Fibromyalgia Treatments and Remedies

Persons with fibromyalgia typically experience long-lasting or chronic pain, as well as muscle stiffness and tenderness. Fibromyalgia affects about 3 million to 6 million people in the United States each year. The disorder mostly affects women and typically develops in early-to-middle adulthood. There is no test for the diagnosis of fibromyalgia. Doctors make a diagnosis by conducting physical examinations, evaluating symptoms, and ruling out other conditions.

Home Remedies for Fibromyalgia

• Physical adjustments. Make physical adjustments in your home or work environment that allow you to function more comfortably, says family practitioner Anne Simons, M.D., an assistant clinical professor of family and community medicine at the University of California’s San Francisco Medical Center. Experiment with working standing up instead of seated, or try changing the height of your desk or chairs to make your daily activities more comfortable.

• Pamper yourself. To minimize your discomfort, Dr. Simons recommends investing in some good pillows, especially a neck-supporting horseshoe-collar when sitting in high-backed chairs, car seats, or airplane seats. Neck-supporting pillows are available at some department stores, medical supply houses, and pharmacies, and through several consumer catalogues.

• Be kind to yourself. You’re not crazy. Fibromyalgia is not “all in your head.” I.J. Russell, M.D., and colleagues at the University of Texas Health Sciences Center in San Antonio performed in-depth physical and psychological evaluations of 78 people with fibromyalgia. They found “no significant relationship” between their pain and their psychological health. Instead of beating yourself up for being “neurotic,” be kind to yourself. Don’t overdo work or play. Take breaks when you feel you need to.

• Catch some zzzz’s. Insomnia is often a particularly maddening aspect of fibromyalgia. To help you get more restful sleep, see the Insomnia Information article.

Exercise

• Move away from your pain. When you’re hurting, you may not feel like taking a walk, riding a bike, playing tennis, or taking an aerobics class. But you should. Exercise can relieve your pain and stiffness. Rheumatologist Theodore Pincus, M.D., a professor of medicine at Vanderbilt University School of Medicine in Nashville, Tennessee, considers regular exercise “the most helpful therapy for fibromyalgia.”

At the University of Calgary in Canada, researchers assessed the symptoms of 60 fibromyalgia sufferers and then enrolled them in a comprehensive exercise program that involved flexibility training (stretching), strength training (weight lifting), and cardiovascular conditioning (aerobics). The program met for one hour three times a week for six weeks. Post-tests showed that prticipants had significantly less pain, fewer tender points, and lower overall symptoms scores.

Sigrid Horven Wigers, M.D. of the department of behavioral medicine, an colleagues at University Hospital, in Trondheim, Norway, corroborated these findings in a study of 60 fibromyalgia sufferers (55 women, five men) who participated in one of three different teatment programs: usual care, an aerobic exercise class (45 minutes three times a week), or stress management program that involved a support group and relaxation training (90 minutes twice a week). After 14 weeks, both exercise and stress management provided significant symptom relief. But of the two, exercise was somewhat more effective.

Relaxation Therapies for Fibromyalgia

• The power of perseverance. In the Swedish study just mentioned, exercise provided a little more relief than stress management—but only in the short term. After the 14-week study, the researchers followed the participants for four more years. Over the long term, about three-quarters of those in the exercise program stopped exercising, and saw their improvement evaporate. But in the stress management group, 69 percent were still using relaxation techniques regularly, and benefiting from them.

• Meditate and move. The Swedish researchers speculated that combining exercise and relaxation might provide greater benefit than either therapy by itself. That’s what researchers from the departments of the rheumatology and complementary medicine at the University of Maryland found in an eight-week study of 28 Baltimore-area fibromyalgia sufferers. The program consisted of weekly, two-and-a-half- hour classes that included: education about the mind-body aspects of pain, training in relaxation-response meditation, and participation in a qigong exercise program. Compared with pre-class symptom scores, after the class, participants reported significantly less pain and fatigue, improved sleep, mood, and quality of life.

While we’re on the subject of meditation, researchers at the Arthritis-Fibromyalgia Center, and Newton-Wellesly Hospital in Massachusetts, assessed the symptoms of 77 fibromyalgia sufferers and then taught them to meditate in a 10-week program. Every participant improved, and half showed considerable improvement.

