Fibromyalgia

by Savvas Ioannides N.D.

Introduction

Fibromyalgia (FM) was once diagnosed as a psychological disorder because of an absence of objective findings on physical examination and usual laboratory and imaging evaluations. Many physicians still today do not accept FM as a discrete illness. However, recent clinical investigation has clarified the neurophysiologic bases for FM and has led to its new classification as a central sensitivity syndrome. Indeed, FM can now be considered a neurosensory disorder characterized, in part, by abnormalities in central nervous system pain processing.

Fibromyalgia typically presents in young or middle-aged females as persistent widespread pain, stiffness, fatigue, disrupted unrefreshing/poor sleep, and cognitive difficulties, often accompanied by multiple other unexplained symptoms, anxiety and/or depression, and functional impairment of daily living activities. These symptoms have neurophysiologic and endocrinologic underlying factors. However, these biologic aspects are likely to originate significantly from psychological, developmental, and socio-cultural variables that lead to chronic unrelieved stress and distress. Female sex, adverse experiences during childhood and a stressful environment and culture are important forerunners of FM. One must view FM from a bio-psycho-social viewpoint rather than biomedical.

In some patients with FM, negative emotional (such as depression and anxiety), motivational, and cognitive stressors dominate the clinical picture. This results in a self-sustaining neuro-endocrine cascade that contributes to flu-like symptoms, depressed mood, fatigue, myalgias, cognitive difficulties, and poor sleep. The biologic elements include pro-inflammatory cytokines, the Hypothalamic-Pituitary-Adrenal axis, other neuro-endocrine axes, and the autonomic nervous system.

The cause of FM remains unknown but appears to be multifactorial. Research has indicated a strong familial component to the development of FM. First-degree relatives of individuals with FM display an eightfold greater risk of developing FM than those in the general population. Family members of FM patients are also much more likely to have other regional pain syndromes such as Irritable Bowel Syndrome and headaches. It is common in 2-13% of population; approximately 80-90% women.

Investigations

  1. FM is diagnosed by exclusion of other diseases because patients with FM do not have characteristic or consistent abnormalities; it is determined by laboratory test results.
  2. Thyroid-stimulating hormone, Thyroid antibodies: Hypothyroidism shares many clinical features with FM, especially diffuse muscle pain and fatigue.
  3. Laboratory sleep assessment only if sleep does not improve with treatment (diet, nutrition, herbs and lifestyle), obtaining a formal assessment by a neurologist experienced in sleep disorders.

Herbal Medicine

Withania somnifera (Withania)

Withania is adaptogenic and tonic via a dopaminergic activity. It reduces stress, sedates and improves sleep. See article Combat Stress With Natural Remedies.

Hypericum perforatum (St John’s wort)

St John’s wort is an antidepressant, up-regulates 5-HT receptors, anxiolytic, antiviral and improves sleep patterns (SSRI action).

Glycyrrhiza glabra (Licorice)

Licorice is an adrenal tonic and adaptogen, anti-inflammatory, antioxidant, antiviral (EBV included), antidepressant (SSRI) and is indicated for chronic stress.

Gingko biloba (Gingko)

Gingko is a powerful antioxidant, vasodilator, improves blood flow, has serotonin and cholinergic effects and is neuroprotective. It is indicated in cerebral ischaemia possibly producing an antidepressant and anxiolytic activity. It increases peripheral and cerebral circulation. Decreased regional blood flow in thalamus and caudate nucleus, which are involved in abnormal central nociceptive processing and functional brain abnormalities may also be part of the pathophysiology of FM.

Bupleurum falcatum (Bupleurum)

Bupleurum is an immune modulator, hepatoprotective, nephroprotective and anti-inflammatory.

Other

Analgesic and anodyne herbs such as Corydalis ambiguaEschscholtzia californica andPiscidia erythrina are highly indicated.

Hypnotics such as Valeriana officinalisHumulus lupulus and Passiflora incarnata are also indicated where sleep abnormalities are present.

Capsicum species (chillies) ointment as a topical analgesic and rubefacient for pain relief.

Nutritional, Lifestyle, Referral, Other

Nutritional

  • A vegetarian or vegan diet has not significantly improved FM in clinical studies but a good wholesome naturopathic diet is imperative to control blood sugar and insulin levels and ultimately reduce pain perception. Fresh fruit, vegetables, wholegrain and lean meats are beneficial.
  • Eat organic food and drink filtered water due to chemical sensitivities.
  • Eliminate stimulants such as coffee and alcohol.
  • Increase water intake to 2 L/day

Supplements

  • Vitamin B Complex
  • Vitamin B12
  • Vitamin C
  • Vitamin E
  • Calcium and Magnesium
  • SAMe – Clinical trials have shown that SAMe improved the symptoms of pain, fatigue, morning stiffness and mood.

Lifestyle

Graded aerobic exercise (e.g. low-impact aerobics, walking, water aerobics, stationary bicycle) should start gently and progress gradually to endurance and strength training.

Acupuncture, relaxation training, visual imagery, distraction for pain management.

Begin a daily practice such as meditation or tai chi to reduce stress and enhance relaxation.

Heat, massage, and other treatments are useful. Diffuse and regional pain is improved by strategies such as sauna, hot baths and showers, hot mud, and massage.

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About Naturopathy by Savvas Ioannides
Savvas Ioannides is a Naturopathic, Herbal and GAPS Diet practitioner who studied at Nature Care College in Sydney. Savvas uses holistic and natural therapies including Herbal remedies and Nutrition to boost your vitality and help you achieve optimum levels of health.

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