If the muscles in your upper back and neck ache all the time for inexplicable reasons, it’s possible you have fibromyalgia. Virtually every day, patients (mainly women) come into the office with what turns out to be this condition. Either they describe long-standing symptoms associated with fibromyalgia, or they’re aware of their diagnosis but were told by their doctors that nothing could be done to help them. While at present no doctor, including me, can cure fibromyalgia, there is plenty we can do to help you feel better. In fact, our integrated approach, using conventional medicines, supplements, and other measures we recommend at WholeHealth Chicago, has produced real benefits for hundreds of my patients.
What is Fibromyalgia?
Fibromyalgia is an exceedingly common disorder affecting upwards of ten million Americans, mainly women. Its defining symptoms are widespread muscle pain, profound fatigue, and an inefficient sleep that fails to provide relief from the constant sense of tiredness. In fact, the word ‘fibromyalgia’ simply means “muscle pain” in Greek. I think the single most important piece of information a person newly diagnosed with fibromyalgia can receive is that real relief is possible. Your pain level can be dropped down from a ‘10’ to a ‘1’ or ‘2,’ your fatigue can diminish and you can actually sleep through the night and awaken refreshed.
It is very important to realize that ‘fibro’ defies our definition of disease. Its symptoms may imitate an autoimmune disease like rheumatoid arthritis, for example, but blood tests for autoimmune disease are never positive. In fact, in order for a doctor to diagnose fibromyalgia, virtually all blood tests and x-rays must be normal. And although symptoms can worsen over time, fibromyalgia will never progress to an extent that is dangerous to the sufferer’s overall health. But despite hearing “All your tests are normal,” fibromyalgia is NOT ‘all in your head,’ and if your current doctor is telling you to ‘live with it’ or ‘there’s nothing more you can do,’ then find another doctor.
Diagnosis. During their medical training, doctors are taught that a disease will always cause physical changes in the body. You can measure these changes by abnormal blood and urine tests, x-rays, scans, and even biopsies. Such abnormal changes within the body are considered “necessary” in order to call a condition an illness. Fibromyalgia is vastly different. Because this is a condition partially defined by having NO positive tests, there is a lingering prejudice among some physicians that fibromyalgia doesn’t really exist. As a consequence, many of its victims have been given inappropriate medications, or regarded as depressed and neurotic, or have even undergone unnecessary surgical procedures.
Unless your physician is willing to consider that a condition with so many symptoms can exist without any positive lab tests, he will have difficulty understanding fibromyalgia.
When fibromyalgia is high on a doctor’s “suspect list” of conditions to look for in his patient, the diagnosis is extremely easy. Added to the triad of (1) widespread muscle pain (lasting at least three months), (2) fatigue, and (3) unrefreshing sleep is the presence of so-called “tender points.” There are 18 of these points, located in a symmetrical pattern on the body, mainly in areas where fibrous tissues tie muscles to bones. Tender points are located at the base of the skull and on the neck, shoulders, upper chest (near the collarbone), elbows, inner knees, outer thighs, lower back, and buttocks.
When firm fingertip is applied to a tender point, a person with fibromyalgia will experience pain, (not discomfort, but PAIN) and in severe cases, can actually be brought to tears and feel lightheaded. The discomfort can actually be felt some minutes after the pressure is removed. As the physician is applying pressure to the tender points, it is very helpful if the patient appreciates the sensation of a similar pressure applied to a spot usually free of tender points (like the front of the thigh). Patients are often surprised at the contrast between a “neutral point” and a “tender point.”
A diagnosis of fibromyalgia is “official” when muscle pain and fatigue have lasted for at least three months, (with other possible causes of pain and tiredness ruled out), sleep is unrefreshing, and the patient reports pain to fingertip pressure at least 11 of the 18 tender points. If the patient has all the signs of fibromyalgia AND happens also to have positive blood/x-ray results of another condition (rheumatoid arthritis, for example), that person is felt to have two separate and distinct conditions.
Other factors. Fibromyalgia affects women more often than men, especially women between the ages of 20 and 50. Although fibromyalgia sometimes appears to be triggered by physical trauma, such as whiplash, more often the real culprit is a history of longstanding chronic emotional stress. In fact, the state of having fibromyalgia seems to be a consequence of changes the body undergoes when the so-called ‘stress response’ (also called ‘fight or flight’) lasts for an extended period of time. Many patients recall how their fibromyalgia began after what may have been one of the most stressful episodes of their entire lives.
