Fibromyalgia

fibromyalgia woman in pain all over
Fibromyalgia

Fibromyalgia

What is Fibromyalgia?

Fibromyalgia is a chronic condition where there is muscle pain at specific points throughout the body, often accompanied by fatigue, sleep and mood disturbances. Certain inflammatory substances produced by the nervous system, called cytokines, are elevated in patients with fibromyalgia.

What causes Fibromyalgia?

There are several theories as to what causes fibromyalgia:

Central Nervous System Hypersensitivity – Patients with fibromyalgia are thought to have a sensitized or hyperactive central nervous system that leads to an increased volume control on pain and sensory processing.

Sleep – Sleep deprivation or lack of quality sleep may play a significant role in the development of fibromyalgia.

MTHFR mutation – MTHFR is an enzyme required to convert inactive folic acid to it’s active form, 5MTHF.  5MTHF is necessary to prevent DNA damage and also to perform a liver detoxification step known as methylation.  Under methylators can experience symptoms such as those in fibromyalgia.

Mitochondrial dysfunction – every cell in your body contains a tiny organelle called the mitochondria, these are the energy generators for the cell.  As we age, mitochondrial function declines.  Many neurodegenerative disorders, diabetes, cancer, fibromyalgia, muscular and cardiovascular diseases have been associated with poor mitochondrial function.

Mineral deficiencies – Studies have noted a correlation between low levels of zinc and the number of tender points in FM and low levels of magnesium and greater fatigue in FM patients.

Tryptophan and nicotinamide deficiencies have also been suggested as a possible cause of fibromyalgia.

What are the symptoms of Fibromyalgia?

An easy memory device for the symptoms of fibromyalgia is the word FIBRO which stands for:

F = Fatigue and Fog (cognitive dysfunction)

I = Insomnia (difficulties with all aspects of sleep including initiation, maintenance and restorative)

B = Blues (depression and anxiety)

R = Rigidity (stiffness in muscles and joints)

O = Ow! (widespread pain and tenderness)

Is there a test for Fibromyalgia?

Fibromyalgia is mainly diagnosed by ruling out other conditions that might lead to widespread musculoskeletal pain, such as rheumatoid arthritis. There are certain points when if pressed in someone with fibromyalgia, will elicit pain.  I would also recommend testing for MTHFR genetic mutation and/or homocysteine (an indicator of an MTHFR defect), vitamin B12, and vitamin D.

What is the naturopathic treatment for Fibromyalgia?

Since fibromyalgia is related to a hyperactive central nervous system (CNS) response, it makes sense to take measures to calm the CNS.  Addressing and improving sleep issues is also important to break the vicious cycle of poor quality sleep and increased pain.

  1. Vitamin B12 is important for healthy nervous system function.  Studies have shown improvement in fibromyalgia (FM), with vitamin B12 injections along with folic acid supplementation.
  2. Vitamin D – low vitamin D levels have been found in patients with chronic pain and heightened central sensitivity.
  3. CoQ10 – Coenzyme Q10 is important for normal function of mitochondria and it’s a powerful antioxidant.
  4. Aloe vera – Research has found that aloe vera significantly reduces the inflammatory cytokines IL-8, TNFα, IL-6 and IL-1β in a dose dependent manner.
  5. Vitamin B1 – Case reports using high dose thiamine treatment in FM found a significant reduction in symptoms after treatment with vitamin B1.
  6. Address mineral deficiencies – Supplementing zinc and magnesium may help reduce the number of tender points and improve fatigue in FM.
  7. Address potential tryptophan and/or nicotinamide deficiencies.

A multidisciplinary approach is best to reduce the abnormal cycle of pain amplification and the related potentially exacerbating behaviours. Beneficial non-drug therapies include aerobic and resistance exercise, stretching, and cognitive behavioral therapy (CBT).

References

Clauw DJ. Fibromyalgia and Related Conditions. Mayo Clin Proc. 2015 May;90(5):680-692. doi: 10.1016/j.mayocp.2015.03.014.

