Fibromyalgia

Frequently Asked Questions

• 1

  What is Fibromyalgia?

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  This condition affects the soft tissue causing pain, muscle stiffness, constant fatigue, disturbed sleep, and cognitive “slowing” and is most prevalent in a young or middle-aged woman. Fibromyalgia is often associated with a variety of additional unexplained symptoms, such as psychological depression, and diminishing quality of activities of daily living.

  In the past, this serious condition was brushed off to be psychological by the mainstream medical community, without exploring the underlying medical causes. This was the case because they lacked an objective of medical findings on screening laboratory tests and medical imaging procedures. However, through recent research, it has been identified that the underlying nervous system pathology for fibromyalgia, is currently believed to be a central sensitivity syndrome.

  In modern medicine practices, Fibromyalgia is currently identified as a neurosensory disorder, which is characterized by conflicts in the way the central nervous system interprets and evaluates stimuli. As a result of this Fibromyalgia is typically associated with other regional pain syndromes, as well as various mood and anxiety disorders. In fact, significant data support the idea that conditions such as fibromyalgia, chronic fatigue syndrome, regional chronic pain syndromes, and some emotional disorders all involve abnormally distresses of the stress response system. In these disorders, the neuroendocrine axis is altered as the body’s stress function causes alterations in the corticotropin-releasing hormone.

  In addition, symptoms associated with Fibromyalgia are often observed in other co-morbid diseases which are characterized by chronic, systemic inflammation, such as rheumatoid arthritis, systemic Lupus erythematosus, and chronic hepatitis C infection. In such cases, to assure the optimum outcome of Fibromyalgia, treatments for the various associated disorders such as systemic inflammation, chronic stress, anxiety and depression, hormone imbalances, and impaired sleep are vital. By using simple and convenient blood tests, imbalances or deficiencies can be uncovered. These can then be treated with targeted natural therapies which may improve the quality of life for those with Fibromyalgia.

• 2

  What are the symptoms of Fibromyalgia?

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  Widespread chronic pain is the primary symptom of fibromyalgia, it lasts for a minimum of three months and may be heightened at tender points. This pain is often accompanied by constant tiredness and frequent sleep disturbances, resulting in feeling even more drained. Furthermore, other common indicators of fibromyalgia include tenderness, stiffness, mood disturbances (e.g., depression and/or anxiety), and cognitive difficulties (e.g., trouble concentrating, forgetfulness, and disorganized thinking). Migraine and tension headaches are also present in more than half of individuals with fibromyalgia. There is also a list of unexplained symptoms which may affect Fibromyalgia patients:

  • Irritable bowel sensations (IBS)
  • Headache
  • Pelvic and urinary problems
  • Weight fluctuations
  • Sexual dysfunction
  • Cognitive dysfunction

  These symptoms can come and go spontaneously, but it is very unfortunate that they are usually experienced so intensely that they can impair the individual daily functioning. Each person’s body is different, therefore it only makes sense that each individual diagnosed with fibromyalgia is affected differently, and their experience(s) will vary. For example, fibromyalgia pain has been described as deep muscular aching, soreness, stiffness, burning, or throbbing. However, symptoms can also be experienced as numbness, tingling, or a strange "crawling" sensation in the arms and legs. These painful sensations are typically described as “widespread”, meaning they can occur above and below the waist, on both sides of the body, as well as in the spine and lower back.

• 3

  What are the causes of Fibromyalgia?

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  Because many fibromyalgia patients appear well upon physical examination, the diagnosis of fibromyalgia was historically considered controversial and, unfortunately, written off by many conventional physicians as a psychosomatic condition, leaving the patient with no medication to relieve the painful symptoms.

  1. Pain Hypersensitivity:

  Evidence from functional magnetic resonance imaging (fMRI) studies of the brain has demonstrated that patients with fibromyalgia are more sensitive to pain than their healthy counterparts. Therefore, fibromyalgia is thought to be a result of some type of neurosensory disorder that disturbs the body’s central nervous system’s ability to process painful stimuli. This dysfunction seems to be a result of neurochemical imbalances that cause the brain to amplify pain through two different mechanisms: (1) allodynia (i.e., a heightened sensitivity to stimuli that are not normally painful); and (2) hyperalgesia (an increased response to painful stimuli). Currently, no one knows exactly how, or why, this central sensitization develops, but researchers have identified several possible theories.

