Fibromyalgia - The Elusive Maladie
Fibromyalgia. It’s a common rheumatic syndrome where patients suffer chronic widespread aching and tenderness in the muscles, fibrous tissues, tendons and other connective tissues. Somewhat surprisingly however, even though this systemic (full body) pain may be extreme, it is experienced without weakness. Additionally, sufferers often suffer excessive fatigue, exhaustion and frequently depression and insomnia (difficulty sleeping).
Much confusion exists regarding the exact nature of fibromyalgia. It has similarities to conditions like arthritis, chronic fatigue syndrome, however it is a completely distinct condition requiring it’s own unique treatment.
It’s similarity to other rheumatic conditions (for example Rheumatoid Arthritis) lies in its inflammatory component, however fibromyalgia is not an inflammatory disease. Rather, it is a condition of muscle tenderness and stiffness with localized areas (Tender Points) of acute actual inflammation. Another difference between them is that arthritis affects joints, whereas fibromyalgia is non-articular (not related to joints). Nor is it the same as Chronic Fatigue Syndrome (CFS), though it is very closely related, affects similar populations, etc. (CFS and Fibromyalgia may be seen as cousins in a sense). This leaves many questions as to it’s origin/causes, the disease process itself, and then in how to treat it.
Other terms often used to describe this chronic, debilitating condition include Myofascial Pain Syndrome, Muscular Rheumatism or Fibromyositis.
The cause of fibromyalgia is not fully understood, however there are many theories about conditions and states that can bring about this chronic, often debilitating disorder. Though it affects women and men alike, women tend to be diagnosed much more frequently than men are (as in CFS). Some of the theories include:
The “Classic Fibromyalgia Patient” is commonly recognized as a young woman in her 20-50’s, hard working and career oriented, perfectionist, and who’s stressed or depressed. Some might call this the “Type-A" Modern Woman.
There is some evidence that there may be an infectious component to onset of fibromyalgia, either bacterial or viral, but this is also not yet proven.
Another component currently being investigated is that of a hereditary or genetic component to the disease. Though fibromyalgia isn't passed directly from parents to their children the way other diseases (such as hemophilia or cystic fibrosis) are, family studies have shown that the chances of developing fibromyalgia are several times higher if one has first degree relatives with fibromyalgia than in families in where no one has fibromyalgia. Interestingly, DNA studies have shown that family members of individuals with pain syndromes (including chronic pain and fibromyalgia) have activated genes that elevate the nervous systems response to physical stimuli from pressure and heat, which explains why they feel heightened and chronic sensations pain while others (without the disease) don’t.
Yet another theory is a connection to SIBO: Small Intestinal Bacterial Overgrowth. It is postulated that the bacterial overgrowth may be releasing excessive amounts of toxic byproducts that overwhelm the livers ability to detoxify them, resulting in a systemic toxemia which causes widespread pain and fatigue.
In all likelihood, there is no single triggering event, rather it is a combination of factors like genetic susceptibility plus an infection, or chronic stress and a severe trauma, that ultimately cause the disorder.
Symptoms are typically present chronically but are exacerbated (made worse) by physical, mental or emotional stress, trauma (for example a car accident or other serious injury), chronic sleep deprivation/disturbance, as well as cold and damp temperatures. Many sufferers experience frequent bacterial, viral or fungal infections (for example Candida), and are likewise aggravated by flare-ups of these conditions.
The symptoms are typically described as starting with diffuse aching and muscle stiffness. These gradually and slowly worsen several weeks or even months. Initially, these symptoms might be akin to general flu-like symptoms, malaise and lethargy, and one may experience low-grade fever and swollen glands. Over time the muscle pain and stiffness become more chronic and constant.
The classic muscular “Tender Points” become extremely tender to touch, and there are often palpable nodules present upon physical examination. The actual diagnosis is made by the presence at least 11 out of 18 trigger points.
The figure below (courtesy of ADAM medical images) depicts the common “Tender Points” of fibromyalgia
Muscle spasms and low-grade inflammation may be experienced by patients as a burning, aching or shooting pain in the affected area.
Sleep is typically poor (usually due to pain and stress) and individuals report trouble both falling asleep and waking up in the morning. After waking there is often day-long overwhelming fatigue (as in CFS) and a “Brain Fog” which lingers through the morning. Some sufferers experience memory loss and poor concentration.
