Medical physicians that are experts in the field of fibromyalgia recommend a multi-faceted treatment program, which is tailor-made for the specific patient and incorporates both pharmacologic and non-pharmacologic therapy (i.e., education on the condition and symptoms, dietary support, nutraceuticals, physical therapy, and cognitive behavioural therapy). It is best advised to use a multidisciplinary approach that incorporates physical, psychological and social factors when treating fibromyalgia patients. This reasoning is formulated on the experience that fibromyalgia and its reaction to therapy are largely shaped by a complex interaction of these various aspects. This type of multidisciplinary treatment would ideally involve a team of clinicians from a variety of medical disciplines (e.g. Integrative physician, physical therapist, and mental health specialists). To have the best results with treatment of fibromyalgia, the management program should be aimed at symptomatic treatment of pain, fatigue, and sleep quality, as well as improving physical capacity and emotional balance.
Education on the diagnosis and treatment of fibromyalgia is very effective in treatment, and to make it more attractive, it is one of the cheapest and least invasive interventions. Educational interventions are particularly beneficial for fibromyalgia patients that have lived with the syndrome for many years and were always told to believe that the symptoms were completely psychological. Having believed that they symptoms are in their heads can cause individuals with fibromyalgia to feel rejected by the medical community, but also result in significant stress, which can potentially worsen symptoms. Therefore, once a diagnosed patients’ becomes well-informed about the disorder not only can it ease the fear of the unknown, but it can also produce a significant therapeutic effect for them. Cognitive behavioural therapy (CBT) and relaxation techniques have been shown to reduce pain and improve sleep. Lifestyle modifications such as exercising regularly, eliminating tobacco use, and reducing excess alcohol consumption should also be considered, as they are strongly associated with decreased pain and fatigue. Although regular aerobic fitness and strength training are significantly beneficial interventions, numerous patients are unwilling or unable to adhere to these regimens (due to pain) and have to try less strenuous alternatives.
2. Dietary Considerations
Obesity is associated with fibromyalgia, and therefore it is not a strange thought that ones’ diet should be conducive to a weight loss program and prevent unnecessary weight gain. It has noted through various studies that a vegetarian diet can be particularly beneficial for decreasing the pain associated with fibromyalgia; not only because they can induce weight loss, but also because they are rich in antioxidants. This vegetarian diet is recommended based on evidence that oxidative damage (caused by, free radicals) plays an important role in the development of fibromyalgia. However, adherence to a specific dietary pattern may not be necessary if antioxidant-rich foods are consumed regularly as part of a healthy diet.
3. Complementary modalities
Acupuncture is one of the suggested treatments for short-term pain relief, but unfortunately, these benefits do not appear to be long-term. There are other alternative interventions that have promising benefits and include movement-based therapies such as yoga, Tai-chi, mindfulness meditation, and hydrotherapy (in which the patient undergoes physical therapy while in the water or simply baths to relieve symptoms). The newer treatment modality of Biopuncture has recently been employed with excellent results in the treatment of muscle-specific trigger-points. This treatment consists of the injection of a natural anti-inflammatory solution in these trigger points, on a monthly basis. For more details see our Biopuncture treatment protocol. INSERT PAGE LINK when adding to websites.
4. Nutraceutical support
There is no proven individual dietary supplement that is effective for relieving all the common symptoms of fibromyalgia. However, the following supplements have either been linked to symptom improvements or recommended by experts to overcome deficits that are common among fibromyalgia patients: Magnesium: Research has revealed that low circulating levels of magnesium may be implicated in the development of fibromyalgia in some individuals. When a patient supplements with magnesium as part of a treatment program it has been shown to reduce symptoms of fibromyalgia, thus making it a frequently recommended supplement. In one clinical trial involving 80 women (60 with fibromyalgia and 20 healthy controls), a diagnosis of fibromyalgia was associated with significantly lower red blood cell and serum magnesium levels. Furthermore, lower magnesium levels were associated with more severe fibromyalgia symptoms. The trial went on to assess the effect of 8 weeks of supplementation with magnesium citrate (300 mg/d) alone or in combination with amitriptyline (10 mg/d) upon several measures of fibromyalgia severity. While both magnesium and amitriptyline alone effectively improved many of the assessed parameters, the combination of the two was more effective than either alone and significantly improved pain, tender points, depression and anxiety scores, as well as sleep disorders and irritability. As part of your blood tests after a Health Renewal consultation, you may be advised to have a red blood cell magnesium test done to ensure that they are not deficient in this important nutrient.
Melatonin: Melatonin is a hormone that helps regulate the sleep-wake cycle in healthy individuals. Clinical studies have found that some fibromyalgia patients often have low circulating levels of melatonin, which can lead to disruptions and unbalanced sleep cycles. It has been noted that fibromyalgia patients appear to secrete less melatonin during the night than healthy controls. Among these patients with low melatonin secretion, melatonin supplementation has been shown to decrease symptoms of fibromyalgia.
S-adenosyl-L-methionine (SAMe): SAMe is a natural compound made from methionine (an amino acid) and adenosine triphosphate (ATP). Supplementation with SAMe has been linked to improvements in morning stiffness, fatigue, quality of sleep, and clinical disease activity among fibromyalgia patients. In addition, other studies have shown that SAMe provides relief from depression, which can be a psychological symptom of people with fibromyalgia.
D-ribose: This compound is a sugar that helps increases cellular energy synthesis in muscle cells. One trial involving 41 fibromyalgia patients found that 5 grammes of D-ribose three times daily significantly improved energy, sleep, mental clarity, pain intensity, and general well-being. Another small trial found that 3 grammes of D-ribose twice daily improved exercise capacity, vitality, and mental outlook in adults aged 50 and older.