  2. Hormonal Influences and Stress

  Although an underlying link has yet to be established, some evidence suggests a role for sex hormones in the etiollogy of fibromyalgia. For example, fibromyalgia predominantly presents in middle-aged women; a population whose hormones have begun to decline or fall out of youthful balance, as they move into menopause. Furthermore, the fluctuating hormone levels caused by endocrine dysfunction commonly produce symptoms that are similar to those of fibromyalgia (e.g., muscle pain/tenderness, exhaustion, and reduced exercise capacity). In one clinical trial, taking a selective oestrogen receptor modulator (SERM) every other day for 16 weeks led to significant improvements in pain and fatigue scores; reduced tender points and sleep disturbances and greater recovery of usual activities compared to placebo among 49 women. These findings implicate oestrogen signalling in fibromyalgia etiollogy. Likewise, perturbations in the hypothalamic-pituitary-adrenal (HPA) axis have been demonstrated in fibromyalgia patients, indicating a possible therapeutic role for dehydroepiandrosterone (DHEA) supplementation and stress management strategies. It is thought that stress functions to cause alterations in corticotropin-releasing hormone (CRH), with associated effects on the neuroendocrine axis.

  The abovementioned evidence is consistent with recent data indicating a relatively high prevalence of growth hormone deficiency among patients with severe fibromyalgia. This deficiency of growth hormone is linked to increased levels of blood cytokines and pain severity. Thus, fibromyalgia patients may benefit from hormone level testing in order to identify and subsequently treat any underlying imbalances or insufficiencies. This can be done with Bio-Identical Hormone Replacement Therapy. In the case of growth hormone (GH)-deficient fibromyalgia patients, GH replacement therapy has been associated with significant improvements in symptoms and quality of life.

  3. Neurotransmitter Imbalances

  Symptoms of fibromyalgia might also be caused by a disruption in the communication between peripheral nerves and the brain. This theory is supported by evidence which indicates that fibromyalgia patients often have lower-than-normal amounts of neurotransmitters (i.e., serotonin, norepinephrine, and dopamine) and as a result frequently suffer from mood disorders like depression and anxiety. If a patient has a low level of serotonin it is particularly significant to fibromyalgia sufferers as an imbalance can contribute to pain sensitivity, sleep disturbances, and mood alterations. Because of this finding Medical Practitioners supports the use of antidepressants for treating fibromyalgia, since antidepressants often increase the circulating amounts of these important neurotransmitters, potentially alleviating the symptoms experienced.

  4. Inflammation

  Generally speaking, fibromyalgia is not believed to be an inflammatory condition, but there is evidence that suggests that some type of inflammatory process may be contributing to its onset and/or progression. While classic inflammatory processes are not observed in fibromyalgia patients, these individuals do exhibit some inflammation-related abnormalities. For instance, the cerebrospinal fluid (CSF) of fibromyalgia patients commonly contains higher-than-normal levels of the inflammatory mediators, substance P and corticotropin-releasing, hormone (CRH). Likewise, the serum of fibromyalgia patients commonly contains higher-than-normal levels of the pro-inflammatory cytokines interleukin-6 (IL-6), interleukin-8 (IL-8), and substance P, while the skin of fibromyalgia patients commonly contains higher-than-normal amounts of mast cells, which can produce IL-6 and IL-8. It is also well documented that fibromyalgia often occurs in conjunction with other chronic inflammatory conditions, such as arthritis, systemic lupus erythematosus, or chronic hepatitis C infection. It is, therefore, possible that inflammation arising from co-occurring medical conditions could play a role in the pathology of fibromyalgia. As a result, some individuals with fibromyalgia, especially those who have been diagnosed with other medical conditions, may respond to supplementation with natural anti-inflammatory agents such as omega-3 fatty acids, curcumin and Boswellia serrata.

