What is fibromyalgia?
Fibromyalgia is a chronic condition characterized by a generalized, aching pain. In the United States, an estimated 10 million people suffer from this disorder. Most are women of childbearing age.
What are the symptoms?
Fibromyalgia symptoms include aches and stiffness in muscles, tendons (which attach muscles to bone) and ligaments (which attach bones to each other). The pain can occur in any part of the body and can be widespread or localized. Symptoms typically develop gradually and frequently come and go in cycles. Women tend to experience more widespread problems, while men more often develop localized symptoms, such as pain in the shoulder.
- Pain. The pain is often described as a deep muscular aching that is either burning, throbbing or sharp. The pain and stiffness is often worse in the morning.
- Fatigue. The sensation of being drained of energy and unable to concentrate can vary from mild to incapacitating.
- Difficulty sleeping. Sleep does not feel refreshing; and fibromyalgia patients report feeling exhausted when they wake up.
- Sensitivities. About 50 percent of patients report sensitivities to noise, bright lights, odors, medications and certain foods.
- Chronic headaches. An estimated 50 percent of patients report migraines or tension headaches.
- Irritable Bowel Syndrome. Between 40 to 70 percent of patients experience diarrhea, constipation, and abdominal pain and gas.
Other symptoms may include dizziness or lightheadedness, menstrual cramping, jaw pain, numbness and tingling sensations, cognitive and memory problems (often called "fibro fog"), temporomandibular joint disorder, pelvic pain, restless leg syndrome, sensitivity to chemicals and temperature, and anxiety and depression. These symptoms can vary in intensity and, like the pain of fibromyalgia, wax and wane over time.
Because none of the symptoms is unique to this condition, physicians cannot make a diagnosis based on the presence of one or more of them. Instead, today's diagnostic criteria specify that patients must have had pain in four quadrants of the body for a minimum of three months and tenderness in at least 11 of 18 specific areas called "tender points" on the neck, shoulders, back, hips, arms or legs that hurt when touched.
What are the causes of fibromyalgia?
New research suggests that imbalances in the nervous system amplify normal sensation, making even a slight touch feel painful. This super-sensitivity to pain appears to be genetic. Fibromyalgia does run in families, and researchers have identified one gene believed to be involved in the syndrome. Patients also have higher-than-normal levels of a neuropeptide called substance P that is involved in the communication of pain signals to the brain, and lower-than-normal levels of the pain-mitigating hormones serotonin and norepinephrine.
Even if you are born with a genetic predisposition to fibromyalgia, you still need to experience something that triggers the disorder. This can be a viral infection, emotional stress, an accident or injury or, perhaps, exposure to certain drugs or chemicals.
What is the conventional treatment?
There is no single reliable treatment for fibromyalgia. It often requires a team approach, enlisting physicians who are familiar with the disorder (not all doctors are; in fact, some physicians argue that fibromyalgia isn't real since no physical signs can be detected by x-rays, blood tests or other diagnostic techniques).
Only a single pharmaceutical drug, pregabalin (Lyrica) has been approved by the FDA for treatment of fibromyalgia, but a number of other drugs are frequently used:
- Painkillers: These can range from familiar over-the-counter drugs such as acetaminophen (Tylenol) to prescription medicines, sometimes including narcotics, for those with severe muscle pain. However, no solid evidence has shown that narcotics are effective for the chronic pain of fibromyalgia and continued use presents a risk of physical or psychological dependence.
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): This category includes aspirin, ibuprofen (Advil, Motrin), and naproxen sodium (Anaprox, Aleve). These drugs work by inhibiting prostaglandins, substance which play a role in pain and inflammation. They can help relieve the muscle aches of fibromyalgia as well as the menstrual cramps and headaches often associated with the disorder.
- Antidepressants: These drugs help elevate levels of serotonin and norepinephrine in the central nervous system. Low levels of these chemicals are associated not only with depression, but with pain and fatigue. Tricyclic antidepressants taken at bedtime in dosages lower than those used to treat depression can help promote restorative sleep, relax painful muscles and heighten the effects of endorphins, the body's natural pain-killers. Other antidepressants, selective serotonin reuptake inhibitors (SSRIs), taken in doses lower than those used to treat depression, can reduce fatigue and some other symptoms associated with fibromyalgia. A combination of the tricyclic, amitriptyline, and the SSRI fluoxetine seems to relieve symptoms better than either drug alone.
- Benzodiazepines: Such as valium may be prescribed to help relax tense, painful muscles and stabilize the erratic brain waves that can interfere with deep sleep. These drugs can also relieve symptoms of restless legs syndrome, which is common among people with fibromyalgia. Because of the potential for addiction, doctors usually prescribe benzodiazepines only when other drugs haven't helped.
In addition, fibromyalgia treatment may include a combination of physical and occupational therapy, as well as instruction in pain-management and coping techniques, and in properly balancing rest and activity.
What natural treatment of fibromyalgia does Dr. Weil recommend?
The following lifestyle changes:
- Exercise. Regular exercise has proven one of the best treatments. Although muscle pain may worsen during exercise, the pain usually dissipates within 30 minutes. Stretching and low-impact aerobic activity (swimming, walking, yoga, or using cardiovascular machines like stationary bikes or elliptical trainers) are often the most effective.
- Regular sleeping habits. This is critical for reducing pain and improving energy and mood.
- Relaxation techniques. Meditation, yoga or breath work can help counteract stress.
- Cognitive-behavioral therapy. To learn how to cope better with symptoms and stress.
- Acupuncture or massage. Both are often helpful in relief of whole-body systemic conditions.
- The Feldenkrais Method. To correct poor posture or habits of movement that may contribute to pain.
Nutrition and Supplements
- A diet rich in organic fruits, vegetables, and whole grains can fortify your body's natural defenses and healing system.
- Eliminate polyunsaturated vegetable oils, margarine, vegetable shortening, all partially hydrogenated oils, and all foods (such as deep-fried foods) that might contain trans-fatty acids. Use extra-virgin olive oil as your principal fat.
- Increase intake of omega-3 fatty acids.
- Eat ginger and turmeric regularly for their anti-inflammatory effects.
- In addition to a daily antioxidant regimen, take 250 mg of magnesium and 500-700 mg of calcium daily to help relax and maintain nerves and muscles. (However, Dr. Weil does not recommend calcium supplements for men.) Boswellia and malic acid may also be beneficial.