In addition, patients frequently experience symptoms from other stress related conditions, including irritable bowel syndrome, temporomandibular joint dysfunction, migraine headaches, chronic anxiety and depression. Like fibromyalgia, the physical symptoms of these conditions are very real and often quite incapacitating, yet diagnostic tests are usually normal.
As far as the concept of chronic stress bringing about muscle pain, it’s helpful to consider how unconsciously all of us tense up our muscles when under emotional pressure. So just imagine keeping your muscles constantly tense, day in and day out and you’re setting the stage for fibromyalgia. Add to this the further stresses of fatigue, poor sleep, and having an undiagnosed or unsatisfactorily treated medical condition. Sadly, after just a few months, the misery of fibromyalgia settles in to becoming a way of life.
Fibromyalgia is frequently confused (even by physicians themselves) with the less common Chronic Fatigue Immune Deficiency Syndrome (CFS or CFIDS), a more disabling condition with added symptoms of a low grade fever, recurrent sore throat and swollen glands. Both conditions do have symptoms in common: fatigue, muscle pain, poor concentration, poor sleep, and symptoms of irritable bowel syndrome. And like fibromyalgia, the real causes of CFIDS are not completely understood. Unlike fibro, there are ‘positive’ lab tests with CFIDS which show subtle changes in the immune system. But CFIDS and fibromyalgia are two separate conditions.
- Chronic and widespread muscle aches, pain, and stiffness (usually at their worst in the morning) present for at least three months
- Extreme sensitivity to pressure in at least 11 of 18 specific tender points on the body
- Chronic or occasional deep fatigue, even after adequate sleep
- Unrefreshing or poor-quality, non-dreaming sleep
- Depression, often accompanied by anxiety
- Difficulty with concentration or performing once simple mental tasks, termed “brain fog” or “fibro-fog.”
- Occasional diarrhea or constipation, suggestive of irritable bowel syndrome
- Symptoms are often preceded by a triggering event. These may include: a period of severe emotional stress; an especially severe episode of the ‘flu; a severe whiplash type injury to the neck
What Causes Fibromyalgia?
Although the exact cause of fibromyalgia is unknown, many scientists relate the disorder to low levels of serotonin, a chemical that relays emotional messages throughout the brain and nervous system. Low levels of serotonin can occur in a variety of conditions, including depression, panic attacks, migraine headaches, severe premenstrual syndrome, and even irritable bowel syndrome. Serotonin abnormalities seem to run in families and are seen in different forms among the women of the same or multiple generations. Women are more susceptible to all the “low serotonin” disorders (both the emotional and the physical ones) because they start out in life with only 25% of the levels found in men.
Some researchers believe that up to 40% of the population may be susceptible to one of the many conditions now attributed to low levels of serotonin. However, “susceptible to” is not the same as actually experiencing one of these disorders. In order to actually fall victim to one of these ‘low serotonin’ conditions (whether depression, or fibromyalgia, or any of the others) usually a “triggering biographical event” in the person’s life is needed. Significant events can be either physical or emotional and play an extremely important role in getting the condition started. A person with an inherited serotonin defect can go for years without any symptoms at all. Then, after something like several weeks of severe emotional stress, the physical or emotional manifestations of the condition begin to occur. Specifically concerning fibromyalgia, it is possible that this serotonin lack is responsible not only for muscle pain but also such symptoms as “brain fog,” sensitivity to odors (like perfumes or chemicals), and the extreme sensitivity to the side effects of medications often seen among fibro patients.
Recently, some attention has been paid to a second chemical, called Substance P, which plays a role in the transmission of pain messages from the body to the brain. Very high levels of substance P may lead to the abnormal sensitivity to pain-producing stimuli present in people with fibromyalgia. Whether high levels of substance P occur because of the constant muscle contraction, or are the cause of the pain itself, is not known. One of the newer treatments for pain relief, applying small amounts of capsacin (cayenne pepper) cream to each tender point several times a day, is thought to work by depleting the accumulated Substance P surrounding the tender point itself.
A third factor in fibromyalgia research involves a system in the body called the hypothalamic-pituitary-adrenal axis. The hypothalamus is a small part of the brain that acts as a connecting link between our emotions and our endocrine glands. It sends messages to the pituitary, the master gland of our body, which controls our thyroid, adrenal, and sex glands (ovary/testes).
