Fibromyalgia

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...the “three pillars of treatment” to be medicine, physical therapy, and supplements. He says that some supplements, along with other treatments and lifestyle changes, have helped his patients experience less pain, more energy, and better sleep.
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"I hate to go back to using Samson as an example, but in many ways, this is what we end up feeling like when fibromyalgia develops. We’ve lost our power, our strength, our desire, our ability to love, and be loved."

Dietary Supplements for Fibromyalgia[edit]

“It would be great if we could just give people a pill to fix their fibromyalgia,” says Mark J. Pellegrino, MD, of Ohio Pain and Rehabilitation Specialists and author of 13 books on fibromyalgia. “But there’s no magic pill. A balanced approach is important.”

  • The nutritional supplements I recommend - By Dr. McNett
Here are the nutritional supplements I'm currently recommending in FMS. I'm open to comments, criticisms, suggestions, etc.
  • B-100 Complex*
1 tablet daily Improves activity of enzymes involved in energy production and brain function.
Many sources seem to suggest that we typically get enough B vitamins in our regular diet, and any extra is simply discard by the body. However, they also note that with certain health conditions, higher doses may be helpful.
  • Calcium/Magnesium*
Ca = 2000mg/day, Mg = 1000mg/day Calcium should be taken in a 2:1 ratio to magnesium to allow for proper tissue functioning. Mg promotes proper muscle function, relieving muscle spasms and tightness, and so reduces muscle pain. Many FMS patients have low Mg levels.
From http://blog.seattlepi.com/naturalnotes/2009/09/01/magnesium-and-calcium-arent-always-the-best-of-friends/
Foods rich in magnesium include unrefined grains, nuts and green vegetables. Green leafy vegetables are particularly good sources of magnesium because of their chlorophyll content.
The RDA for adult magnesium intake is between 270 mg – 400 mg.
As RDA is a minimum intake level, I generally suggest about twice that amount from all sources.
If you look at plants and babies you notice their high degree of flexibility. This comes from a higher magnesium and lower calcium level, 3 or 4 to 1.
For this reason I have suggested for years a 2-to-1 ratio of magnesium to calcium which is not commonly used. This was the common recommendation from biochemists in the 1940s-1960s.
Calcium should be taken during the day. Magnesium is best taken at bedtime for better utilization and better sleep. The reason for this is that calcium is antagonistic towards magnesium, as they act biochemically to cancel each other out.
From http://ods.od.nih.gov/factsheets/magnesium
Tap water can be a source of magnesium, but the amount varies according to the water supply. Water that naturally contains more minerals is described as "hard". "Hard" water contains more magnesium than "soft" water. When we moved to texas we stoped drinking as much tap water. Is my problem really an issue of low magnesium levels that can contribute to agitation, anxiety, restless leg syndrome, sleep disorders, irritability, nausea and vomiting, abnormal heart rhythms, low blood pressure, confusion, muscle spasm and weakness, hyperventilation, insomnia, poor nail growth, seizures, migraine, asthma, allergies, fibromyalgia, ADD, and nervous disorders.
  • Vitamin C*
1000mg twice a day initially, then increase by 1000mg a day until stools get soft. Vitamin C acts as an antioxidant, promoting healing, and stimulates the immune system. If you have a weak stomach, consider using sodium ascorbate instead.
  • Vitamin A*
25,000 IU daily for one month, then 10,000 IU daily. Vitamin A promotes healing, immune function, and cell growth. It also has a strong antioxidant effect. High doses should not be taken if you are or could become pregnant. Cod-liver oil is a good source, with about 14,000 IU per tbsp. (also 1400 IU Vit D and many essential fatty acids).
From http://www.nlm.nih.gov/medlineplus/ency/article/002400.htm
Retinol is an active form of vitamin A. It is found in animal liver, whole milk, and some fortified foods. . . eggs, meat, fortified milk, cheese, cream, liver, kidney, cod, and halibut fish oil.
Carotenoids are dark-colored dyes (pigments) found in plant foods that can turn into a form of vitamin A. There are more than 500 known carotenoids. One such carotenoid is beta-carotene.
Acute vitamin A poisoning usually occurs when an adult takes several hundred thousand IUs of vitamin A. Symptoms of chronic vitamin A poisoning may occur in adults who regularly take more than 25,000 IU a day.
  • Vitamin E*
800 IU daily (best if “natural,” “mixed tocopherols”) Powerful antioxidant, lowering risk of cancer and atherosclerosis. Helps circulation, tissue repair, and blood clotting, strengthens capillary walls, makes platelets less sticky, promotes healthy nerves, muscles, and skin structures. If hypertensive, start at 200 IU/day and work up, checking BP frequently.
From http://www.webmd.com/vitamins-supplements/ingredientmono-954-VITAMIN%20E.aspx?activeIngredientId=954&activeIngredientName=VITAMIN%20E
It's found in many foods including vegetable oils, cereals, meat, poultry, eggs, fruits, vegetables, and wheat germ oil.