Boomershine CS. Fibromyalgia: the Prototypical Central Sensitivity Syndrome. Curr Rheumatol Rev. 2015 Jun 18. [Epub ahead of print]

Choy EH. The role of sleep in pain and fibromyalgia. Nat Rev Rheumatol. 2015 Apr 28. doi: 10.1038/nrrheum.2015.56. [Epub ahead of print]

Regland B, Forsmark S, Halaouate L, Matousek M, Peilot B, Zachrisson O, Gottfries CG. Response to vitamin B12 and folic acid in myalgic encephalomyelitis and fibromyalgia. PLoS One. 2015 Apr 22;10(4):e0124648. doi: 10.1371/journal.pone.0124648. eCollection 2015.

Nichols TW Jr, Gaiteri C. Morton’s foot and pyridoxal 5′-phosphate deficiency: genetically linked traits. Med Hypotheses. 2014 Dec;83(6):644-8. doi: 10.1016/j.mehy.2014.09.003. Epub 2014 Sep 16.

von Känel R, Müller-Hartmannsgruber V, Kokinogenis G, Egloff N. Vitamin D and central hypersensitivity in patients with chronic pain. Pain Med. 2014 Sep;15(9):1609-18. doi: 10.1111/pme.12454. Epub 2014 Apr 14.

Garrido-Maraver J, Cordero MD, Oropesa-Avila M, Vega AF, de la Mata M, Pavon AD, Alcocer-Gomez E, Calero CP, Paz MV, Alanis M, de Lavera I, Cotan D, Sanchez-Alcazar JA. Clinical applications of coenzyme Q10. Front Biosci (Landmark Ed). 2014 Jan 1;19:619-33.

Sendur OF, Tastaban E, Turan Y, Ulman C. The relationship between serum trace element levels and clinical parameters in patients with fibromyalgia. Rheumatol Int. 2008 Sep;28(11):1117-21. doi: 10.1007/s00296-008-0593-9. Epub 2008 May 22.

Budai MM, Varga A, Milesz S, Tőzsér J, Benkő S. Aloe vera downregulates LPS-induced inflammatory cytokine production and expression of NLRP3 inflammasome in human macrophages. Mol Immunol. 2013 Dec;56(4):471-9. doi: 10.1016/j.molimm.2013.05.005. Epub 2013 Aug 1.

Costantini A, Pala MI, Tundo S, Matteucci P. High-dose thiamine improves the symptoms of fibromyalgia. BMJ Case Rep. 2013 May 20;2013. pii: bcr2013009019. doi: 10.1136/bcr-2013-009019.

Gheita TA, Sayed S, Gheita HA, Kenawy SA. Vitamin D status in rheumatoid arthritis patients: relation to clinical manifestations, disease activity, quality of life and fibromyalgia syndrome. Int J Rheum Dis. 2014 Oct 7. doi: 10.1111/1756-185X.12426. [Epub ahead of print]

Cordero MD, Alcocer-Gómez E, Culic O, Carrión AM, de Miguel M, Díaz-Parrado E, Pérez-Villegas EM, Bullón P, Battino M, Sánchez-Alcazar JA. NLRP3 inflammasome is activated in fibromyalgia: the effect of coenzyme Q10. Antioxid Redox Signal. 2014 Mar 10;20(8):1169-80. doi: 10.1089/ars.2013.5198. Epub 2013 Sep 19.

Blankfield A. Kynurenine Pathway Pathologies: do Nicotinamide and Other Pathway Co-Factors have a Therapeutic Role in Reduction of Symptom Severity, Including Chronic Fatigue Syndrome (CFS) and Fibromyalgia (FM). Int J Tryptophan Res. 2013 Jul 21;6(Suppl 1):39-45. doi: 10.4137/IJTR.S11193. Print 2013.

Summary
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Fibromyalgia
Description
Fibromyalgia is a pain syndrome characterized by tender points in muscles all over the body. It is associated with fatigue, poor sleep, depression and brain fog. It affects women more than men. The cause may be a number of factors related to normal function of the nervous system and muscles.
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