When we experience stress, the emotional signal is relayed from our brain (hypothalamus), through the pituitary, to our adrenal glands whose hormones (like adrenalin and cortisol) are involved in our physical response to stress (‘flight-or-fight’ phenomenon) which contract our muscles to run or fight. The response is meant for emergencies only. Quickly turned on, then quickly-off. But if the stress is nonstop, for weeks or months, the constant contraction of muscles becomes painful. And in time, the adrenals, left in the “on” position, simply become exhausted trying to perform their task efficiently. Understand the adrenals are not diseased in any way, just depleted. This depletion of our adrenal glands may be partially responsible for the fatigue of fibromyalgia
One extremely controversial area of exploration into a possible cause of fibromyalgia has emerged from neurosurgical research. Virtually all the symptoms of fibromyalgia including fatigue can occur when external pressure is placed on the upper part of the spinal cord as it emerges from the skull and passes through the upper bones of the spine. Two of these conditions, the Chiari malformation, and cervical stenosis (stenosis = narrowing), can be corrected by surgery with often dramatic relief of symptoms. Neurosurgeons who perform this procedure are very quick to point out that they are not offering a surgical cure for fibromyalgia, but that if a fibromyalgia patient happens to have one of these surgically correctable conditions, there may be some hope for relief of symptoms with an operation. Actual success from this surgery, which is undeniably an extremely risky operation, is not common and for this reason, most physicians have been very skeptical about its value.
Treatment and Prevention
The Conventional Medicine approach to fibromyalgia
Whether practicing conventional medicine, alternative medicine, or a blending of both the goal of fibromyalgia treatment should be fourfold: (1) relieve pain; (2) promote efficient and restful sleep; (3) relieve the severe fatigue; (4) end the ‘brain fog.’
Most conventional physicians start with an incorrect assumption: that the patient has a “chronic, incurable condition” which she will “have to learn to live with.” Then the doctor will try to deal with symptoms. The reason the first assumption is incorrect is that although the susceptibility to flare-ups of fibro are permanent, years, even decades can pass without any manifestations the condition.
The focus of conventional therapy is on pain relief and sleep improvement, with less attention paid to fatigue and brain fog. Most physicians will begin with an analgesic, usually a non-steroidal anti-inflammatory (NSAID) drug. This has always seemed an odd choice to me as there is no evidence of inflammation in the painful muscles, and indeed, most patients report little relief from these drugs. Numerous studies have shown that conventional physicians woefully undertreat patients in pain, fearing ‘addictions’ and ‘drug dependence’ that never seem to occur. I will discuss pain medications for fibromyalgia in the section “Our Approach to Fibromyalgia at WholeHealth Chicago.”
I join other conventional physicians and regularly prescribe a second group of medications used for muscle discomfort. These are the so-called muscle relaxants, like Flexeril™ (cyclobenzaprine) and Zanaflex.™ Drowsiness is the major side effect with these drugs and patients using the full dose will likely walk around in a mental fog. This side effect can be used to the fibro patient’s advantage, helping to promote a deep and efficient sleep. In fact, patients starting muscle relaxants often report their first good night’s sleep in years! For daytime use, only very tiny doses of Flexeril (like one-quarter of a tablet) may be fine.
Another medication getting mixed reviews for fibro pain is Neurontin™ (gabapentin). This was initially developed for epilepsy but has proven useful for any of the chronic pain syndromes.
An important group of medications used by most conventional physicians are the anti-depressants. For one reason or another, many patients are reluctant to use these. With justification, they will comment to their doctors how they wouldn’t be depressed if they weren’t in pain. Actually, the anti-depressants are being used to increase serotonin and would probably be more acceptable if they were re-named “serotonin increasers” rather than anti-depressants. At WholeHealth Chicago, we will use natural alternatives to raise serotonin, like St. John’s Wort and 5-HTP, only resorting to prescription medications if these fail. Some prescription medications include Elavil™ (amitryptiline) Effexor-XR™, Prozac™, Celexa™ and Wellbutrin™.
Since fibromyalgia symptoms will always improve when you start sleeping well, some doctors recommend a mild sleeping pill, even allowing it on a regular basis. The best of the prescription medicines seems to be Ambien™. Again, because fibromyalgia patients are very sensitive to medicines, one-half of the small size (5 mg.) tablet often works well. This can be used long term with virtually no ill effects.