Chlorella: Chlorella is a genus of single-cell green algae. This plant grows in fresh water and contains high concentrations of important vitamins, minerals, dietary fibre, nucleic acids, amino acids, enzymes, and other substances. Because of the potent combination of ingredients, Chlorella has been shown to relieve symptoms of fibromyalgia when used as a supplement. In a small pilot trial, 18 patients with fibromyalgia experienced an average 22% decrease in pain intensity after taking chlorella daily for two months.
Coenzyme Q10 (CoQ10): CoQ10 is an essential component of healthy mitochondrial function, as well as a powerful antioxidant. CoQ10 has also demonstrated anti-inflammatory and analgesic (pain relief) properties. Researchers believe that low CoQ10 levels may play a role in the development of fibromyalgia symptoms because
- CoQ10 has been found lacking within the blood cells of many fibromyalgia patients, and
- Subsequent CoQ10 supplementation (300 mg/d for 9 months) has been linked to a significant improvement in symptoms in a small preliminary trial.
- Other data from case reports (see Mitochondrial Dysfunction, under the question “What are the causes Fibromyalgia?”) also suggest a role for CoQ10 in relieving fibromyalgia symptoms.
Acetyl-L-carnitine: This amino acid is an acetylated version of the amino acid L-carnitine, which is a mitochondrial membrane compound that aids in the generation of metabolic energy and guards against oxidative damage, often caused by free radical activity. It has been suggested that fibromyalgia syndrome may be associated with metabolic alterations including a deficit of carnitine. In one double-blind, randomised, placebo-controlled trial involving 102 fibromyalgia patients, 1,000 mg (oral) and 500 mg (intramuscular injection) of acetyl-L-carnitine daily significantly improved pain and cognitive symptoms more than placebo. The treatment was well tolerated by the patients, who enjoyed relieved symptoms.
Omega-3 fatty acids: Omega-3 fatty acids can only be synthesised to a limited extent by the human body, but are vital for normal metabolism. Omega-3’s can lessen several cellular properties and have been shown to reduce inflammation as one of its benefits. Among fibromyalgia patients, omega-3 fatty acid supplementation has been linked to significant improvements and alleviation in pain severity, tender point counts, fatigue, and depression. Another case report indicates that supplementation with fish oil (providing 2,400 – 7,200 mg of EPA/DHA daily) eased neuropathic pain in a small number of subjects with fibromyalgia and/or related neuropathic pain. Health Renewal suggests that the omega-6 to omega-3 ratio be kept at or below 4:1 for optimal health.
Vitamin D: Patients with fibromyalgia often have impaired mobility and therefore get less exposure to sunlight. This lack of sun exposure contributes to the vitamin D deficiency frequently observed in this population. In one trial involving 100 women with fibromyalgia, 61% were found to be vitamin D deficient (blood levels of 25-hydroxyvitamin D <30 ng/mL). Upon supplementation with vitamin D, 42 (69%) of those women reported significantly improved symptoms when their vitamin D levels reached ≥ 30 ng/mL; the improvement became more significant when their vitamin D levels exceeded 50 ng/mL. Fibromyalgia patients should have their vitamin D levels checked regularly. Health Renewal suggests that a 25-hydroxyvitamin D level of 50 – 80 ng/mL should be targeted for optimal health among most ageing individuals.
5. General Support
To increase anti-oxidant protection and mitochondrial support the following nutrients may render additional benefits:
Superoxide Dismutase (SOD): This endogenous antioxidant is found in decreased amounts among fibromyalgia patients. Superoxide Dismutase occurs in plants and can thus be extracted from them, to make effective supplements. In one double-blind trial, supplementation with 1,000 mg/day of a plant superoxide dismutase extract significantly boosted SOD activity and decreased CRP levels in athletes compared to placebo.
Vitamins A, C, E, and the mineral Zinc: All these Vitamins & Zinc mineral provide antioxidant protection. In one study, fibromyalgia patients had lower blood levels of vitamins A and E, as well as increased lipid peroxidation when compared to healthy controls. Another study found that fibromyalgia patients had lower zinc and magnesium levels than healthy controls. In a survey of over 300 fibromyalgia patients, 35% reported using vitamin C; and vitamin C combined with vitamin E has been shown to boost antioxidant activity in conditions related to oxidative stress. All of these nutrients are usually available in a high-quality comprehensive multivitamin.
B-vitamins: B-vitamins are important cofactors in a variety of metabolic events and it has been reported in a survey to be used by a 25% of fibromyalgia patients. Homocysteine is a damaging metabolic by-product whose levels are kept in check by adequate B-vitamin intake. In one study, women with fibromyalgia were shown to have higher levels of homocysteine in their cerebrospinal fluid than healthy controls. Other evidence indicates that an intravenous infusion of several vitamins (i.e., B-complex vitamins), may be useful in fibromyalgia. Moreover, B-vitamins are essential for maintaining optimal mitochondrial function.
NADH: Nicotinamide adenine dinucleotide (NADH) is a coenzyme that supports numerous metabolic reactions critical for optimal cellular function. For example, NADH helps recycle CoQ10, thereby aiding in cellular energy production. It also possesses considerable antioxidant potential. Supplementation with NADH has been shown to improve energy in people with chronic fatigue syndrome, in addition, NADH supplementation relieved sleepiness and cognitive deficits in people suffering from jet lag. In other trials, NADH improved cognitive function among people with Alzheimer’s disease and relieved Parkinson’s disease symptoms. While NADH has yet to be studied in people with fibromyalgia, these findings are encouraging since fibromyalgia sufferers often experience fatigue and suboptimal cognition, which might be alleviated with the supplementation of NADH.