to 3 mg one time before bed) may help sleep.
• Zinc (30 mg per day) is essential for proper immune function.
• Phosphatidyl choline and phosphatidyl serine (300 mg per day) may help depression and improve memory.

Herbs

Herbs may be used as dried extracts (capsules powders teas) glycerites (glycerine extracts) or tinctures (alcohol extracts). Teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers; 10 to 20 minutes for roots. Drink 2 to 4 cups per day.

The following herbs may help increase resistance to stress and strengthen the immune system. Siberian ginseng (Eleuthrococcus senticosus) schizandra berry (Schizandra chinensis) ashwaganda root (Withania somnifera) gotu kola (Centella asiatica) and astragalus root (Astragalus membranaceus). Use ginseng alone or with equal parts of two to three herbs. Take 20 to 30 drops two to three times per day. These may need to be taken for four to six months for maximum benefit.

Herbs that alleviate pain and nervous tension include the following: black cohosh (Cimicifuga racemosa) kava kava (Piper methysticum) skullcap (Scutellaria laterifolia) passionflower (Passiflora incarnata) lavender (Lavendula officinalis) and valerian (Valeriana officinalis). Combine equal parts and take as a tincture 20 to 30 drops two to three times per day.

Essential oils of jasmine lemon balm rosemary and clary sage relieve nervous exhaustion and may be used in aromatherapy. Place several drops in a warm bath or atomizer or on a cotton ball and inhale.

Homeopathy

Homeopathy may be useful as a supportive therapy.

Physical Medicine

Two to four cups of Epsom salts in a warm bath can soothe aching muscles.

Acupuncture

Acupuncture treatment may be helpful in stimulating circulation and promoting a sense of well-being.

Massage

Massage may reduce stress and improving circulation.

Following Up

Education and support groups may help you manage your condition.

Supporting Research

Abraham GE Flechas JG. Management of fibromyalgia: rationale for the use of magnesium and malic acid. J Nutr Med. 1992;3:49–59.

Caruso I Sarzi Puttini P Cazzola M et al. Double-blind study of 5-hydroxytryptophan versus placebo in the treatment of primary fibromyalgia syndrome. J Int Med Res. 1990;18:201–209.

Chaitow L. Fibromyalgia: the muscle pain epidemic. Part I. Available at: www.healty.net/library/articles/chaitow/fibromy/fibro1.htm.

Fauci AS Braunwald E Isselbacher KJ et al eds. Harrison's Principles of Internal Medicine. 14th ed. New York NY: McGraw-Hill; 1998:1955–1957.

Holland NW Gonzalez EB. Soft tissue problems in older adults. Clin Geriatr Med. 1998;14:601–603.

Kelley WN ed. Textbook of Rheumatology. 5th ed. Philadelphia Pa: WB Saunders; 1997:511–518.

Koopman WJ. Arthritis and Allied Conditions: A Textbook of Rheumatology. 13th ed. Baltimore Md: Williams & Wilkins; 1993:1619–1635.

Nicolodi M Sicuteri F. Fibromyalgia and migraine two faces of the same mechanism. Serotonin as the common clue for pathogenesis and therapy. Adv Exp Med Biol. 1996;398:373–379.

Romano TJ Stiller JW. Magnesium deficiency in fibromyalgia syndrome. J Nutri Med. 1994;4:165–167.

Russell IJ. Fibromyalgia syndrome: formulating a strategy for relief. J Musculoskel Med. 1998;November:4–21.

Starlanyl D Copeland M. Fibromyalgia and Chronic Myofascial Pain Syndrome: A Survival Manual. Oakland Calif: New Harbinger Publications Inc; 1996:215–224 227–235.

Tyler VE. Herbs of Choice: The Therapeutic Use of Phytomedicinals. New York NY: Haworth Press; 1994.

Wolfe F Smyth HA Yunus MB et al. American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia: report of the Multicenter Criteria Committee. Arthritis Rheum. 1990;33:160–172.

Copyright © 2000 Integrative Medicine Communications

The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application use or misuse of any of the information contained herein including any injury and/or damage to any person or property as a matter of product liability negligence or otherwise. No warranty expressed or implied is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. This material is not intended as a guide to self-medication. The reader is advised to discuss the information provided here with a doctor pharmacist nurse or other authorized healthcare practitioner and to check product information (including package inserts) regarding dosage precautions warnings interactions and contraindications before administering any drug herb or supplement discussed herein.