Because of the controversy regarding the neurosurgical approach to fibromyalgia, it is unlikely your doctor will be sending you to a neurosurgeon. However, not a few patients complaining of pain in the neck and upper back have undergone diagnostic x-rays of the spine, are found to have a small herniated disc, and have undergone surgery. Since the disc wasn’t causing the symptoms, within a few weeks all their fibromyalgia symptoms return in full force. If you have been advised to have disc surgery but believe that fibromyalgia may actually be present, ALWAYS (but ALWAYS!) GET A SECOND OPINION. Even getting a consult from a good chiropractor may be worthwhile if you have the fortitude to endure the wrath of your surgeon when you tell him you’re seeing a chiropractor for a second opinion.
OUR APPROACH TO FIBROMYALGIA AT WHOLEHEALTH CHICAGO
A Detailed History. New patients are often surprised how we spend what seems an unusual amount of time reviewing the course of a person’s life. But all information, even facts about childhood and adolescence, is extremely important for both the doctor as well as the patient in an understanding of how and why fibromyalgia occurred. Many patients have been experiencing other manifestations of low serotonin disorders far longer than they thought. Regular childhood “tummy aches,” irritable bowel syndrome during finals week at college, episodes of depression and anxiety, visits to the dentist for TMJ pop up frequently as a person’s biography gets explored in depth.
Some tests, but not many. Fibromyalgia is a clinical and not a laboratory diagnosis. Therefore, extensive diagnostic testing is not helpful and you’re better off spending your health care dollar on therapy like acupuncture, a deep massage, or even a week at a spa. We use tests depending on the individual situation. There are no “standard tests” that apply to everybody.
· Complete blood count; chemistry and autoimmune profile: most patients have had these done already and if normal, need not be repeated. These must be “normal” to confirm the diagnosis of fibromyalgia.
· Thyroid gland function: underactive thyroid occurs regularly among chronically fatigued individuals. You will also be asked to measure your basal temperature. When this is unusually low, an underactive thyroid gland may be present even though blood tests are normal. If abnormalities are present, we prescribe only natural thyroid or Cytomel™
· Adrenal gland function: (Great Smokies Lab) since the adrenal gland can become “exhausted” from the chronic stress of fibro, it’s important to measure levels of cortisol and DHEA. If low, these are restored to normal.
Tests which depend on specific circumstances:
· Candida antibodies and culture. (Great Smokies Lab) Although no study has ever shown candida to be a sole cause of fibro, any patient with a history of heavy antibiotic use or recurrent vaginal infections, merits that candida be ruled out as a cause of chronic fatigue
· Comprehensive stool digestive analysis with testing for parasites. (Great Smokies)This test would only be recommended if chronic digestive symptoms, such as irritable bowel syndrome, accompany the fibromyalgia. Although intestinal parasites do not cause fibromyalgia, they certainly can contribute to chronic digestive symptoms.
· Female hormone levels. (Great Smokies) Some women experience fibromyalgia in almost exact synchronicity to PMS, even a ‘super-PMS’ lasting as long as three weeks. PMS is due to a combination of hormonal imbalance and low serotonin levels. Treating both hormonal imbalance and low serotonin levels can often produce a dramatic improvement in one’s sense of well-being.
At the end of your visit, you will be given a copy of “Your Healing Path,” an individually prepared summary of what will be planned during the next few days or weeks. On the Path, you see what tests have been ordered (and why), medications, nutritional supplements, dietary instructions, and (if needed) referrals to either conventional specialists or alternative practitioners.
1. Pain control. Fibromyalgia is a chronic pain syndrome and it is exceedingly important to break the cycle of “pain>impaired sleep>fatigue>increased stress>increased pain.” To do so, adequate pain medications are required. Probably because of their low levels of serotonin, fibro patients are extremely sensitive to medications (as well as chemicals, odors, etc.). Most pain can be diminished dramatically with very low doses of appropriate pain medications. Two groups of medicines work almost always without fail: tramodol (Ultram™, Ultracet™) and the opioids. Patients are skittish about using such medicines as Vicodin™, Oxycontin™ and the new Duragesic™ patch, usually with concerns about drug dependence or even addiction. Since the pain of fibro can melt away with virtually pediatric doses of these medicines, such problems simply do not occur. Addiction means using a medicine inappropriately, and for ‘sensations’ other than the drug was designed. Pain medicines were designed for chronic pain, and a fibro patient is using the drug appropriately. The commonest sentence we hear is that good pain control “gave me my life back.”
