Symptoms, Causes & Treatment
Fibromyalgia is a chronic condition characterised by long-term, widespread pain and tenderness in the muscles, tendons, joints and other soft tissues that persists for at least 3 months.
Previously, diagnosis was based primarily on identification of 11 out of 18 tender points around the body. However, this criterion is no longer used and diagnosis is based on overall symptom picture along with exclusion of other disorders.
Most patients with fibromyalgia also experience fatigue, non-restorative sleep, depression and/or anxiety, headaches, irritable bowel syndrome and impaired cognition. Symptoms may vary in intensity or may come and go. It is most common in women (80%) aged 20 to 50.
Fibromyalgia is a syndrome of conditions and symptoms that require an individualized approach. Correcting multiple imbalances in a variety of systems such as the gastrointestinal system, HPA axis, brain-gut axis, detoxification and inflammation pathways and mitochondrial dysfunction if often required to recover from Fibromyalgia.
Causes of Fibromyalgia
- The cause of fibromyalgia is scientifically unknown. Genetic predisposition is thought to play a role. However, it is our diet, lifestyle and environment that impact our genes the most.
- Often an untreated gut condition such as a parasite or pathogenic bacteria overgrowth is at the core of the condition. Other times a traumatic event or chronic stress has caused major dysfunction in the HPA axis and stress response.
- Patients often attribute a precipitating event to the initial onset of symptoms e.g. a flu-like illness, or physical or emotional trauma. Lyme disease, Epstein Barr Virus, mould exposure etc are all common triggering causes on the condition.
- Possible mechanisms include:
- Mitochondrial dysfunction i.e. changes in glycolysis, increased lactate production, and low ATP and phosphocreatine synthesis
- Altered cerebral blood flow, neurotransmitter status (especially serotonin, which is found to be low in FM patients) and increased pain perception
- Nutritional deficiency e.g. magnesium, B-complex, vitamin D, B12 etc
- Adrenal hypo responsiveness and circadian rhythm abnormalities
- Immune dysregulation
Signs and symptoms of Fibromyalgia
- Widespread pain and tenderness in the soft tissues
- Pain originates from tender points in the back of the neck, shoulders, chest, lower back, hips, shins, elbows and knees
- Pain may be a deep ache, or shooting and burning
- Tendency to wake up with body aches and stiffness
- Pain may be worse with activity, cold, damp weather, anxiety and stress, or at night
- Fatigue: occurs in 90%
- Disordered sleep patterns: lack of restorative non-REM sleep – wakes in the morning feeling unrefreshed
- Mental/emotional disturbances: occur in over 50% e.g. depression, anxiety, poor concentration, forgetfulness, mood swings, irritability etc.
- Other symptoms include headaches, numbness and tingling, palpitations, IBS, and irritable bladder
- Chronic fatigue syndrome (often co-exists with fibromyalgia)
- Polymyalgia rheumatica
- Myofascial pain syndrome
- SLE (Lupus)
- Rheumatoid arthritis
TREATMENT STRATEGY FOR FIBROMYALGIA
- Reduce muscle pain, inflammation and spasm
- Reduce oxidative stress
- Support neurotransmitter production
- Support mitochondrial function
- Support circulation (of blood to brain and muscles)
- Support adrenal function
- Support thyroid function
- Support immune response
- Address digestive dysfunction
- Identify/address any nutritional deficiencies
- Improve sleep quality
- Manage stress
Diet plan guidelines for Fibromyalgia
- Fresh, whole food, mainly plant-based, alkalising, anti-inflammatory, antioxidant diet: Mediterranean style diet high in fresh fruit and vegetables, legumes, fish, nuts and seeds, olive oil. A Paleo or Auto-immune Pale (AIP) diet is often recommended at our clinic
- Identify and eliminate
any food allergens
- An elimination/challenge trial may be useful in uncovering sensitivities e.g. dairy, soy, citrus, peanuts, wheat, fish, eggs, corn, tomatoes, salicylates. Gluten sensitivity, in particular, is common. This is where an AIP diet works very well, especially for the first few months of treatment
- A rotation diet, in which the same food is not eaten more than once every four days, may be helpful in reducing sensitivities
- Minimise pro-inflammatory foods: sugar, refined carbohydrates, trans fats, excessive commercially raised red meat, omega-6 fatty acids, caffeine and alcohol
- Emphasise anti-inflammatory foods: in cold-water oily fish, berries, seeds, turmeric, ginger, green tea, olive oil
- Emphasise antioxidant-rich foods to promote tissue repair: berries, green tea, turmeric, fruits and vegetables
- Include probiotic and prebiotic foods: high fibre foods, yoghurt, kefir, fermented vegetables, kombucha, etc. (Pending status of gut testing)
Supplements that support Fibromyalgia
* Functional testing should be conducted before choosing supplements to correct imbalances, these supplements are examples that benefit fibromyalgia, targeted support specific to the individual patient is required
- Vitamin C and bioflavonoids – reduce inflammation and oxidative stress; support adrenal health
- Omega-3 fatty – reduce inflammation; support healthy neurotransmitter function; repair of mitochondrial cell membranes
- Bromelain – reduce systemic inflammation
- Magnesium – magnesium reduces muscle spasm and supports mitochondrial energy output. In combination with malic acid, shown to significantly improve pain and tenderness measures.
