I have a special interest in Fibromyalgia.
Fibromyalgia is a challenging disorder – for patients and for doctors in terms of trying to find effective treatment.
Speaking as someone who has a special interest in fibromyalgia, generally once you have the condition you are stuck with it. In some rare instances it may resolve without treatment.
Standard medicine focuses on symptom relief and avoidance of symptom worsening.
Functional medicine takes a different approach.
Functional medicine asks two questions:
- What is the root cause of this particular patient’s fibromyalgia and
- What can we do to, insofar as it is possible, to ‘fix’ the root cause of the fibromyalgia and, insofar as possible, make the fibromyalgia go away so that they do not have to spend the rest of their days on antidepressants, sleeping pills and pain-killers.
Below is an article which I have written on fibromyalgia.
The first sections review the ‘standard’ medical information.
In the later sections I describe the functional medicine approach to fibromyalgia.
I have also included a typical case history of a patient with fibromyalgia.
Fibromyalgia is a common neurologic health problem causing persistent widespread pain and tenderness (sensitivity to touch). The pain and tenderness tend to come and go and move about the body. Most often, people with this chronic (long-term) illness are fatigued , frequently have sleep problems and also other associated symptoms. For a diagnosis of fibromyalgia standard medical screening laboratory tests must be normal and other diagnoses with similar symptoms must have been excluded..
Key descriptive points in Fibromyalgia
- The pain is widespread – both above and below the waist and on both sides of the body
- The pain is persistent – over three months duration
- There are multiple tender sites within the body
- There will be associated symptoms which may include fatigue, difficulty sleeping, on restorative sleep, cognitive problems (aka ‘brain fog’)
- The standard medical tests are normal and other possible diagnostic explanations have been considered and excluded
- The diagnostic criteria which needed eleven out of eighteen areas of the body to be tender to touch were abandoned some years ago
Who gets fibromyalgia and how common is it?
- Is estimated to affect 2 to 4% of the population
- Is much, much commoner in women
- Most frequently presents in midlife but also may present during the teenage years or in the elderly
- People who already have a rheumatic disease are at greater risk for fibromyalgia
Conditions which may be confused with fibromyalgia
It is important to determine whether your symptoms are caused by some other underlying problem. Joint pain is not a diagnostic feature of fibromyalgia. Other diagnostic possibilities which need to be considered include:
- Rheumatic diseases.Certain conditions — such as rheumatoid arthritis, Sjogren’s syndrome and lupus — can begin with generalized aches and pain.
- Mental health problems.Disorders such as depression and anxiety often feature generalized aches and pain.
- Neurological disorders.In some people, fibromyalgia causes numbness and tingling, symptoms that mimic those of disorders such as multiple sclerosis and myasthenia gravis.
Tests that may be needed to diagnose fibromyalgia
While there is no lab test to confirm a diagnosis of fibromyalgia but a doctor may want to rule out other conditions that may have similar symptoms and blood tests may include:
- Full blood count
- Erythrocyte sedimentation rate (ESR)
- Rheumatoid factor
- C- Reactive protein (CRP)
- Thyroid function tests
- Vitamin D levels
The cornerstone for a reliable diagnosis of fibromyalgia is a careful physical exam of the joints and muscles together with the neurological exam to look for other causes of the patient’s symptoms. Newer American College of Rheumatology guidelines no longer require an “eleven out of eighteen tender points”
The standard medical tests all will be negative i.e. normal in fibromyalgia
Other clues to a possible diagnosis of fibromyalgia
People who have fibromyalgia also often wake up tired, even after they’ve slept continuously for more than eight hours. Brief periods of physical or mental exertion may leave them exhausted as well as having problems with short-term memory and the ability to concentrate.
Fibromyalgia often coexists with other health problems including :
- Irritable bowel syndrome
- Jaw / temporomandibular joint pain
- Anxiety or depression
- Frequent or painful urination or interstitial cystitis
Fibromyalgia symptoms sometimes begin after a physical trauma, surgery, infection or significant psychological stress. In other cases, symptoms gradually accumulate over time with no single triggering event.
Risk factors for fibromyalgia include:
- People who have post-traumatic stress disorder appear to be more likely to develop fibromyalgia.
- Some infective illnesses appear to trigger or aggravate fibromyalgia
- Your gender.Fibromyalgia is diagnosed more often in women than in men.
- Family history and genetics.Because fibromyalgia tends to run in families, there may be certain genetic mutations that may make you more susceptible to developing the disorder.
- Many people who have fibromyalgia also have tension headaches, temporomandibular joint (TMJ) disorders, irritable bowel syndrome, anxiety and depression
- Other disorders.If you have osteoarthritis, rheumatoid arthritis or lupus, you may be more likely to develop fibromyalgia.
Below is an outline of the standard medical treatment for fibromyalgia
In general, treatments for fibromyalgia include both medication and self-care. The emphasis is on minimizing symptoms and improving general health. No one treatment works for all symptoms.