2. Sleep. The second major issue with fibro is sleep. It has long been recognized how fibromyalgia patients make dramatic improvements when they sleep well. In fact, some researchers believe that at it’s heart, fibro is a chronic sleep disorder. Many patients respond nicely to natural sleep therapies, like melatonin and valerian. Others require something stronger like Ambien™ or Restoril™. Recent studies have shown that Ambien can be used on a long term basis (up to three years) without any ill effects.
3. Relief from chronic fatigue. Usually the combination of pain control, efficient sleep and restoration of normal thyroid/adrenal function brings an end to fatigue. However, some cases of fibro are actually “fatigue-dominant” and require additional therapy. Although certain nutritional supplements can be effective, like ginseng and NADH, sometimes medications are necessary. Doctors specializing in fibro and chronic fatigue (including myself) find that Ritalin™ or the new Provigil™ can be very effective to relieve the constant and chronic fatigue.
4. Relief from brain fog. Again, by the time pain, sleep, and fatigue have been addressed, the patient experiences considerable improvement in memory, focus and concentration abilities. Interestingly, serotonin is well known as a necessary substance for brain cells to grow and mature, so that as serotonin rises, people actually feel ‘smarter.’ Some fascinating research has shown how nutritional supplements can improve brain fog. These include: acetyl-L-carnitine, phosphatidyl serine, phosphatidyl choline, gingko biloba and pregnenolone. Prescription drugs for debilitating brain fog include piracetam and selegine.
What makes the WholHealth Chicago approach to fibromyalgia truly unique is a team of practitioners having years of experience treating this condition using alternative therapies. Once a plan using medications and supplements has been outlined, the real progress begins when you use “alternative medicine.” We get our best results with the patient who has learned to combine the best medicines of both worlds, conventional and alternative.
How we select which therapy is ‘right’ for you
There is simply no formula when it comes to matching the “best” treatment or treatments for an individual case of fibromyalgia. Every person is unique and ultimately I can only offer my suggestions about what might be the best course for you to take. Among the many factors in decision-making might be: a significant “biographical” component to developing fibro (psychotherapy); a dominance of musculoskeletal symptoms along the neck and spine (chiropractic); the need for tension within the muscles to be released (deep tissue massage); an extremely complex combination of pain, fatigue, and emotional issues, dating back for years (traditional Chinese medicine, homeopathy).
Chiropractic. (Paul Rubin, D.C.) Chiropractic research has shown that some cases of fibromyalgia come about as a consequence of misalignment of the spine. If this is the case, you might benefit substantially from a series of adjustments to the neck and spine to correct this. A condition termed “post-traumatic fibromyalgia,” in which fibro symptoms can be dated from a physical injury, oftens responds especially well to chiropractic plus serotonin enhancing supplements/medications.
Traditional Chinese Medicine. (Mari Stecker, Lic. Ac.) In virtually all fields of alternative medicine, both symptoms and the development of disease are envisioned as imbalances of a person’s “vital force.” This is known as qi (pronounced ‘chee’) in Chinese medicine. Acupuncture and the judicious use of Chinese herbal combinations to balance one’s qi and can provide significant long lasting relief of fibromyalgia.
Massage. (Susan Barney, C.M.T.) Deep tissue massage, especially when performed on a regular basis, can have a dramatic effect on symptom control. Susan is extremely familiar with fibromyalgia and can provide deep tissue treatment to your painful ‘tender points.’.
Counseling. (Larry Stoler, Ph.D.) Since so much of fibromyalgia is triggered by how your body reacts to stress, psychotherapy is often necessary to explore what has been adversely affecting your life. Dr. Stoler teaches you to use an energy balancing technique called Chi-Lel to release muscle-knotting stress
Homeopathy. (M.J. Roman, Ph.D.) This two hundred year old field of medicine, widely practiced throughout the world (except in the U.S.) uses miniscule amounts of natural substances to trigger self-healing processes. As M.J. well knows, I refer my ‘tough’ cases to her. Those that have progressed nicely but seem to have reached a plateau, and need one more step to achieve a sense of ‘wellness.’
Important: For many patients, the real breakthrough in their fibromyalgia occurs when they appreciate the connection of their symptoms to longstanding stressors in their lives. For example, the discovery that fibromyalgia pain dramatically lessens during an extended vacation, or after a change in jobs can be eye-opening. For this reason, I frequently recommend that patients take a week at a health spa. There are dozens of these and not as expensive as you think. When, the fifth day of healthful eating, Yoga, massage, etc., you feel “well” for the first time in months or years, you’re finally “getting it” in regard to this condition. Of course, on returning home, and back to routine, your symptoms start coming back…well, it may be time for some counseling.
