Fibromyalgia is a disorder that is characterized by widespread, chronic pain of unspecific origin. Pain may be experienced in the muscles, tendons, ligaments and joints. Other areas of the body may be impacted in a manner consistent with tactile allodynia, which means sensitivity to what may otherwise be considered non-painful stimuli even when that area is not targeted. In other words, even the slightest pressure can cause pain to spread to other areas. While not life-threatening, fibromyalgia can be quite disabling, with pain varying in intensity and lasting anywhere from a few days to several months or even years.

It is estimated that fibromyalgia affects more than 5,000,000 Americans, with at least 80% of this number being women. While women suffer from fibromyalgia more frequently than men, it is interesting to note that they usually experience symptoms differently. Women typically feel widespread pain throughout the body, while men usually experience pain isolated to the face or an area of the body frequently exercised during occupational or recreational activities.

Risk Factors

• Gender Fibromyalgia occurs more frequently in women than men.

• Age While fibromyalgia can affect anyone of any age, it is most commonly seen in adults between 30 and 50 years of age.

• Family History Fibromyalgia tends to run in families.

• Sleep Disturbances Those who experience sleep disturbances, including sleep apnea and restless legs syndrome, may be at greater risk for developing fibromyalgia.

• Rheumatic Disorders The risk for fibromyalgia appears to be greater for those who have rheumatic disorders, such as lupus or rheumatoid arthritis.

• Injury Particularly injury or trauma to the upper spine.

• Infection There is some evidence to suggest that viral or bacterial infection may be a potential cause of fibromyalgia.

• Impaired Muscle Metabolism

Symptoms and Diagnosis

The American Academy of Rheumatology (ACR) has set some guidelines to help practitioners arrive at a diagnosis of fibromyalgia, which stipulate that there must be unexplained tenderness felt for at least three months in at least 11 of 18 identified tender points located along the sides, front and back of the body. However, many practitioners feel that these guidelines are too unyielding and may not address the symptoms of all candidates. In addition, fibromyalgia patients often experience pain of varying degree and duration that may not fall in line with these criteria.

Unfortunately, there is no standard laboratory test that can confirm or deny the presence of fibromyalgia. To complicate matters, a patient may spend months or years visiting different doctors to seek an explanation for their symptoms without success. Therefore, in addition to applying the ACR criteria, the physician may use other diagnostic tools to help rule out other conditions that can mimic the symptoms of fibromyalgia, such as Cushing's syndrome, chronic fatigue syndrome, carpal tunnel, lupus, or multiple sclerosis.

A discussion of medical and family history will likely also be taken into account, as well as the appearance of accompanying symptoms commonly experienced with fibromyalgia. These include:

• Chronic fatigue.
• Sleep disturbances (i.e., sleep apnea or restless legs syndrome).
• Tingling or numbness.
• Irritable bowel or urinary problems.
• Sexual dysfunction.
• Mood disorders, including depression.
• Frequent tension headaches.
• Cognitive disorders (i.e., poor concentration).

Causes of Fibromyalgia

Fibromyalgia is still a poorly understood disorder. However, researchers have made progress in recent years in identifying some potential causes. The most current thinking involves central sensitization, which equates to a reduced threshold of pain due to an increase in neurotransmission in the brain that triggers pain signals. Researchers believe that this impairment of the central nervous system may be caused by inflammatory cytokines, which promote inducible nitric oxide synthase (INOS) in muscles. Elevated INOS levels produce several reactions, such as:

• Unwarranted stimulation of pain receptors.
• Increased levels of pain neurotransmitters, such as substance P.
• Increased oxidation of free radicals and by-products of nitric oxide, such as peroxynitrite.
• Impaired flow of nutrients to muscles following exercise.

There is also some evidence that indicates a relationship between fibromyalgia and a decrease in hypothalamic-pituitary-adrenal activity, which can lead to a decrease in available levels of growth hormone, androgens (steroid hormones), cortisol and DHEA (dehydroepiandrosterone).

Recommended Supplements in the Treatment of Fibromyalgia

• Antioxidants

Since oxidative stress is associated with fibromyalgia, it may be helpful to supplement with antioxidants to help counteract free radical damage from elevated levels of oxidants, such as peroxynitrite. Recommended antioxidants include omega-3, vitamin C, vitamin E and selenium.

• Vitamin B-6

The active form of pyridoxine can help to increase the activity of adenosine triphosphate (ATP), the molecule responsible for delivering and storing energy in cells. Studies have shown that fibromyalgia patients are often deficient in ATP.

• Magnesium

This nutrient is necessary for energy production and transport from ATP to muscles. Some studies have shown that magnesium supplementation is helpful in reducing symptoms of fibromyalgia.

• SAMe (S-adenosylmethionine)

SAMe is a compound naturally produced by the body. One of its main actions is regulate the production and metabolism of neurotransmitters such as serotonin, norepinephrine, and dopamine. Studies have shown that supplementation with SAMe has helped fibromyalgia patients, who report a decrease in pain and muscle strength, as well improved mood and quality of sleep.

Herbs Used in the Treatment of Fibromyalgia

Cayenne

Cayenne pepper contains capsaicin which, when prepared in a cream and applied topically, can help to reduce local pain. Of particular note is that this agent appears to block the activity of substance P.

Safety Precautions

Omega-3

• Do not take in combination with warfarin (Coumadin).

• Discontinue two weeks before and after any surgical procedure.

Vitamin C

• Do not take if you have kidney stones, sideroblastic anemia, or sickle cell anemia.

Magnesium

• Do not take if you have a history of kidney disease.

Vitamin B-6

• Consult with a physician if you are being treated with levodopa.

SAMe

• Do not combine with antidepressant medications.

References

1. Pall ML. Nitric oxide and the etiology of chronic fatigue syndrome: giving credit where credit is due. Med Hypotheses. 2005a;65(3):631-3.

2. Bagis S, Tamer L, et al. Free radicals and antioxidants in primary fibromyalgia: an oxidative stress disorder? Rheumatol Int. 2005 Apr;25(3):188-90.

3. Ozgocmen S, Ozyurt H, et al. Antioxidant status, lipid peroxidation and nitric oxide in fibromyalgia: etiologic and therapeutic concerns. Rheumatol Int. 2005a Nov 10;:1-6.

4. Ozgocmen S, Ozyurt H, et al. Current concepts in the pathophysiology of fibromyalgia: the potential role of oxidative stress and nitric oxide. Rheumatol Int. 2005b Nov 20;1-13.

5. Vecchiet J, Cipollone F, et al. Relationship between musculoskeletal symptoms and blood markers of oxidative stress in patients with chronic fatigue syndrome. Neurosci Lett. 2003 Jan 2;335(3):151-4.

6. Holdcraft LC, Assefi N, et al. Complementary and alternative medicine in fibromyalgia and related syndromes. Best Pract Res Clin Rheumatol. 2003 Aug;17(4):667-83. Review.

7. Tavoni A, Vitali C, Bombardieri S, et al. Evaluation of S-adenosylmethionine in primary fibromyalgia. A double-blind crossover study. Am J Med. 83.5A (1987): 107-110.

8. Volkmann H, Norregaard J, Jacobsen S, et al. Double-blind, placebo-controlled cross-over study of intravenous S-adenosyl-L-methionine in patients with fibromyalgia. Scand J Rheumatol. 26.3 (1997): 206-211.

Written by Karyn Siegel-Maier 2008

Prepared for Ardis Health