(*most of these will be present at least to some degree in a good high-potency vitamin-mineral supplement)
  • Coenzyme Q-10 $$
90mg daily improves oxygenation of tissues and the conversion of oxygen and carbohydrates into energy. Enhances the immune system, increases strength of muscles, and protects the heart. (absorbed better if taken with a little fat, like peanut butter)
After taking this regularly for a few months I started having a flair up. Not blaming it, but it doesn't seem to have been effective at preventing it.
From http://www.webmd.com/vitamins-supplements/ingredientmono-938-COENZYME%20Q-10.aspx?activeIngredientId=938&activeIngredientName=COENZYME%20Q-10
A vitamin-like substance found throughout the body, but especially in the heart, liver, kidney, and pancreas. It is eaten in small amounts in meats and seafood. Coenzyme Q-10 can also be made in a laboratory. It is used as medicine.
Coenzyme Q-10 is manufactured by fermenting beets and sugar cane with special strains of yeast.
  • L-carnitine $$
1000-3000mg/day Works with Coenzyme Q-10 to promote energy production (metabolizes fat).
http://www.umm.edu/altmed/articles/carnitine-l-000291.htm
Found in red meat (particularly lamb) and dairy products are the primary sources of carnitine. It can also be found in fish, poultry, tempeh, wheat, asparagus, avocados, and peanut butter.
From Wikipedia
No advantage appears to exist in giving an oral dose greater than 2 g at one time, since absorption studies indicate saturation at this dose.
  • Malic Acid w/ Magnesium
2 tablets twice a day Increases sugar metabolism to make energy.
  • Asian (Panax) Ginseng
100-200mg/day (standardized for 4-7% ginsenoside level) Promotes energy, helps body (and mind) adapt to stresses, enhances mental and physical performance.
  • Methylsulfonylmethane (MSM)
1000-2000mg twice a day A source of sulfur for the body, promoting the production of synovial fluid (in joints) and encouraging toxin breakdown.
  • Betaine HCl
1-2 caps (325-650 mg) pc Raises body levels of SAMe, which lowers homocysteine levels (3X normal in FMS patients) and acts as an antidepressant. SAMe has been shown to help FMS, but only at levels of 800mg/day and when given IV. (the cost of the SAMe alone would be >$120/mo) Betaine provides SAMe to the body much more cheaply.
  • Supplements from other web-sites:
  • 5-HTP (5-Hydroxytryptophan)
This is a building block for the brain chemical serotonin. Low levels of serotonin are associated with depression, so it’s believed that raising serotonin levels can lead to a better mood. One study found that 5-HTP supplements may also help ease anxiety, insomnia, fibromyalgia pain, and morning stiffness. In the 1980s, 5-HTP supplements were associated with a serious illness called eosinophilia-myalgia syndrome (EMS). However, it’s believed that a contaminant in some products caused those EMS episodes.
  • SAMe (S-Adenosyl-L-Methionine)
This amino acid derivative may boost levels of serotonin and dopamine, another brain chemical. Limited research suggests SAMe may improve mood and sleep.
  • Magnesium
Low levels of this element may be linked to fibromyalgia. However, research has not turned up solid evidence that taking magnesium supplements improves symptoms.
  • Melatonin
This hormone is often used in supplements to improve sleep. It may also ease fibromyalgia pain.
  • St. John’s wort
Though this herb is sometimes used to treat certain fibromyalgia symptoms, there’s no solid evidence that it works. A few studies suggest it may help with mild depression. But it can also limit the effectiveness of some medications.
  • Vitamin B12
A Swedish study demonstrated low levels of vitamin B12 in the cerebrospinal fluid of people with fibromyalgia and chronic fatigue syndrome.
Twelve women who met the criteria for both fibromyalgia and chronic fatigue syndrome were studied, along with a control group of 18 healthy women.
Levels of homocysteine in cerebrospinal fluid were over three times higher in the women who had fibromyalgia and chronic fatigue syndrome compared to the control group. Cerebrospinal fluid vitamin B12 levels were also low in 7 out of 12 people with fibromyalgia and chronic fatigue syndrome.
Capsaicin (pronounced cap-SAY-sin) is the active ingredient in chili peppers. It is thought to temporarily relieve pain.
When applied to the skin, capsaicin cream has been found to deplete substance P, a neurochemical that transmits pain, which desensitizes a person to pain. People with fibromyalgia have been found to have higher levels of substance P.
  • Homeopathy
Therapeutic system of medicine that started in the late 18th century. Homeopathy is based on the principle of "like cures like." That means that remedies that would cause a potential problem in large doses will actually encourage the body to heal more rapidly if given in small doses. Practitioners use small diluted formulas of plant, mineral, and animal substances to treat various ailments. The hope is these formulas will stimulate the body to throw off the offender.
  • Common Treatments for Fibromyalgia:
   5-HTP
   Amitriptyline
   Cymbalta
   Diclofenac
   Effexor
   Exercise
   Flexeril
   Lyrica
   SAM-e
   Savella
   More Drugs
   More Vitamins & Supplements