Nutritional supplements that relax muscles and raise serotonin levels, combined with regular aerobic exercise, massage, and relaxation techniques, can really help control the symptoms of fibromyalgia.
Frequently used nutritional supplements
NOTE: All nutritional supplements are available in our Natural Apothecary. You can order by telephone or send an e-mail to email@example.com. I personally recommend a telephone order (Anne Marie or Laura at 773-296-6700 ext. 2001) so that any questions you have about a product can be answered to your satisfaction.
The mineral magnesium, a natural muscle relaxant, has been found deficient in people with fibromyalgia. The product Fibroplex combines magnesium with malic acid to enhance absorption. In one preliminary study, fibromyalgia sufferers reported less pain and reduced muscle tenderness after two months on a treatment regimen that included high doses of magnesium and malic acid. Allow at least two months for results to begin to appear.
Fibroplex 120 tablets $23.98 (Dose: 2 tablets twice a day)
St. John’s wort (freeze dried, Eclectic Institute) and 5-HTP (5-hydroxytryptophan, Allergy Research) increase serotonin levels in the brain, help ease depression, and improve tolerance to pain. The 5-HTP makes more serotonin, while SJW prevents its breakdown. The end result is a slow but steady rise in serotonin levels.
St. Johns’ Wort, freeze dried: 90 capsules (450 mg.) $27.00 (Dose: 1 capsule twice a day with food)
5-HTP: 100 capsules (50 mg.) $32.80 (Dose: 1 capsule 2 or 3 times a day)
Coenzyme Q10 (PhytoPharmica) and NADH (Enada) may help relieve your symptoms if you have a significant component of fatigue with your fibromyalgia. Each of these is involved in maintaining the mitochondria, the energy producing unit of the cell. A recent study from the University of Texas found NADH very helpful in reducing the fatigue of fibromyalgia.
Co Q 10: 60 gelcaps (50 mg) $35.00 (Dose: one daily)
NADH: 30 tabs (5 mg.) $29.95 (Dose: 1 tab once or twice a day)
Phosphatidyl serine, Acetyl-L-Carnitine, Phosphatidyl choline are all involved in healthy mental functioning. For very severe brain fog, these are taken separately and in substantial doses. For the typical mid-to-moderate brain fog of fibromyalgia, a combination product by Amni can work extremely well
NeuroTone: 120 caps $56.00 (Dose: 1 or 2 capsules twice a day)
Melatonin (Douglas Labs) or the herb valerian (freeze dried, Eclectic Institute) can help you get to sleep more easily. It is well established by clinical studies and numerous patient observations that getting a good night’s sleep is one of the most valuable of therapies for fibromyalgia. For many patients, it’s virtually a rule of thumb that poor sleep equals a painful next day, and deep sleep means a much lower level of discomfort.
Melatonin: 60 caps (3 mg.) $8.00 (Dose: 1 or 2 caps at bedtime)
Valerian, freeze dried: 90 caps (500 mg.) $19.00 (Dose: 1 to 3 capsules at bedtime)
I used to recommend the herb kava (freeze dried, Eclectic Institute) which did double duty for someone with fibromyalgia, both acting as a mild tranquilizer (similar to Valium) and a non-sedating muscle relaxant. However, recent concerns have surfaced about the safety of kava when used long term, or with someone having a history of liver disease. I still will suggest a short course of kava in the right individual. Now, more often than not, an amino acid mix cutely named “Zen” (Allergy Research) acts in a similar fashion on the brain and musculoskeletal system.
Kava, freeze dried: (90 capsules) $19.00 (Dose: 1-3 capsules daily, as needed)
Zen: (50 capsules) $19.00 (Dose: 1-3 capsules daily, as needed)
Other supplements may be recommended, depending on the specific clinical condition
DHEA (dehydrepiandrosterone, PhytoPharmica), a key hormone secreted by the adrenal glands, DHEA often low in people with fibromyalgia. Supplements can help redress this deficiency; however, most experts feel this should be done under the direction of a physician.
