What is fibromyalgia syndrome?
Fibromyalgia is a pain disorder characterised by profound fatigue and chronic, widespread pain and tenderness, at ‘trigger points’, in the joints, muscles, and other soft tissues. As well as increased sensitivity to pain and sensory stimuli such as noise, heat, cold, and smells, fibromyalgia sufferers experience sleep disturbance related to pain, numbness or tingling, and cognitive dysfunction.
The name fibromyalgia comes from ‘fibro’ for fibrous tissues, ‘my’ for muscles, and ‘algia’ for pain. Primarily a central nervous system disorder, the pain results from neuro-chemical imbalances, including the initiation of inflammatory pathway in the brain, which leads to abnormal pain processing. In other words, the brain mistakenly over-reacts to pressure and exaggerates the feeling of pain.
The brain tissues of a person with fibromyalgia syndrome appears abnormal and functions incorrectly, but whether the brain abnormalities are directly responsible for the condition, or are secondary to some other cause remains unclear.
Allodynia means a heightened and painful response to a stimulus that usually does not cause pain. A person with fibromyalgia has allodynia of the soft tissues at ‘trigger points’ around the shoulders, thighs, knees, and across the lower back.
People with fibromyalgia describe the pain as diffuse aching or burning, from head to toe that varies in intensity and location, but is usually felt in the parts of the body used most. The degree of fatigue ranges from simply feeling more tired than usual without reason to complete exhaustion, which comes on suddenly.
Fibromyalgia is more common than rheumatoid arthritis and the pain can be just as severe as the pain experienced with rheumatoid arthritis. With appropriate treatment a person with mild to moderate symptoms can maintain day-to-day activities and manage a modest workload. However, a person with severe symptoms may not be able to cope daily activities such as working, looking after a family, or socialising.
Each person has his or her unique set of symptoms, which can be mild, moderate, or severe. Symptoms can present on a constant daily basis, come and go over months or weeks, and even disappear for extended periods.
Fibromyalgia can be a challenge to diagnose. Diagnostic blood tests, x-rays, or scans rely on inflammation or joint damage to diagnose pathology, but these signs aren’t present in fibromyalgia. However, these diagnostic tests are useful in ruling out other conditions that might be the cause of pain.
No cure is available for fibromyalgia, but pain medication and anti-inflammatory drugs can relieve symptoms.
Conventional medical treatment for fibromyalgia
Fibromyalgia is one of the most common reasons for being referred
to a rheumatologist. The condition involves widespread pain accompanied by fatigue, sleep disturbance, and heightened tenderness to touch. Fibromyalgia does not involve any damage to the joints or muscles that can explain the symptoms.
Your doctor may refer you to a rheumatologist for treatment of fibromyalgia. Because rheumatologists treat other musculoskeletal conditions such as arthritis, they understand the effects of chronic pain and fatigue. Treatments aim to improve sleep, stretch muscles that have been affected by spasm, rebuild muscle symmetry, and restore stamina through exercise.
Conventional medical treatment aims to relieve pain symptoms and improve sleep quality. Not all medications work the same way for every person, so pain management can take time to achieve good results. Regular review by a medical doctor is needed, in order to ensure medication is effective.
Five types of medications are used to treat fibromyalgia – antidepressants, anticonvulsants, narcolepsy drugs, pan relievers, and sleep aides. These medications act on the brain chemistry to reduce pain, improve quality of sleep, and ease anxiety or depression.
While certain over-the-counter medications may help relieve the pain of fibromyalgia, a person with severe pain may require the expertise of a pain specialist at a hospital-based pain clinic.
Fibromyalgia patients often suffer with depression so antidepressant drugs are often prescribed to manage different aspects of the illness. Tricyclic antidepressant drugs are often prescribed as these drugs will help both sleep and pain, and can improve energy levels and a person’s capacity to function normally.
SSRI antidepressants: Prozac (fluoxetine), Zoloft (sertraline), Aropax (paroxetine)
SNRI antidepressants: Cymbalta (duloxetine), Pristiq (Desvenlafaxine), Milnacipran (savella)
Tricyclic antidepressants: Endep (amitriptyline), GenRx Clomipramine (Clomipramine)
The Australian Therapeutic Goods Association has approved Milnacipran, a mixed serotonin-norepinephrine reuptake inhibitor (SNRI), for the treatment of fibromyalgia.
Learning how to manage fibromyalgia can be the best way to deal with the condition. A combination of medication, heat, rest, exercise, and stress reduction will enable a person with fibromyalgia to retain a worthwhile life.
