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FIBROMYALGIA

By Dr. Keith E. Lewis
May 22, 2008


Fibromyalgia is a relatively a common disorder characterized by widespread diffuse muscle pain, stiffness, and disturbed sleep. People with fibromyalgia have pain that may last for months or even years. Some people with fibromyalgia will be in constant pain, varying from day to day. The disease or condition itself is very complicated, it is very poorly understood, and unfortunately there is not a specific diagnostic test that would indicate the presence of fibromyalgia. 

The American College of Rheumatology in 1990 actually developed a classification guide to identifying and diagnosing fibromyalgia. There has not yet been discovered a cause of fibromyalgia. However, there are many theories available currently as to the why. 

Fibromyalgia does tend to affect women more than men. It is estimated that approximately 80% of the patients diagnosed with fibromyalgia are women usually between the age of 30 and 60 years old. It has been guesstimated that approximately 10 million people in the United States have fibromyalgia and perhaps even 5% of the entire world's population. 

Patients with fibromyalgia present with a variety of different types of conditions and symptoms. This would include chronic fatigue, sleep disorders, numbness and tingling in various parts of their body, some degree of sexual dysfunction as well as a feeling of malaise and lethargy.

Although we do not really understand what causes fibromyalgia, there is ongoing research considering this condition. Recently researchers have been starting to rethink what causes fibromyalgia. Fibromyalgia at one time was thought to be only a musculoskelatal disorder. The neuro research is implicating the central nervous system as truly the cause. According to the some of the newest research, the disease is characterized by central sensitization of the spinal cord and central nervous system.  This sensitization may occur because of inflammatory cytokines that trigger inducible nitric oxide syntheses in muscle tissue. The inducible nitric oxide syntheses causes inappropriate stimulation of pain receptors and an increase in oxidants such as peroxynitrite radical and other ROS species. 

Many patients with fibromyalgia report that their symptoms began after they experienced some sort of a trauma, particularly trauma to the head or neck like a whiplash.

Fibromyalgia also seems to be aggravated by infection. Chronic viral infections have also been thought to be a possible trigger mechanism. Hormonal imbalances and hormonal deficiencies have also been included in this list. 

All people with fibromyalgia have widespread significant pain, oftentimes debilitating pain. One of the other symptoms that we have noticed with our patients and are also indicated in the medical literature is unrefreshing sleep. Patients go to bed tired, they wake up tired, muscle and joint stiffness which is chronic in nature, tension headache again chronic in nature with varying degrees of intensity day to day. Patients typically experience painful menstrual periods. They have irritable bowel activity with reoccurring diarrhea, constipation, vaginal pain and dryness, difficulty with concentration, and related cognitive function. These patients also typically are depressed and experience a variety of different mood disorders. Restless legs syndrome is a common symptom or condition associated with fibromyalgia. Patients also experience irritable bladders and urinary complaints such as urinary incontinence.

Fibromyalgia has also been associated with depression of the hypothalamic-pituitary-adrenal axis which oftentimes is called the HPA axis. Researchers believe this may be the cause or caused by the chronic pain and sleeplessness associated with the disease which tends to suppress or depress HPA activity including growth hormone, androgen, and cortisol levels.

As previously stated, diagnosis of fibromyalgia is very complicated and in fact no single test detection. The American College of Rheumatology has identified 18 pressure points that are sensitive to digital pressure. If in fact, 11 of these sites are positive for pain, then a diagnosis of fibromyalgia can be confirmed.

Another condition which is often associated with fibromyalgia oftentimes misdiagnosed as fibromyalgia is chronic fatigue syndrome. The researchers more recently believe that these two conditions are related and they have similar underlying mechanisms. Both the diseases affect women more than men, most commonly involved chronic debilitating fatigue, muscle pain, poor sleep, and difficulty with clear thinking, and both tend to last for months and years, and neither can be cured.