Physical Therapy[edit]

  • Acupuncture
In a 2006 Mayo Clinic study, acupuncture appeared to significantly reduce fatigue and anxiety among people with fibromyalgia. Other studies have suggested that acupuncture can temporarily ease fibromyalgia pain as well. Yet researchers who analyzed several clinical trials, including the Mayo Clinic study, concluded that overall, acupuncture is not effective in treating fibromyalgia.
Studies show that acupuncture may alter brain chemistry. It appears to do this by changing the release of neurotransmitters. These neurotransmitters stimulate or inhibit nerve impulses in the brain that relay information about external stimuli and sensations such as pain. In this way, the patient's pain tolerance is increased. One acupuncture treatment in some patients may last weeks to help alleviate chronic pain.
  • Massage
Massage can reduce muscle tension and ease pain in the muscles and soft tissue. It can also improve circulation and range of motion and boost production of natural painkillers. Some studies suggest it can improve your mood. And it may help people with fibromyalgia sleep better, too.
Deep tissue massage may be helpful for those with fibromyalgia. The reason is therapists use greater pressure than is used in Swedish massage. In so doing, they target the deep layers of muscle. Using a series of slow strokes and direct pressure, the therapist will strive to release chronic patterns of muscular tension. Sometimes, the therapists use their elbows or thumbs to push hard into the deepest grain of the muscle to reduce tension.
Neuromuscular massage combines the basic principles of ancient Oriental therapies, such as acupressure and shiatsu, with specific hands-on deep tissue therapy. The goal is to reduce chronic muscle or myofascial (soft-tissue) pain.
  • Chiropractic
A very common alternative treatment for fibromyalgia pain. People use it to treat pain of pressure points, back pain, neck pain, shoulder pain, headaches, and pain from musculoskeletal injuries. Chiropractic may be effective for fibromyalgia because it helps improve pain levels and increase cervical and lumbar ranges of motion.
  • Biofeedback
To individualize the reduction of stress in the treatment of fibromyalgia, biofeedback is often recommended. This mind/body relaxation technique uses electronics to measure stress-related responses in the body. The idea behind biofeedback is that people can use information about their body's internal processes to learn to control those processes.
With biofeedback, you are connected to a machine that informs you and your therapist when you are physically relaxing your body. Sensors detect muscle tension, heart rate, breathing pattern, the amount of sweat produced, or body temperature. Any one or all of these can let the trained biofeedback therapist know if you are learning to relax.
The instruments magnify signals that you might not otherwise notice. As a result, you can use this visual or auditory response to learn how to control certain bodily functions. The ultimate goal of biofeedback is to use this skill outside the therapist's office when you are facing real stressors.
With fibromyalgia pain, you know the "real stressor" is the pain itself. Nevertheless, other daily stressors can cause your fibromyalgia to flare. What you want to do is respond in a healthy way to the chronic stressors. If learned properly, electronic biofeedback can help you control your heart rate, blood pressure, breathing patterns, and muscle tension, potentially reducing pain.