Medications can help reduce the pain of fibromyalgia and improve sleep. Common choices include:
- Pain relievers.Over-the-counter pain relievers such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others) may be helpful. Your doctor might suggest a prescription pain reliever such as tramadol (Ultram). Narcotics are not advised, because they can lead to dependence and may even worsen the pain over time.
- Duloxetine (Cymbalta) and milnacipran (Savella) may help ease the pain and fatigue associated with fibromyalgia. Your doctor may prescribe amitriptyline or the muscle relaxant cyclobenzaprine to help promote sleep.
- Anti-seizure drugs.Medications designed to treat epilepsy are often useful in reducing certain types of pain. Gabapentin (Neurontin) is sometimes helpful in reducing fibromyalgia symptoms, while pregabalin (Lyrica) was the first drug approved by the Food and Drug Administration to treat fibromyalgia.
A variety of different therapies can help reduce the effect that fibromyalgia has on your body and your life. Examples include:
- Physical therapy.A physical therapist can teach you exercises that will improve your strength, flexibility and stamina. Water-based exercises might be particularly helpful.
- Occupational therapy.An occupational therapist can help you make adjustments to your work area or the way you perform certain tasks that will cause less stress on your body.
- Talking with a counselor can help strengthen your belief in your abilities and teach you strategies for dealing with stressful situations.
Lifestyle and home remedies
Self-care is critical in the management of fibromyalgia.
- Reduce stress.Develop a plan to avoid or limit overexertion and emotional stress. Allow yourself time each day to relax. That may mean learning how to say no without guilt. But try not to change your routine completely. People who quit work or drop all activity tend to do worse than do those who remain active. Try stress management techniques, such as deep-breathing exercises or meditation.
Get enough sleep. Because fatigue is one of the main characteristics of fibromyalgia, getting sufficient sleep is essential. In addition to allotting enough time for sleep, practice good sleep habits, such as going to bed and getting up at the same time each The timeline concept is really important: when did the illness begin was there any association with menopause or perhaps a gastrointestinal infection, and operation or an injury.
- day and limiting daytime napping.
- Exercise regularly.At first, exercise may increase your pain. But doing it gradually and regularly often decreases symptoms. Appropriate exercises may include walking, swimming, biking and water aerobics. A physical therapist can help you develop a home exercise program. Stretching, good posture and relaxation exercises also are helpful.
- Pace yourself.Keep your activity on an even level. If you do too much on your good days, you may have more bad days. Moderation means not overdoing it on your good days, but likewise it means not self-limiting or doing too little on the days when symptoms flare.
- Maintain a healthy lifestyle.Eat healthy foods. Limit your caffeine intake. Do something that you find enjoyable and fulfilling every day.
I see my role as helping patients especially when the standard medical treatment is not working for them.
My medical philosophy also differs from the standard medical approach.
Standard medicine for fibromyalgia concentrates on symptom management and helping the patient to, hopefully, not get worse
My approach is the functional medicine approach : Let us try to find out what is wrong and fix it.
“You have this disorder which is called fibromyalgia. The cause of fibromyalgia differs between patients. Let us try and see what is causing your fibromyalgia and see if we can actually ‘fix’ it . Let us see if over time by working together we can reduce or eliminate the painkillers, the antidepressants, the sleeping pills and the anxiety medicines and try to get you to a point where you are pain-free, energetic and are able to once more live a ‘normal’ life.”
It is a precondition of seeing me that patients have been investigated by their GP or consultant so I have the comfort of knowing that life-threatening disease has been excluded.
The completed health questionnaire is important – you and I need to work together as a team.
Please complete health questionnaire carefully.
Timeline is an important
An example of past medical history
birth to 10 years
aged 4- 8 lots and lots of sore throats
aged 8 tonsils removed
Do you / did you – some things which I always keep in mind when I am trying to assemble the ‘fibromyalgia jigsaw’. Issues which I am thinking about.
Is your digestion a possible trigger / do you suffer frequent gastrointestinal symptoms? Remember a huge part of the immune system resides in the abdominal cavity
What about persistent vaginal candidiasis /thrush or possibly gastrointestinal fungal overgrowth?
Do you live in a mouldy, damp environment?
Could this person have a deficiency of stomach acid or a deficiency of digestive enzymes.
Is it possible that this individual might be inefficient at absorbing zinc or maybe, despite supplementation, they might have persistent low magnesium levels
Might a patient with dental amalgam fillings which are leaking mercury have a system which is not efficient at excreting/ detoxifying mercury.
Have you experienced onset or worsening of symptoms since menopause?
Did a serious infective episode kick things off?
Maybe roestrogen levels may suddenly have dropped (partial ovarian failure) without periods is actually disappearing?
Is there as significant food intolerance?
Could you maybe have a methylation abnormality which would affect both ability to detoxify foreign compounds but also affects serotonin availability and how your body handles hormones
Might you possibly have elevated free copper
What about either elevated or else very depressed salivary free cortisol levels.
At the end of the first consultation we organise the investigations.
At the second consultation (usually about four weeks after the first consultation) we formulate an individualised initial treatment plan which addresses the likely causes your particular case.