Fibromyalgia

Fibromyalgia Overview:

Fibromyalgia is considered a functional somatic syndrome, indicating the lack of an understanding towards its specific cause. Similar to chronic fatigue syndrome, fibromyalgia was once referred to as neurasthenia and was dismissed by doctors for hypochondriasis. This condition is very similar to chronic fatigue syndrome, and is only differentiated by the presence of musckuloskeletal pain in fibromyalgia, and fatigue in chronic fatigue syndrome.

Causes are thought to involve dysregulation of the HPA axis. This includes a dysfunction of pain modulatory systems within the central nervous system, immune and neuroendocrine dysfunction and dysautonomia.

 

Aetiology:

The main symptom of fibromyalgia is chronic, widespread pain. Other symptoms that are common include fatigue, sleep disturbances, mood disorders, and a reduction in concentration and memory. 

Neurophysiologic studies have identified abnormalities of pain processing at various levels in the nervous system in patients with fibromyalgia, although there not been found a single change unique to fibromyalgia. These changes include:

  • Peripheral sensitisation at the primary somatosensory neuron
  • Central sensitization at the level of the dorsal horn
  • Changes at the level of the thalamus and brain gray matter
  • Impairment of the natural pain inhibition mediated via descending pathways from the brainstem to the dorsal horn of the spinal cord, termed diffuse noxious inhibitory control.
 

Comorbidities:

Irritable bowel syndrome, migraine and chronic pelvic pain.

 

Symptoms:

Chronic, Multi-Regional Pain

Sleep Disturbances

Fatigue

Changes In Cognitive Function

Mood Disorders

Forgetfulness

Poor Concentration

Numbness or Tingling In The Fingers

Bladder Fullness

Nocturia

Dyspareunia

Frequent Side Effects To Drugs


Diagnostic Considerations:

The diagnosis of fibromyalgia is centred on widespread pain, and an absence of any physical findings that could indicate another condition. 

Lab testing that can be helpful with investigation (but not diagnosis) includes:

  • Full Blood Count
  • Erythrocyte Sedimentation Rate (ESR)
  • C-reactive protein (CRP)
  • Thyroid Functional Testing
  • HbA1c
  • Creatinine Kinase Levels
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Therapeutic Aims:

1. Support HPA Axis

  • Adaptogens (Rhodiola rosea, Eleutherococcus senticosus, Rehmannia glutinosa)
  • Adrenal Tonics (Rehmannia glutinosa, Glycyrrhiza glabra)

2. Improve Phase 1 & 2 Liver Detoxification

  • Hepatoprotectives (Silybum marianum, Cynara scolymus)

3. Reduce Pain Symptomatically

  • Analgesics (Eschscholzia californica)

4. Normalise And Promote Restorative Sleep

  • Sedatives (Zizyphus spinosa, Piper methysticum)
  • Nervine Relaxants (Passiflora incarnata)

5. Enhance Mood And Address Neurotransmitter Production

  • Thymoleptics (Hypericum perforatum)

6. Support Glucose Metabolism

  • Hypoglycemics (Panax ginseng, Gymnema sylvestris)
  • GLUT 4 Upregulators (Panax ginseng)

7. Improve Circulation

  • Peripheral Vasodilators ()
  • Vasodilators (Gingko biloba)

8. Address Autoimmune Symptoms (If Aplicable)

  • Immunomodulators (Ganoderma lucidum)

9. Address Associated Gastrointestinal Symptoms

  • Bitters (Cynara scolymus, Silybum marianum, Taraxicum officinalis)
 

Differential Diagnosis:

Diagnosis of fibromyalgia is primarily made via exclusion. There are currently no laboratory or clinical tests that can confimr fibromyalgia diagnosis. 

 

Cautions

  • Avoid using herbs with high salicylate content
  • 5-Hydroxytryptophan and Hypericum perforatum are contraindicated in conjunction with antidepressant use
 

Herbs For Fibromyalgia:

  • Astragalus membranaceus
  • Scutellaria lateriflora
  • Lavandula angustifolia
  • Hypericum perforatum
  • Valeriana officinalis
  • Virburnum opulus
  • Andrographis paniculata
 

Dietary Considerations:

  • Eliminate allergenic foods
  • Reduce refined CHO, SFA
  • Reduce OH, caffeine
  • Avoid glutamate (MSG)
  • Aspartate (aspartame)
  • Antioxidants
  • Increase EFA intake
 

Nutritional Considerations:

  • Vitamins A, C,E
  • CoQ10
  • Chromium
  • Calcium
  • 5-Hydroxytryptophan (contraindicated in conjunction with antidepressants)
  • B complex
  • Zinc
  • Melatonin
  • Vitamin D
  • EFA
  • Phosphatidyl choline and phosphatidyl serine
  • Iron
  • Mg
  • Acetyl-L-Carnitine
  • SAMe
 

Lifestyle Considerations:

  • Stress management
  • Epsom salt baths
  • Gentle exercise
  • Gentle yoga
  • Sleep hygiene
  • Acupuncture
  • Lymphatic massage
 

Author:

Justin Cooke

The Sunlight Experiment

Updated: November 2017


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