Other commonly reported symptoms may include anxiety and/or depression, irritability, IBS (irritable bowel symptoms), bladder irritability and urinary frequency as well as general malaise.
Although symptoms vary in intensity and pain can be very severe in some individuals, fibromyalgia is not life threatening, nor does it lead to muscle or joint damage. Rather it is a chronic disease, meaning it is slow and lingering, typically does not resolve and may severely limit a person's ability to work, go to school, or take care of routine needs.
Unfortunately, at this time fibromyalgia has no known cure, and therefore must be managed as a chronic condition. Management is critical though as pain and other symptoms are experienced daily for the approximately 1 million (3% of) diagnosed Canadians and 5.8 million Americans.
Given the confusion and complexity of the disorder, it is best dealt handled on in a very individual basis, by a practitioner who will align treatment with the unique patient, their particular symptoms as well as their goals. This type of treatment forms the cornerstone of Naturopathic Medicine, a branch of health care that is often very successful in helping those suffering from fibromyalgia and other chronic diseases.
In Allopathic Medicine, Fibromyalgia is only just starting to make appearances in literature. It is in fact not even acknowledged by many conventional medical doctors, which makes diagnosis exceptionally difficult. Even laboratory testing yields no abnormal blood pictures (except slightly elevated ESR), meaning there isn’t any established testing available. Management by those MDs who do treat it typically includes antidepressants and tranquilizers as well as muscle relaxants, anti-inflammatory drugs (including NSAIDs) and nerve blocking agents. Unfortunately, not only do these medications all have multiple side effects that may be felt even more acutely by those with fibromyalgia, they typically offer or only short-term relief.
On the other hand, Naturopathic Medicine has much to offer sufferers of Fibromyalgia. An important part is recognizing that sufferers of the disorder are all individuals, and so to are the causes, disease processes and optimal treatment methods/prescriptions. Rather that utilizing “umbrella therapies” (like muscle relaxants, antidepressants, etc) Naturopathic Physicians treat the cause as well as the individual patient. We take the time to identify what the most likely triggers and instigating factors might be as well as how they’re impacting the individual and the proceed to treat them while at the same time working to alleviate current symptoms.
Naturopaths may employ multiple modalities, including diet and lifestyle counseling, botanical medicines/herbs, supplements, homeopathy, physical medicine and detoxification which allow them to not only highly individualize treatment but to bring about long term healing.
Botanical/herbal remedies, homeopathy and supplemental therapies, when used in the correct combinations and dosages can be extremely helpful at easing symptoms of pain and tenderness, bladder and bowel irritability, mental/emotional concerns (like anxiety, depression and irritability), insomnia, as well as any other symptoms patients may experience.
The most important lifestyle modifications that a Naturopath will counsel on include:
Diet and Detoxification are paramount to the treatment of fibromyalgia. Toxin accumulation, food sensitivities and certain foods aggravate inflammation in the body, and therefore removal of these can vastly improve symptoms.
Rest and stress reduction, both physical and mental, is quite possibly the most important component in the alleviation of pain associated with fibromyalgia. It is critical that individuals have well-established rest periods and work to minimize stress as much as possible.
Regular exercise is the third essential factor. Optimal exercises include yoga, Tai Chi, walking, biking and swimming, all of which allow the muscles and joints to be lightly used and stretched without over-straining them.
Heat application over tender areas can also be very beneficial for symptom management for many patients. This can include Epsom salt baths (which will also help relax muscles), sauna, or a hot-water bottle/heating pad (not too hot!) over tender areas.
Preparing a therapeutic Epsom Salt bath
Epsom salt baths are excellent for relaxation as they bring magnesium into muscles and joints which helps with relaxation and therefore pain alleviation. They are also very beneficial in detoxification protocols as they induce sweating, which one method the body uses to remove toxins.
Pour 2-3 cups of Epsom salts (Magnesium Sulphate) into your tub and run a hot bath (as hot as you can tolerate).
Soak in it for 10-15 minutes, sipping water or tea occasionally (to prevent dehydration).
Consider adding 5-10 drops of an essential oil or crushed herbs such as lavender (for relaxation), chamomile (for pain and relaxation), rosemary (for mental stimulation) or rose (to help alleviate depression).
When you’re ready to exit the bath, do so slowly as you may feel faint.
Note: it's advisable to have a family member check that you don’t become drowsy or fall asleep.
Dr Katarine Holewa, ND