DHEA 60 caps. (25 mg.) $8.00 (Dose: 1 capsule daily)
DHEA 60 caps. (5 mg.) $5.50 (Dose: 1 capsule daily)
A good adrenal support combination product may be needed when fatigue is a dominant symptom. If the adrenal hormone test (discussed above) shows adrenal exhaustion, a product containing two ginsengs (Panax and Siberian), vitamin B-5, and licorice may be a good idea
Adren-Plus 60 caps. $18.00 (Dose: 2 caps each morning)
Capsacin cream. A topical cream available by prescription (Zostrix™) and now sold over-the-counter was originally developed for the pain from herpes zoster (shingles). A recent study demonstrated unequivocal effectiveness in relieveing fibromyalgia pain. To use this correctly, locate your most painful tender points with fingertip pressure. Mark each with an ‘X’ using a skin marking pen. Then, several times a day, rub a pea-sized amount of the cream into the ‘X.’ After several days, this will reduce the pain causing “Substance P” located around the tender point. This treatment can be continued indefinitely. However, you’ll discover that once or twice a day is sufficient for maintenance.
Capsaicin Cream (Swedish Bitters) 15 gm. $19.95
A PMS herbal combination (Tyler Encapsulations) especially one containing the herb vitex (also called chasteberry) can be very beneficial for women whose fibromyalgia seems to get worse just before their menstrual period. A recent series of articles in conventional medical literature has only confirmed what herbalists have known for years, that Vitex does indeed balance hormones and reduces the physical symptoms of PMS
PMS Herbal 126 capsules $25.50 (Dose: 2 capsules twice a day when NOT menstruating)
SUMMARY OF SUPPLEMENTS
- Fibroplex (magnesium/malic acid
- Dose: Two tablets twice a day
- St. John’s Wort (freeze dried, 450 mg.)
- Dose: One capsule twice a day with food
- 5-HTP (5 hydroxy tryptohan, 50 mg.)
- Dose: One capsule twice a day
- Coenzyme Q-10 (Co Q 10, 50 mg.)
- Dose: One capsule daily
- Neurotone (acetyl-L-carnitine, phosphatidyl serine and choline)
- Dose: One or two capsules twice a day
- “Zen” (GABA, threonine)
- Dose: One capsule 2 or 3 times a day for anxiety
- PMS Herbal Combination
- Dose: 2 capsules twice a day when not menstruating
- Adren Plus (ginsengs, licorice, B-5)
- Dose: 2 capsules each morning
- DHEA (dehydroepiandroterone sulfate, 5 or 25 mg.)
- Dose: one capsule each morning
- Valerian (freeze dried, 500 mg.)
- Dose: 1-3 capsules at bedtime
- Melatonin (3 mg.)
- Dose: 1-2 capsules at bedtime
- Capsacin Cream
- Dose: apply to tender points 2-3 times a day
Eat smaller, more frequent meals. For proper muscle function, your body needs protein and carbohydrates throughout the day. To maintain a steady supply, eat several small meals during the day instead of three large ones. In addition, try to eat plenty of fruits and vegetables to get immune-boosting vitamin C, as well as foods high in magnesium, which helps muscle relaxation. Magnesium can be found in dark leafy greens, nuts, and pumpkin and sunflower seeds.
Cut back on alcohol, caffeine, and sugar. All three of these substances take away more energy than they give, and may even be contributing to your pain, sleep problems, and any depressive feelings you may be having. Try cutting caffeine and alcohol out of your diet for at least three months, at which time you can reintroduce them gradually and see how you feel. As far as sugar is concerned, it’s best to stay away from simple carbohydrates such as cookies and cakes, especially at bedtime.
Apply heat. To relieve pain and stiffness, reduce inflammation, and increase circulation, soak in a very hot bath to which you’ve added up to two cups of Epsom salt (magnesium sulfate) just before bed. Test the temperature of the water with your foot, not your hand, to make sure it’s hot enough. Keep adding more hot water from the tap while you are soaking. While still warm from the bath, go immediately to bed. Having the bed prewarmed with an electric blanket may allow a restful sleep and result in less pain on arising. On those days you awaken with a lot of discomfort, go immediately to a hot. If a bath is not convenient, you can take a hot shower o apply a heating pad instead.
Exercise regularly. Begin a gradual but steadily more difficult program of aerobic exercise. Instead of taxing already sore muscles, aerobic exercise seems to help ease the symptoms of fibromyalgia. If you haven’t been exercising, consult your doctor first, then start with low-impact activities such as walking, swimming, or bicycling. Be very careful not to overtax yourself with exercise or you’ll experience a real worsening of symptoms the following day.