  5. Sleep Dysfunction

  Although sleep disturbance is an obvious consequence/symptom of fibromyalgia, some researchers believe that non-restorative sleep (NRS) may actually cause and/or contribute to fibromyalgia-related pain. This bi-directional relationship is further supported by studies of fibromyalgia patients where it was shown that an improvement in sleep quality is linked to significant reductions in fibromyalgia symptom intensity. Since the hormone serotonin is involved in pain signalling and sleep regulation, some researchers have suggested that abnormally low serotonin levels, (which is common and occurrence among fibromyalgia patients) may be one possible explanation for this connection. Clinical studies have also found that fibromyalgia patients may have low circulating levels of melatonin, which can lead to disruptions in sleep cycles. Among these patients, melatonin supplementation has been shown to improve sleep and fatigue-related symptoms. As with pain, fibromyalgia-related sleep dysfunction should be managed in a step-wise fashion, starting with the least risky treatment. For many of those with fibromyalgia, improving sleep hygiene is enough to make a significant difference. The patient’s sleep environment should be dark, cool, and quiet, and external distractions should be minimised. The sleep cycle should be normal, implicating the patient has consistent bedtime and morning awakening time, and healthy lifestyle considerations, such as adequate exercise, smoking and avoiding nighttime alcohol use. Improving these habits may also help improve sleep quality.

  If improved sleep hygiene practices do not alleviate the sleeping problem the patients may require pharmacotherapy, which will be based on the patient’s specific problem with sleep, i.e. initiation, maintenance, quality or duration.

  6. Mitochondrial Dysfunction.

  The mitochondria are the “energy house” components within the cellular function, which are responsible for the generation of the energy & proper functioning of cells. Evidence indicates that if the mitochondria are dysfunctional, symptoms of fibromyalgia may arise. For example, reports of two patients with fibromyalgia revealed impaired mitochondrial function and deficiency in coenzyme Q10 (a critical compound necessary for proper mitochondrial function) in blood and skin cells. Similarly, in another case report, a 41-year-old woman diagnosed with fibromyalgia, but who had been unresponsive to a variety of conventional treatments, was later found to have significant mitochondrial dysfunction. Her symptoms improved dramatically when treated four times daily with a cocktail of mitochondrial nutrients including coenzyme Q10 (200 mg), creatine (1,000 mg), L-carnitine (200 mg) and folic acid (1,000 mcg.). In addition, dysfunctional mitochondria contribute to increased oxidative stress, which has its own list of negative impacts on the body. In a study involving 20 fibromyalgia patients and 10 healthy controls, the fibromyalgia patients had greater levels of a mitochondrial-derived free radical (superoxide) in their blood cells and increased lipid peroxidation compared to the healthy subjects.

  7. Fibromyalgia & Obesity

  It has long-since been common knowledge that there is a very strong relationship between obesity and chronic pain. More recent evidence suggests that this association is particularly true for fibromyalgia patients. For example:

  • In a study of 2009, researchers reported that 71% of fibromyalgia patients enrolled in their study were either overweight or obese and exhibited common laboratory findings associated with obesity such as elevated levels of IL-6, catecholamines, cortisol, and CRP. The researchers pointed out that both obese patients and those with fibromyalgia presented with reduced sleep duration and quality. This lead to the conclusion that excess weight and obesity may play a significant role in fibromyalgia and its related dysfunction(s).
  • In a study of 2010, consisting of 215 fibromyalgia patients, it was reported that nearly 80% of participants were either overweight or obese. These same patients exhibited increased tender point sensitivity, reduced physical strength and lower-body flexibility, shorter sleep duration, and greater restlessness during sleep.
  • In 2011 a review article concluded that fibromyalgia patients are 40% more likely to be obese and 30% more likely to be overweight. In addition to concluding that obesity is highly prevalent among fibromyalgia patients, the researchers also proposed the following possible mechanisms that might explain this link:
  • Alterations in the painkilling mechanisms which naturally occurring in the body.
  • Endocrine system dysfunction (such as thyroid and sex hormone imbalances)
  • Systemic inflammation (e.g., cytokine imbalance)
  • Too little physical activity
  • Cognitive and sleep disturbances
  • Psychiatric conditions (e.g., depression)
  • Dysfunction of the growth hormone (GH)/insulin-like growth factor-1 (IGF-1) axis
• 4

  What integrative measures are recommended?

