Fibromyalgia (FM) is a common, yet not well understood disorder that affects thousands of Canadians. The word fibromyalgia comes from the Latin term for fibrous tissue (fibro) and the Greek term for muscle (myo) and pain (algia). It is marked by widespread muscle pain, fatigue, and multiple tender points on specific areas of the body. The challenges with FM are that the symptoms are not clearly visible, and it cannot be diagnosed by a particular blood test or marker. As such, FM is still associated with a stigma among both medical professionals and the public. For those with FM, not being understood can be just as painful as the symptoms of the disease.

Defining Fibromyalgia

The American College of Rheumatology (ACR) has established two criteria for the diagnosis of FM: a history of widespread pain lasting more than 3 months and the presence of 11 or more tender points out of 18 standard sites on the body (neck, shoulders, back, hips, and upper and lower extremities).

Theories – Causes

While there are various theories and contributing factors, the underlying cause(s) are not known.  For many sufferers there is an event or experience that triggers the onset of the disease, such as an infection, emotional stress, trauma, injury or exposure to certain drugs or chemicals. According to a recent paper in the Annals of Internal Medicine, 33 percent of FM patients also suffer from multiple chemical sensitivity.

FM seems to run in families. Researchers have identified one gene believed to be involved in the syndrome. A new 4-year study funded by the National Institutes of Health (NIH) will examine this further.

Those with rheumatoid arthritis and other autoimmune diseases, such as lupus, appear to be at greater risk for developing FM.

Individuals with FM have elevated levels of a chemical, called substance P that is involved in our sensation of pain signals. They also have lower levels of serotonin and norepinephrine – two very important chemical messengers in the brain that modulate pain as well as mood.

A recent study has demonstrated that an imbalance of oxidants and antioxidants may be at play in the development of FM. Researchers from Turkey found significantly increased levels of the oxidant malondialdehyde and decreased levels of the antioxidant superoxide dismutase in patients with FM compared to controls.

Treatment for FM

A comprehensive program that includes counseling (emotional support), proper nutrition, exercise, stress management and the use of various supplements to reduce symptoms and improve well-being offers the greatest benefit for FM sufferers. In some cases medication may be required to control pain, inflammation and insomnia, however it is always best to try the non-drug approaches first.

The following nutritional supplements have been studied for their benefits in FM:

SAMe – short for S-adenosylmethionine, this nutrient is involved in many biochemical reactions in the body, including the production of neurotransmitters (serotonin), antioxidants, hormones and the sulfur-containing compounds of the joint. Levels are depleted with age and in those with depression, liver disorders and osteoarthritis. SAMe has been studied for FM and found to alleviate pain, fatigue, and stiffness and improve mood. SAMe is very safe and not associated with the unpleasant side effects seen with prescription antidepressants. The recommended dose is 800 mg of natural (Iso-Active) SAMe daily. It is best to choose a form that is enteric coated. Take on an empty stomach.

5-HTP – short for 5-hydroxytryptophan, this supplement helps to boost serotonin levels and alleviate depression symptoms. It may also be helpful in reducing tender points, anxiety and in improving sleep quality. It is not good to combine this supplement with prescription antidepressants or other drugs that modify serotonin levels. Recommended dose is 100 mg three times daily.

Melatonin – this hormone is responsible for regulating our sleep cycles. Supplementing with melatonin may help to shorten time needed to fall asleep, reduce night time wakening and improve sleep quality. In one study 3 mg of melatonin at bedtime was found to reduce tender points and to improve sleep and other measures of disease severity.

Antioxidants – preliminary research has found that vitamin E supplements could be helpful in improving the symptoms of FM. Considering the new research on the oxidant-antioxidant imbalance seen in FM, it makes sense to consider supplementing with a good antioxidant.

Magnesium – one study found that a combination of magnesium (300-600 mg) and malic acid (1200-2400 mg) helped to reduce muscle pain in people with fibromyalgia.

Since stress is known to aggravate the symptoms of FM, it is important to find ways to cope effectively. Here are some tips to consider:

  • Relaxation techniques, such as breathing exercises, meditation and yoga
  • Regular exercise, such as walking, swimming, stretching and Pilates
  • Healthful diet – lots of fresh fruits, vegetables, whole grains, lean protein and essential fats
  • Positive outlook – counseling and cognitive therapy can be very helpful
  • Sleep – important for overall well being
  • Minimizie alcohol, caffeine and consumption of fast food and processed food (which are full of dangerous chemicals and preservatives)

References:

Abraham G, Flechas J. Management of fibromyalgia: Rationale for the use of magnesium and malic acid. J Nutr Med 1992;3:49–59.

Barsky AJ, Borus JF. Functional somatic syndromes. Ann Intern Med. 1999 Jun 1;130(11):910-21.

Citera G, Arias MA, Maldonado-Cocco JA, et al. The effect of melatonin in patients with fibromyalgia: a pilot study. Clin Rheumatol 2000;19:9–13.

Caruso I, Sarzi Puttini P, Cazzola M, Azzolini V. Double-blind study of 5-hydroxytryptophan versus placebo in the treatment of primary fibromyalgia syndrome. J Int Med Res 1990;18:201–9.

Jacobsen S, Danneskiold-Samsoe B, Andersen RB. Oral S-adenosylmethionine in primary fibromyalgia: Double-blind clinical evaluation. Scand J Rheumatol 1991;20:294–302.

National Institute of Arthritis and Musculoskeletal Disorders and Skin Diseases,  NIH Publication NO. 04-5326 June 2004. Accessed November 8, 2004: http://www.niams.nih.gov/hi/topics/fibromyalgia/fibrofs.htm

Rheumatol Int 2003 Dec 20;[Epub ahead of print]. “Free radicals and antioxidants in primary fibromyalgia: an oxidative stress disorder?”