Psychologists at Oregon Health Sciences University in Portland have reported similar success with a weekly 90-minute group that met for six months. Participants learned about fibromyalgia, exercised and practiced relaxation techniques together, and attended a support group that periodically included their spouses. Based on before-and-after assessments of 104 participants, overall symptom scores improved an average of 25 percent and 70 percent reported fewer tender spots.

• Feel better with biofeedback. If you have fibromyalgia, you’re caught in a vicious cycle. You’re hyper-sensitive to stress, which aggravates your pain and other symptoms, which, in turn, makes you even more sensitive to stress. Relaxation therapies can break this cycle. At the Cedars Sinai Firbromyalgia Rehabilitation Program, biofeedback is the relaxation therapy of choice. “Biofeedback teaches deep relaxation quickly and easily,” director Jeanne Melvin, O.T.R., an occupational therapist, explains. “We find that it helps relieve fibromyalgia pain and improves sleep.”

• Get help with hypnotherapy. In Nieuweigein, the Netherlands, Dutch rheumatologists assigned 40 long-term fibromyalgia sufferers to either 12 weeks of hypnotherapy or physical therapy. Both groups showed improvement, but those who received hypnotherapy enjoyed significantly greater benefit.

Elimination Diet

• The food connection. Food sensitivities can cause achiness, lethargy, and other symptoms similar to fibromyalgia. Russell Jaffe, M.D., Ph.D., director of Serammune Physician’s Laboratory in Reston, Virginia, wondered if the type of elimination diet that helps treat food intolerances might also help people with fibromyalgia. He asked 32 fibromyalgia sufferers to either maintain their usual lifestyle, or have tests to identify foods, medications, food additives, and environmental chemicals to which they might be sensitive. Those who had the tests were asked to avoid the substances that provoked reactions. The control group reported no symptom changes, but the elimination-diet group noted rapid symptom improvement. After six months, they experienced 50 percent less pain, 30 percent less stiffness, 50 percent more energy, and 40 percent less depression.

The foods, additives, and chemicals that caused the most problems included: monosodium glutamate, MSG (43 percent of the group), yeast fungus (38 percent), caffeine (35), chocolate/cocoa (35), food colorings (35), colas (35), shrimp (35), dairy products (25), sulfite preservaties (23), xylene (23), yogurt (23), NutraSweet, aspartame (20), BHA food preservative (20), cadmium (20), lead (20), Tylenol, acetaminophen (20), sodium benzoate (20), and organges (20).

“The problem with a formal elimination diet,” says Alan Brauer, M.D., founder of TotalCare Medical Center in Palo Alto, California, one of the nation’s first clinics to combine mainstream and complementary therapies, “is that they require more discipline than most people have, even when they’re medically supervised. Food-sensitivity testing is a quicker, easier way to go. It’s expensive, but if it helps, it’s worth it.”

Social Support

• Enlist your loved ones. Because fibromyalgia is a mysterious condition, your family and friends may not appreciate the problems it causes, and may express skepticism about your symptoms and any disability you suffer. This can be infuriating, but it’s also understandable. Educate those close to you about fibromyalgia, and enlist their support. For information, you can contact:

• The Fibromyalgia Network, P.O. Box 31750, Tucson, AZ 85751-1750; (800) 853-2929.
• Fibromyalgia Alliance of America, P.O. Box 21990, Columbus, OH 43221-0990; (614) 457-4222.
• The National Chronic Fatigue Syndrome and Fibromyalgia Association, P.O. Box 18426, Kansas City, MO 64133; (816) 931-4777.
• Fibromyalgia Rehabilitation Program, Cedars Sinai Medical Center, Los Angeles, (310) 855-6161.

• Join a support group. There’s nothing as comforting as talking wtih people who know exactly what you’re going through. That’s why support groups are so popular and powerful. The organizations listed above may be able to refer you to a group near you. If no group exists in your area, why not start one? You can get help from The American Self-Help Clearinghouse, Saint Clares-Riverside Medical Center, Denville, NJ 07834; (973) 625-7101.