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  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 behavioral 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 the 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.

  1. Education

  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 the 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 patient 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-behavioral 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 excessive 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.

  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 grams of D-ribose three times daily significantly improved energy, sleep, mental clarity, pain intensity, and general well-being. Another small trial found that 3 grams 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 fiber, 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 of 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 relieving symptoms.

  Omega-3 fatty acids: Omega-3 fatty acids can only be synthesized 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 their 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 minerals 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.

• 5

  How is Fibromyalgia diagnosed?

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  In most cases, a Doctor will diagnose fibromyalgia on the basis of widespread pain lasting for a minimum of three months that is not a characteristic of any other medical condition. However, the American College of Rheumatology (ACR) has developed in-depth criteria for the diagnosis of fibromyalgia, but many physicians don’t strictly adhere to these criteria. There are various reasons why Doctors have trouble diagnosing fibromyalgia. The first is that fibromyalgia patients typically do not exhibit any obvious abnormalities upon physical examination, laboratory analysis, and/or radiologic imagining. Secondly, fibromyalgia patients are often affected by at least one of the following disorders:

  • chronic fatigue syndrome (CFS),
  • irritable bowel syndrome (IBS),
  • interstitial cystitis (IC), and
  • temporomandibular disorder (TMD).

  Therefore, distinguishing the symptoms associated with fibromyalgia from the aforementioned conditions can be fairly confusing, even for experienced physicians. For these reasons, all other conditions and disorders first need to be ruled out, meaning the only remaining condition can be fibromyalgia and then be treated as such.

• 6

  Why does conventional medicine sometimes fail in efforts to prevent & treat Fibromyalgia?

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  Traditional therapy for fibromyalgia includes a wide variety of medications such as these:

  • Pain relievers (e.g., opioids; non-opioid analgesics; local anesthetics)
  • Sleeping Aids
  • Anti-inflammatories (e.g., nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Antidepressants
  • Botulinum toxin (Botox®)
  • Muscle relaxants
  • Anticonvulsants

  While all the above medications are commonly used to treat fibromyalgia, the FDA has only approved 3 specific drugs for this condition. Since June 2007, pregabalin, which is an anticonvulsant drug, became the first to be approved for the treatment of fibromyalgia. A year later the second was identified as duloxetine, an antidepressant drug. Lastly the antidepressant, milnacipran was FDA approved in January 2009 to be the third alternative treatment option for fibromyalgia. Unfortunately, neither one of these medications is effective for the treatment of all the symptoms and disabilities associated with fibromyalgia. Furthermore, some patients either fail to respond or develop significant side effects to these drugs, especially since they are required to be on them long-term. It is normally only after less invasive therapies have failed, such as lifestyle changes, that pharmacotherapy is tried. Fibromyalgia patients often present with different symptoms and unrelated symptom severities, hence there is no universally applicable drug treatment algorithm available. As a result, physicians have to customise direct treatment and normally start with treating the most bothersome symptoms, furthermore, they will aim to organise potential therapies by the mechanism of action and start with drugs that carry the lowest side effect profile.

• 7

  What are the risk factors for Fibromyalgia?

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  Gender: Studies and statistics show that women are seven times more likely to develop fibromyalgia the men, although it may develop in men or women.

  Age The age groups of 20-60 include the individuals that are at the highest risk of developing the onset of fibromyalgia, although it may occur at any age.

  Genetic Factors: Studies have shown, individuals with family members who suffer from fibromyalgia, are at a higher risk of developing it themselves. Hence, genetic factors can be a risk factor and increase one’s chances of developing this condition.

  Lifestyle stressors: Individuals that have recently experienced a traumatic physical or emotional event (such as divorce, car accident, etc.) may be at a higher risk of developing fibromyalgia as a result.

  Comorbid diseases: People suffering from other conditions such as headaches, migraines & different types of arthritis, are at increased risk for developing fibromyalgia. This is because their chronic pain causes sensitization of the central nervous system, which is believed to be one of the underlying causes of Fibromyalgia.

  Sleep Disorders: Some experts say sleep disorders such as insomnia and irregular sleep-wake cycles, could be a root cause of fibromyalgia. Many sufferers have indicated a long history of sleep problems, and people diagnosed with disorders such as sleep apnea may be at increased risk.

