Fibromyalgia

Also indexed as: Fibromyositis, Fibrositis, Myofascial Pain Syndrome, Myofibrositis, Primary Fibromyalgia Syndrome

Fibromyalgia is a complex syndrome with no known cause or cure. Its predominant symptom is pain in the fibrous tissues, muscles, tendons, and ligaments, although other symptoms may be experienced. Research has demonstrated that the axis connecting the three glands primarily responsible for the stress response (hypothalamus, pituitary, adrenals) may be dysfunctional in people with fibromyalgia.1 Inflammation of the involved structures is generally absent in fibromyalgia.

Of the estimated three to six million people2 affected by this disorder in the United States, the vast majority are women between 25 and 45 years of age.

Checklist for Fibromyalgia

Rating Nutritional Supplements Herbs
2Stars 5-HTP
SAMe		  
1Star D-Ribose
Magnesium
Malic acid
Melatonin
Vitamin B1
Vitamin E		  
See also:  Homeopathic Remedies for Fibromyalgia
3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star An herb is primarily supported by traditional use, or the herb or supplement has little scientific support and/or minimal health benefit.

What are the symptoms of fibromyalgia? Trigger-point pain at characteristic locations is the defining symptom of fibromyalgia. The most commonly affected locations are on the occiput (nape of the neck), the neck itself, shoulders, trunk, low back, and thighs. Other symptoms may also be experienced, including fatigue, chest pain, low-grade fever, swollen lymph nodes, insomnia, frequent abdominal pain, irritable bowel syndrome, and depression.3

How is it treated? Treatment commonly involves a combination of medications, including one of several antidepressants, to diminish pain and improve sleep (e.g., amitriptyline [Elavil®], cyclobenzaprine [Flexeril®], fluoxetine [Prozac®], sertraline [Zoloft®], paroxetine [Paxil®], and fluvoxamine [Luvox®]). Low-impact exercise programs to improve aerobic fitness, stretching techniques to ease muscle tension, and cognitive therapy for coping with stress and emotional disorders are also included in conventional treatments. Numbing medicine can be sprayed onto or injected into trigger points to assist muscle stretching. Oral pain relievers, such as aspirin (e.g., Bayer®), ibuprofen (e.g., Advil®), and acetaminophen (Tylenol®), may also be recommended. However, one double-blind trial found no difference between ibuprofen and placebo with respect to treating fibromyalgia symptoms.4

Dietary changes that may be helpful: A vegan diet (includes no animal products) that is also low in salt may help women with fibromyalgia. In a controlled clinical trial,5 women with fibromyalgia were put on a special diet consisting only of raw foods—primarily fruits, vegetables, nuts, seeds, legumes, and cereals (such as rolled oats). The diet also contained several fermented foods, including a fermented yogurt-food made from oats, a fermented beverage made from wheat berries (called Rejuvalac), and several types of fermented vegetables, particularly cabbage. During the three-month trial, women following the therapeutic diet experienced a significant reduction in body weight, pain, morning sickness, use of painkillers, depression, and the number of sore fibromyalgia points, compared with those who continued to eat their regular diet. Due to the liberal use of nuts and seeds, this diet was not low in fat; for example, 31% of all calories came from fat. Nonetheless, the total number of calories was relatively low (less than 1,900 calories per day), which was probably responsible for the decrease in body weight.

In a preliminary report, four women with fibromyalgia experienced marked improvement or complete resolution of their symptoms within months after eliminating monosodium glutamate (MSG) or MSG plus aspartame from their diet. In each case, symptoms recurred whenever MSG was ingested.6

Lifestyle changes that may be helpful: Low-intensity exercise may improve fibromyalgia symptoms. People with fibromyalgia who exercise regularly have been reported to suffer less severe symptoms than those who remain sedentary.7 8 9 In a controlled trial, a program consisting of two 25-minute exercise classes plus two educational sessions per week for six weeks resulted in immediate and sustained improvement in walking distance, fatigue, and well-being in a group of people with fibromyalgia;10 however, no reductions in pain, anxiety, or depression were seen. In a more recent controlled trial, a 35-minute exercise program in a warm pool once a week for six months, coupled with counseling sessions, led to improvements in hand-grip strength and endurance, as well as to reductions in pain, distress, depression, and anxiety.11 The results of this trial, and other similar trials, suggest that underwater exercise training, in combination with a counseling intervention, should be considered by people with fibromyalgia.