People with chronic fatigue sometimes often have a sore throat that can last for many months but that does not develop into an upper respiratory illness. Those patients with chronic fatigue syndrome also have swollen glands, run low grade fevers which we typically do not find in fibromyalgia patients. Patients with chronic fatigue also tend to have elevated blood antibodies and tender lymph nodes both of which are indicative of infections. Patients with fibromyalgia tend to find that mild exercise improves their overall sense of well being while patients with chronic fatigue syndrome normally find even the gentlest exercise debilitating. Patients with fibromyalgia also report that both heat and massage often reduces muscle pain and standing or sitting too long in a single position makes their pain significantly worse. These symptoms are not typical of one with chronic fatigue syndrome. 
Current conventional treatment which is not very effective in the treatment of fibromyalgia includes the following: Analgesics to kill pain, antidepressants to elevate mood and alleviate pain, and sleep agents to help promote rest.

Several nutritional supplements have also been found to be very effective in the treatment of fibromyalgia. Omega-3 fatty acids help fight inflammation and scavenge-free radicals. Antioxidants also aid in doing the same. Other antioxidants that have been helpful with the patients include selenium, vitamin C, and vitamin E. Hormonal therapy has also been suggested as a possible treatment for fibromyalgia patients. Trying to balance the HPA axis has been very beneficial, we have found when treating our patients in controlling their condition.

Boosting ATP or adenosine triphosphate levels producing the energy output of the mitochondria at a cellular level has also been very valuable in the treatment of fibromyalgia. Using a supplement called D-Ribose has been very effective for out patients and several studies have concluded that it is very beneficial in the treatment of fibromyalgia.

Magnesium and malic acid: Magnesium is essential for healthy muscle function. The enzymes that liberate energy from ATP require magnesium to function properly. 

A review of the studies reveals that magnesium and malic acid are found very scarcely in the blood vessels in people with fibromyalgia. Vitamin B6 pyridoxine is required to boost the action of magnesium and malic acid in creation of ATP. Coenzyme CoQ10 as well as alkatriene have also been shown to be very valuable in the production of ATP. In using combination with magnesium and D-Ribose, we have found tremendous change in our patients' ability to better manage their pain and control pain levels in general.

Rest is extremely important. Fibromyalgia patients typically do not sleep well. Melatonin is a pineal hormone that has been widely studied for its ability to produce sleep. In the body, melatonin is secreted in response to darkness causing sleepiness. Melatonin may be a benefit for sleep pattern.

Diet as previously stated is extremely important. Consume plenty of calcium for bone density. Foods high in calcium include milk, ice cream, yogurt, broccoli, hard cheese, oyster, sardines, spinach, and oranges. Apples are very high in malic acid and antioxidant important in limiting muscle pain. Blueberries have been shown to have higher antioxidants than any other fruit, vegetable, nut, or herb. Carbohydrates increase serotonin levels. Another supplement that helps improve the serotonin levels is HTP or 5-HTP.

Essential fatty acids reduce fatigue and protein helps improve mental alertness.

Caffeine is a strong stimulant, should be avoided particularly late in the day to ensure that it does not negatively impact sleep, and alcohol should never be used to mask the pain.
Exercise for fibromyalgia patients is extremely important but exercise should be performed in a very gradually progressing process. Walking, swimming, isometric and stretching exercises, supporting good posture, being ergonomically aware of chairs you sit in, beds you sleep in is extremely important. 

Tobacco use: People with fibromyalgia should not smoke. Smokers with fibromyalgia have low pain thresholds and more sleep problems than nonsmokers. Nicotine withdrawal can cause spasms and vascular constriction and it is worsened by smoking leading to increased numbness, burning, and tingling. 

Other treatments that one might try are massage, chiropractic, physical therapy, acupuncture, and psychotherapy. As previously stated, several supplements may be beneficial in the management of fibromyalgia. They would include D-Ribose, magnesium, malic acid, coenzyme Q10, alkatriene, vitamin B6, vitamin C, and omega-3 fatty acids. 


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