  Stress: People coming from stressful environments or who are particularly vulnerable to stress (either physiological or psychological) develop fibromyalgia more frequently than those impacted less by stress. Studies have suggested that post-traumatic stress disorder (PTSD) or chronic stress may play a strong role in the development of fibromyalgia. High-stress levels are also known to trigger flare-ups in many people with fibromyalgia.

• 8

  Can a wellness gene test be done at Health Renewal?

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  A multi-gene DNA test can routinely be added to the assessment of:

  • blood cholesterol and
  • glucose levels,
  • blood pressure and
  • body mass index (BMI) as part of Wellness Programs offered by healthcare practitioners.

  It includes analysis of variation in clinically useful genes that may contribute to:

  • abnormal cholesterol levels,
  • homocysteine accumulation,
  • blood clotting,
  • iron overload and
  • inflammation.

  Some of these abnormalities contribute to the development of type II diabetes, obesity, and hypertension. Oxidative stress, detoxification of carcinogens, and oestrogen exposure are also important considerations in this context.

  This pathology-supported genetic test is performed in conjunction with an assessment of any food allergy or intolerances known to be associated with many chronic disorders. The results of the genetic test are combined with clinical indicators and lifestyle factors to identify a combination of risk factors that may lead to disease development or progression if left untreated.

• 9

  Why should one not self-medicate?

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  For all health conditions, the nutraceuticals are individually tailored by the Health Renewal Doctor. The doctor will decide- based on your history, physical examination, and blood tests what would be the best for you and your specific needs and/or deficiencies. It cannot be over-emphasized that one must not self-medicate. Self-Medicating is done when a person takes prescription medication or nutraceuticals on their own without a doctor's supervision and/or consent. By not having a physical examination and blood testing done by a qualified and practicing integrative medical practitioner, you could be not treating vital deficiencies or conditions such as elevated blood pressure, high sugar level, high-stress levels (that can lead to adrenal burnout ), and high blood clotting factors that could lead to heart attacks and stroke. In addition, a program of dietary supplementation should not be launched without the supervision of a qualified physician. Several of the nutrients suggested in this protocol may have adverse effects. There is no single supplement prescribed to clients as there is no magic bullet that can support all the essential nutrients that one's body needs. Today's food is not functional and we need to supplement in order to maintain optimal bodily functions and nutrition.

• 10

  How do I get started?

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  Make an appointment to consult with your Health Renewal Doctor who is an integrative doctor and he/she will assist you in determining your risk factors and how best to prevent any problems or conditions that you may be susceptible to. The importance of early management of any condition cannot be overstated. Once certain conditions set in and damage to organs occurs, complete recovery may be difficult to attain. The best results for prevention and longevity are early detection of a possible problem combined with conventional treatments, nutritional supplements, and a healthy diet and lifestyle.

• 11

  How do we treat this at Health Renewal?

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  The initial medical consultation at Health Renewal will be approximately 45 minutes. During the 45 minute consultation, your Health Renewal doctor will obtain a FULL medical history from you to determine your personal risk.

  In-office treatments such as carboxytherapy may also be recommended for certain conditions such as hair loss, erectile dysfunction ED, menopause, or PMS. If you need to lose weight our Renewal Institute Diet may be recommended. All these recommendations will be summarised on a sheet or printout out which you can take home with you. The nutraceuticals offered at Health Renewal are of superior quality (Solgar) and are not rancid nor contain Hg (mercury ) or PCB'S (which is very important for Omega 3 Essential fatty acids EFA's). They are also free of gluten, preservatives, wheat, dairy, soy, yeast, sugar, artificial flavor, sweetener, and color. We have a great professional team made up of doctors, trained and registered nurses, and therapists to support you at any time.

• 12

  What should you bring along to your appointment with your Health Renewal doctor?

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  1. You are kindly requested to bring any supplements that you are currently taking, along with to your consultation. The doctor can check the ingredients in this and take them into account when prescribing a treatment plan for you.

  2. Also, if you have had any blood work done in the past 6 months, please bring the results along to the consultation. Should you not be in possession of the hard copies, please request these results from the lab you visited. Usually, your ID number is sufficient.