Nutritional supplements that may be helpful: People with fibromyalgia often have low serotonin levels in their blood.12 13 14 Supplementation with 5-HTP may increase serotonin synthesis in these cases. Both preliminary15 16 and double-blind trials17 have reported that 5-HTP supplementation (100 mg three times per day) relieves some symptoms of fibromyalgia.

Some studies have found low vitamin B1 (thiamine) levels and reduced activity of some thiamine-dependent enzymes among people with fibromyalgia.18 19 The clinical significance of these findings remains unknown.

One early preliminary study described the use of vitamin E supplements in the treatment of “fibrositis”—the rough equivalent of what is today called fibromyalgia. Several dozen individuals were treated with vitamin E using amounts ranging from 100–300 IU per day. The results were positive and sometimes dramatic.20 Double-blind trials are needed to confirm these preliminary observations.

Intravenous S-adenosylmethionine (SAMe) given to people with fibromyalgia reduced pain and depression in two double-blind trials;21 22 but no benefit was seen in a short (ten-day) trial.23 Oral SAMe (800 mg per day for six weeks) was tested in one double-blind trial and significant beneficial effects were seen, such as reduced pain, fatigue, and stiffness, and improved mood.24

A preliminary trial found that a combination of magnesium and malic acid might lessen muscle pain in people with fibromyalgia.25 The amounts used in this trial were 300–600 mg of elemental magnesium and 1,200–2,400 mg of malic acid per day, taken for eight weeks. A double-blind trial by the same research group using 300 mg magnesium and 1,200 mg malic acid per day found no reduction in symptoms, however.26 Though these researchers claimed that magnesium and malic acid appeared to have some effect at higher levels (up to 600 mg magnesium and 2,400 mg malic acid), the positive effects were not demonstrated under blinded study conditions. Therefore, the evidence supporting the use of these supplements for people with fibromyalgia remains weak and inconclusive.

Melatonin supplementation may be useful in the treatment of fibromyalgia. In a preliminary trial, 3 mg of melatonin at bedtime was found to reduce tender points and to improve sleep and other measures of disease severity, though pain and fatigue improved only slightly.27

Are there any side effects or interactions? Refer to the individual supplement for information about any side effects or interactions.

Other integrative approaches that may be helpful: Stress is believed by some researchers to be capable of aggravating fibromyalgia symptoms. Stress-reduction techniques, such as meditation, have proven helpful in preliminary research.28

Acupuncture may be useful for short-term relief of fibromyalgia symptoms. In one preliminary trial, acupuncture produced a significant decrease in pain and point tenderness along with related biochemical changes measured in the fibromyalgia patients’ blood.29 Another uncontrolled trial used electroacupuncture (acupuncture with electrical stimulation) treatment in people with fibromyalgia who were unresponsive to conventional medical therapies. After an average of seven treatments per person, 46% claimed that electroacupuncture provided the best relief of symptoms when compared to all other therapies, and 64% reported using less medication for pain relief than prior to electroacupuncture.30 A double-blind trial compared fake acupuncture to electroacupuncture and reported significant differences in improvement in five of eight outcome measurements among people with fibromyalgia.31 Short-term pain reduction in people with fibromyalgia has been reported in other studies, some of which were at least partially controlled; however, long-term benefits have never been investigated in a controlled clinical trial.32 Long-term controlled trials are necessary to conclusively determine whether acupuncture is a useful treatment for fibromyalgia.

Joint manipulation, chiropractic, and related treatments may be helpful for relieving some of the symptoms of fibromyalgia. A preliminary study33 found that almost half of people with fibromyalgia who received chiropractic care had “moderate to good” improvement. A small preliminary trial34 evaluated the effect of four weeks of chiropractic treatment (three to five times per week) consisting of soft tissue massage, stretching, spinal manipulation, and general advice and information. Treatment resulted in a significant decrease in pain and an increase in range of neck movement, but there was no improvement in tender points or in ability to function in daily life. Another preliminary trial35 evaluated a longer treatment period (30 sessions) consisting of spinal manipulation and deep pressure massage to tender points in the muscles. More benefit was reported by this study, as 60% of the patients experienced significant pain reduction, reduced sensed of fatigue, and improved sleep. These benefits persisted one month after the treatment was completed. People who did not feel better after 15 treatments were not likely to benefit from this type of treatment. No controlled research has evaluated manipulation therapies for fibromyalgia.

References:

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