- B-complex – support energy output and neurotransmitter synthesis
- Coenzyme – support mitochondrial function and improve oxygenation of tissues
- N-acetyl cysteine – reduce oxidative stress and inflammation; improve endothelial function
- Acetyl-l carnitine- supports ATP production and reduces muscle pain, tenderness and depression
- GABA – down-regulates pain signals in the brain and helps manage anxiety and depression
- L-tryptophan – supports serotonin production, improves sleep, reduces pain, depression and anxiety
- SAMe – supports serotonin production, regulates methionine pathway and methylation
- D-ribose – needed for ATP synthesis; boosts energy, increases muscle recovery, improves exercise tolerance, relieves pain and fatigue
- Vitamin D3 – (dosage depends on vitamin D status): to support immune response
- Probiotics – pending gut testing
Herbal Medicine treatment that supports Fibromyalgia
** Herbs containing salicylates may exacerbate symptoms of fibromyalgia
- Reduce muscle pain – Jamaican dogwood, willow bark, corydalis
- Reduce muscle spasm – crampbark, valerian, skullcap
- Reduce inflammation – turmeric, boswellia, black cohosh, ginger, baical skullcap
- Reduce oxidative stress – turmeric, ginkgo
- Support neurotransmitter production – St John‘s wort, saffron, rhodiola (all raise serotonin levels in depressed patients)
- Support circulation – ginkgo, ginger, cinnamon, prickly ash
- Support adrenal function and immune response – rhodiola, withania, Korean ginseng, Siberian ginseng, schisandra, gotu kola, astragalus.
- Support thyroid function – withania, rehmannia
- Reduce nervous tension and improve sleep quality – skullcap, passionflower, chamomile, lavender, lemon balm
Lifestyle / Physical measures
- Regular, gentle exercise: crucial to improve energy and mood; a gentle, progressive exercise program should be introduced.
- Regular exposure to sunshine
- Stress management: yoga, tai chi, relaxation exercises
- Aromatherapy to relieve nervous exhaustion: essential oils of jasmine, lemon balm, rosemary and clary sage – place several drops in a warm bath, an atomiser or cotton ball
- Epsom salt baths: to soothe aching muscles
- Therapeutic massage is helpful in reducing stress-related symptoms, improving circulation and increasing the overall sense of well-being
Functional Medicine Treatment of Fibromyalgia
Fibromyalgia is a syndrome of symptoms that often develop from a single traumatic event or illness. Other times an untreated condition such as a parasite or virus compromises multiple body systems of the patients and causes the onset of Fibromyalgia.
To treat Fibromyalgia, an individualized and targeted approach is required. Utilising thorough testing of the gut, a comprehensive blood chemistry panel, organic acids test and other targeted testing is required to identify imbalances and crucial in developing a individualized treatment plan to return the patient to health.
At our Perth clinic of Advanced Functional Medicine we have treated many cases of Fibromyalgia, with a number of patients suffering for years prior to becoming a patient at our clinic. We treat the person, not the condition and have excellent results in assisting patients overcome Fibromyalgia.
If you, a family member or friend are suffering from Fibromyalgia we would love to hear from you. What treatments have worked best for you? Have you had your gut tested with a stool and SIBO test and if so, what was the outcome? Were you prescribed pharmaceutical medications?