Getting the right support from family, friends and other people who have fibromyalgia can be invaluable. Professional counselling may help a person to cope with the changes brought on by the illness. Playing an active role in treatment, by staying informed, will maximise the benefits.
Nutritional medicine treatment for fibromyalgia syndrome
Nutritional medicine treatment for fibromyalgia syndrome employs vitamin and mineral supplementation to boost the immune system, ease pain, and increase energy supply. A nutritional specialist will first take a detailed history and then assess for any nutrient deficiencies.
According to the US National Fibromyalgia Research Association, when refined sugar, caffeine, alcohol, fried foods, red meat, and processed foods are eliminated, or significantly reduced, fibromyalgia symptoms are reduced. Today’s Western diet contains many of these foods, which tend to irritate muscles and affect the immune system.
Many people with fibromyalgia are very sensitive to refined sugar. Unfortunately, many people with fibromyalgia eat high-GI carbohydrates and sugar to boost energy levels. While this provides a short-term boost, too much sugar will lead to too much insulin and eventually blood sugar becomes abnormally low, called hypoglycemia, and stress hormones are released.
Learning about and eating low-GI carbohydrates will prevent the roller coaster ride caused by high-GI carbohydrates. The elimination of refined sugar from the diet enables the body to better manage blood glucose levels, when carbohydrates are eaten.
More than 75% of people with fibromyalgia have some type of sleep disturbance. A good night’s sleep most nights is essential for the body to repair and restore, which is particularly important for a person with chronic aches and pains. A person with fibromyalgia should avoid or reduce stimulants such as caffeine, alcohol, chocolate, and refined sugar as these foods can interfere with normal sleep patterns, and enhance fatigue.
Increasing the intake of green leafy vegetables will provide optimal nutrition. When it comes to quantity, these foods offer so much benefit, eat as much as you desire, within reason. In general, try to eat at least five servings of vegetables each day (excluding potato chips or other deep fried vegetable).
The vitamins, minerals, and disease-fighting phytochemicals in leafy greens keep pain and inflammation under control and the fibre lowers cholesterol, controls blood pressure, balances glucose levels, and aids digestive health. A variety of leafy green vegetables can provide calcium, potassium, beta-carotene, folate, and vitamins A, C, E and K.
An adequate amount of lean protein, whey protein, and creatine monohydrate will help support the musculoskeletal system in its repair process. Proteins contain essential amino acids that are important for muscle health.
Avoid or reduce the amount of processed foods, which generally contain saturated and hydrogenated fats and refined sugar. Processed foods cause harm in two ways, both of which are pro-inflammatory.
An elimination diet is used to systematically evaluate whether a certain food causes or worsens symptoms. Foods that tend to provoke allergic reaction are eliminated from the diet for at least 10 days (Mel check). The most common problem foods are grains that contain gluten (wheat, rye, oats), dairy products, eggs, corn, soy and tofu, peanuts, citrus fruits, yeast, refined sugars, caffeine, alcohol. Processed foods should be avoided as they usually contain chemical additives, preservatives, artificial colourings and flavourings.
Each day, one particular food is returned to the diet to establish whether symptoms recur. The process might need to be repeated in order to clearly establish which foods are problematic.
Eating a diet of mainly raw or lightly cooked fruits and vegetables, with far less high-fat meat and more fish or lean poultry, promotes better health in general.
A vegan, gluten-free diet has been shown to help relieve pain, improve quality of sleep, and enhance overall health in fibromyalgia patients. This type of diet reduces the intake of foods known to promote inflammation due to oxidative stress and favours foods with anti-inflammatory properties that lessen free radical production and enable oxidation.
These nutritional tips may help reduce symptoms:
- Eliminate potential food allergens – dairy, wheat (gluten), corn, soy, preservatives, food additives
- Get tested for food allergies and intolerances
- Eat antioxidant foods – fruits (such as blueberries, cherries, and tomatoes) and vegetables (such as kale, spinach, and capsicum)
- Avoid refined foods – white breads, pastas, sugar
- Eat less red meat and more lean meat, fish, tofu, or beans for protein
- Use healthy cooking oils – such as olive oil or coconut oil
- Reduce or eliminate trans fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, margarine
- Avoid alcohol, tobacco, and caffeine
- Limit foods high in sugar, salt, fat, and
- Drink at least 6 to 8 glasses of filtered water daily.
(Source: Fibromyalgia – University of Maryland Medical Center)