Life Style Changes[edit]

  • Diet


  • Sleep
If you find that you are sleeping poorly, you're not alone. With Fibro, pain and poor sleep happen in a circle. Each worsens the other. Fortunately, there is a lot you can do to help yourself sleep better. The National Fibromyalgia Association, the National Pain Foundation, the National Sleep Foundation, and other expert organizations recommend the following steps to help people sleep:
  • Stick to a sleep schedule.
If you go to bed at the same time every night, your body will get used to falling asleep at that time. So choose a time and stay with it, even on weekends
  • Keep it cool.
When a room is too warm, people wake up more often and sleep less deeply. According to the National Sleep Foundation, studies show that you're likely to sleep better in a room that's on the cool side. So try turning down the thermostat and/or keeping a fan on hand
  • Cut Caffeine
As evening approaches, cut out the caffeine. Caffeine has a wake-up effect that lasts. It's best to avoid it well before bedtime. That includes not just coffee, but also tea, colas, and/or chocolate
  • Avoid alcohol before bed.
That “nightcap” may make you sleepy at first. But as your blood alcohol levels drop, it has the opposite effect. You may find yourself wide awake
  • Exercise in the afternoon.
Afternoon exercise may help you sleep more deeply. But exercising before bedtime can make it harder to fall asleep
  • Nap if you need to
But be brief. If you're so tired that you must take a nap, set the alarm for 20 minutes. Snooze any longer and you may have trouble falling asleep at night
  • Make your room a relaxing refuge.
Treat yourself to comfortable bedclothes and snuggly pajamas. A white-noise machine or fan may help you fall asleep to a soothing background sound
  • Develop a relaxing bedtime routine.
Reading helps some people fall asleep. So does listening to soft music. Do whatever works for you. But try to follow the same routine every night to signal your body that it's time for sleep
  • Set Limits When You Have Fibro
It’s also important to know your limits and to let others know that you may not be able to do everything you used to. “You shouldn’t feel bad when you need to say ‘no’ to requests,” Matallana says. “Fibromyalgia is a legitimate chronic illness. You have the right to do what you need to do to take care of yourself.”
  • Keep your options open
“When you get an invitation or request to do something, tell the person that you’re very interested, but you’d like to think about it and get back to them in 24 or 48 hours,” Jones says. “That way, if you decide you can’t do it, you won’t feel so put on the spot.”
  • It’s OK to cancel.
If you’ve scheduled something and you aren’t feeling well enough to do it, reschedule. “Don’t beat yourself up if you can’t do something,” Matallana says. “Try to remember that there will be other times you can do it.”
  • Keep a fibromyalgia journal.
Recording your activities, meal times, sleeping schedule, and how you feel each day can help you identify what causes your symptoms to flare.
  • Delegate
Negotiate with your spouse or family members to take over certain tasks, such as cooking or cleaning, when you can’t do them. Try to work with your family to come up with solutions together.
  • Take a break
If you’ve been active on organizations or committees, consider taking a break for a period of time while you focus on taking care of yourself.
  • Eat out or order in
Rather than having family or friends over for dinner or holidays, make reservations at a restaurant or order in.
  • Plan activity during the hours you feel the best.
For many people with fibromyalgia, this is between 10 a.m. and 3 p.m., but it may be different for you.
  • Don’t be afraid to ask for help
“People will usually go out of their way to help if you ask for it,” Matallana says. “But they need to know what you’d like them to do.”
  • Emotional Needs
Learning to cope with Fibromyalgia can be a challenge. Good emotional support can help. Try reaching out to family and friends. Talk to your loved ones about how to help give you Fibromyalgia support.
It’s also important to work closely with a health care professional who understands your condition.
  • Stress Management
Stress plays a big role in how you respond to different situations, both physically and emotionally. Stress can have a significant impact on your ability to do the things that are important to you.
A type of therapy called cognitive behavioral therapy has also been found to be helpful. Studies show it can reduce pain severity and improve function. Cognitive behavioral therapy helps us see how our thoughts affect how we feel and what we do.