Try to get plenty of sleep. Studies have shown that the severity of fibromyalgia pain during the day is directly proportional to the lack of sleep the previous night. Try to get at least eight hours of sleep at night. Sticking to a regular sleep schedule, even on weekends, can help. A firm mattress may minimize nocturnal muscle pain and also induce better sleep.
Do self-massage. Applying pressure to tender points can relieve pain and soreness. An S-shaped massage tool sold at health-food stores is extremely useful for pressing the difficult-to-reach tender points of your neck, shoulders, and upper back. These points tend to hold the greatest tension in many people.
Try meditation or yoga. If practiced consistently under the supervision of trained practitioners, mind-body techniques, such as meditation and yoga can help relieve muscle tension and stress, and improve sleep as well. Yoga will also help you become stronger, so you won’t tire as easily. Once you’ve learned meditation or yoga from an instructor, you should try practice at home morning and evening for at least 15 minutes.
When to Call a Doctor
- If you experience the symptoms of fibromyalgia for three months. (Call your doctor sooner if the condition keeps you from carrying out your day-to-day activities.)
- If you have severe difficulty sleeping
- If you are depressed
- If you have chronic muscle pain and other causes of your symptoms, such as flu or arthritis, have been eliminated as diagnostic possibilities.
- Berman BM, Swyers JP, Ezzo J. The evidence for acupuncture as a treatment for rheumatologic conditions. Rheum Dis Clin North Am 2000;26:103-115.
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From David Edelberg, M.D. at WholeHealth Chicago: As you may have discovered, heat from a hot bath or shower provides almost immediate (though temporary) relief. To achieve long-lasting effects, you’ll need to relieve stress, and work on lifestyle issues. Supplements will help to restore the integrity of your muscles, build up the serotonin levels in your brain, and help reduce stress.
How to Take the Supplements
Everyone should start with magnesium/malic acid, the herb St. John’s wort, and the amino acid 5-HTP. When used together, these last two seem very effective at raising serotonin levels (and pain tolerance). However, if you’re already taking a prescription antidepressant, don’t use these supplements without the approval of your doctor.
If low energy is a significant issue for you, add coenzyme Q10 and NADH (a relative of the B vitamin niacin), which help provide energy to muscle cells. Start the NADH at the lower dose for a couple of weeks; some people experience mild overstimulation if they begin at a higher level.
If your muscles feel especially tense, or if you emotional stress aggravates your condition, include the herb kava, which acts as both a nonsedating tranquilizer and a muscle relaxant. Most nutritionally oriented physicians also suggest a potent antioxidant; grape seed extract will take care of this nicely.
If you have low levels of the adrenal hormone DHEA, (and your doctor can do a blood test to measure it), getting those levels back to normal might improve your energy. Taking our recommended dose of DHEA for two months will bring most depleted levels back to normal. Then continue the same dose twice a week to maintain levels. (You can take DHEA along with all of the other supplements recommended here.)
If you are having trouble with poor concentration or short-term memory, the so-called “fibro fog,” then add the amino acid-like substance phosphatidylserine (PS). And finally, since the highly publicized antidepressant SAMe is rather expensive, I would hold off on taking it until after you’ve given the St. John’s wort adequate time to take effect. The St. John’s wort/5-HTP combination is so effective that I’d wait at least six weeks before adding SAMe to this.
Of special interest:
If getting a good night’s sleep is often difficult for you, try taking the some melatonin (1-3 mg) about a half hour before you go to bed.
If you have symptoms of irritable bowel along with your fibromyalgia, you definitely might benefit from using peppermint oil (1 or 2 capsules three times a day between meals).
If your fibromyalgia seems to get worse just before your menstrual period, a PMS herbal combination (2 capsules twice a day when not menstruating) may help you lessen your symptoms. Important:
We at WholeHealth Chicago strongly recommend that everyone take a high-potency multivitamin/mineral and well-balanced antioxidant complex every day. It may be necessary to adjust the dosages outlined below to account for your own daily vitamin regimen. All of our supplement recommendations also assume you are eating a healthful diet.
Be aware that certain cautions are associated with taking individual supplements, especially if you have other medical conditions and/or you’re taking medications. Key cautions are given in the listing below, but you need to see the WholeHealth Chicago Reference Library for a comprehensive discussion of each supplement’s cautions and drug/nutrient interactions. The Healing Path for Fibromyalgia provides more extensive therapeutic information about this condition.
For product recommendations and orders click here for the Natural Apothecary or call 773-296-6700 ext. 2001.
David Edelberg, MD