  Depending on the exact prescription given, you may be required to return to the doctor within 2 to 3 months’ time, in order to ensure optimum thyroid hormone levels are achieved. This will be determined by a repeat blood test and may be requested by your Health Renewal doctor.

• 13

  How often should I see the integrative Doctor?

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  After the two weeks follow-up, the initial blood results will be discussed and patient-specific nutraceuticals may be initiated. A second follow-up evaluation and a blood test at 8 weeks is recommended to measure serum improvements in your Lipogram, homocysteine, and other essential blood results. Follow-up appointments should be every 6 months.

• 14

  Health Renewal Tip: What can you do to prevent Fibromyalgia?

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  The importance of early management of any condition cannot be overstated. Once certain conditions set in and damage to organs occurs, complete recovery may be difficult to attain. The best results for prevention and longevity are early detection of a possible problem combined with conventional treatments, nutritional supplements, and a healthy diet and lifestyle.

  • Listen to your body. Because you have good days and bad days with fibromyalgia, start each morning assessing how you feel. If you didn't sleep well the night before, plan your day accordingly and arrange to do less. If you feel well-rested and your pain is tolerable, do more. Remember that moderation is key, and always be flexible. You never know when you'll have a flare of the condition, so listen to your body and take breaks when you need them.
  • Exercise regularly. At times, moving may be the last thing you feel like doing. However, moving can actually make you feel better and more energised. Regular, gentle exercise can help ease the pain, stress, and other fibromyalgia symptoms. It is important that you start slowly and try activities like walking, swimming, and stretching, even if it's only for a minute or two at a time. If you feel good, you can increase how long you work out and how hard, once again, listen to your body in this regard.
  • Massage. Massage has been used for centuries as a way to ease muscle pain and reduce stress. Massage is also used to help improve range of motion and deal with symptoms of depression and anxiety. If you can tolerate more vigorous forms of massage, it may help relieve deep muscle pain caused by fibromyalgia. You also can try relieving some fibromyalgia pain yourself: try massaging painful areas with a tennis ball or other firm object and easing the tension knots. By doing it yourself you can gauge the intensity and exact areas affected.
  • Hot & Cold. Heat, especially moist heat, may relieve soreness and stiffness from fibromyalgia by boosting blood flow to the places where you hurt. Apply a warm, moist washcloth to the painful area, or try taking a shower or soaking in a bath. You also can reduce the deep muscle pain of fibromyalgia with a cold pack. An easy, and inexpensive, tip for making your own cold pack is wrapping a towel around a bag of frozen vegetables!
  • Get a good night’s sleep. Fibromyalgia symptoms can often disrupt sleep due to pain, restless legs syndrome, or other reasons. It is essential that you try to establish good sleep hygiene. This practice includes trying to set a sleep schedule by going to bed and waking up at the same time every day and avoiding naps. Develop a relaxing bedtime routine, which may be reading relaxing books and taking a warm bath. Also make your bedroom conducive to sleep by keeping it dark, cool, and free of distractions like TV and computers.
  • Set boundaries. It may not be easy, but you may have to become a little bit selfish with your body and time. It is essential that you learn to say “no”, especially when you are pressured by too many demands. This might mean not accepting every invitation or going on every outing, you might even have to back out at the last minute once in a while. At times you will have to put your own needs first, and your friends and family will understand when you just don't have the energy for everything, rather stay at home and rest so you can build your energy levels for the next excursion.
  • Supplementation. Some studies suggest that certain over-the-counter herbs and supplements (such as magnesium, melatonin, and SAM-e), can help relieve fibromyalgia symptoms. It's very important you talk with your doctor before trying any supplement, and avoid self-medicating. Some supplements can have harmful effects if combined with other drugs.
  • Reduce your stress. Too much stress may trigger and worsen your fibromyalgia symptoms. Reducing stress levels may help to ease depression, anxiety, and fatigue and even improve sleep quality. It is essential that you make time for yourself every day to decompress and relax. Be sure to do something you love like read, listen to music, or take a walk. You may also want to use that time for meditation or deep-breathing exercises, whatever it takes for some guilt-free time to de-stress. Look after yourself!