Supplements for Fibromyalgia

• Magnesium and Malic Acid. At the University of Texas Health Sciences Center in San Antonio, researchers gave 24 fibromyalgia sufferers either a placebo or the supplement combination (150 mg of magnesium and 600 of malic acid) twice a day for four weeks, followed by higher-dose supplementation (300 mg of magnesium and 1200 mg of malic acid) twice a day for another six months. The initial month of low-dose supplementation had no effect, but by the end of the six months those taking the larger dose reported significantly less pain and tenderness.

Guy Abraham, M.D., a Torrance, California researcher, came up with similar findings in a study of 15 fibromayalgia sufferers who took either a placebo or a combination of malic acid (1200 to 2400 mg/day) and magnesium (300 to 600 mg/day). After eight weeks, the placebo group reported a slight increase in tender points, but those taking the supplements enjoyed a significant reduction in tenderness.

• Try tryptophan. Studies dating back 20 years show that supplementation with 5-hydroxy-L-tryptophan relieves fibromyalgia symptoms. Researchers at L. Sacco Hospital in Milan, Italy, gave either 5-hydroxy-L-tryptophan or a placebo to 50 fibromyalgia sufferers. The supplement produced significant improvement, with only mild and transient side effects.

Tryptophan was available over the counter as a supplement until some years ago when a contaminated batch led the Food and Drug Administration to pull it from health food store shelves. Today, 5-hydroxy-L-tryptophan is available only by prescription. If you’re interested in trying it, consult your doctor.

Herbal Medicine for Fibromyalgia

• Red pepper to the rescue. The compound that gives red pepper its spicy heat is capsaicin. Capsaicin is also a powerful pain reliever, now available in several over-the-counter products. At the Medical College of Wisconsin in Milwaukee, rheumatologists gave 45 fibromyalgia sufferers either a placebo cream or one containing capsaisin (0.025 percent) for four weeks. The placebo group reported an increase in pain and tenderness, but those using the herbal compound reported significant relief.

Chinese Medicine

• Strengthen your defensive chi. Chinese medicine views fibromyalgia as an invasion of Wind, Cold, and Damp because your defensive life energy (chi) isn’t strong enough to keep them out. “Using the miltary metaphors the Chinese often employ,” explains San Francisco Chinese physician Efrem Korngold, L.Ac., O.M.D., co-author (with Harriet Beinfield, L.Ac.) of Between Heaven and Earth: A Guide to Chinese Medicine. “there’s no guard at the gate.” If your fibromyalgia is caused primarily by Wind, you experience pain and feel worse in drafts. If Damp is the main culprit, you experience tenderness and feel better in dry environments. And if Cold is your main problem, you experience constant achiness and feel better when warm.

Chinese herbal treatment involves strengthening chi, and expelling Wind, Cold, and Damp. The formulas used are individually tailored depending on the physician’s assessment of the cause(s) of your condition. To strengthen chi, Dr. Korngold prescribes astragalus. Herbs that expell Wind and Dampness include Clematis root, gentian root, and Chaenomelis fruit. To expell Wind and Cold, he recommends cinnamon twig and dried ginger.

• Points vs. pain. In its 1997 Consensus Statement on the benefits of acupuncture, a panel of the National Institutes of Health recommended it for fibromyalgia because acupuncture often relieves pain. At the University Hospital in Geneva, Switzerland, researchers gave 70 fibromyalgia sufferers either real or sham electroacupucture (acupuncture with low-level electric current run through the needles). After six sessions over three weeks, the sham group showed no improvement, but half of the electroacupuncture group showed significant improvement, and one-quarter enjoyed almost complete relief from fibromyalgia symptoms.

Points Dr. Korngold recommends include:

• Spleen 9. On your inner leg below your knee, in the hollow behind your shinbone (tibia) one thumb width below your knee crease.

• Liver 3. In the hollow behind and between the knuckles of your big toe and second toe.

• Large Intestine 4. On top of your hand, in the center of the muscle webbing between your thumb and index finger.

• Gall Bladder 20. In the hollow below the base of your skull, about two thumb widths out from the midline of your spine.

Homeopathy for Fibromyalgia

• Make the most of a microdose. At St. Bartholomew’s Hospital in London, rheumatologists gave 23 fibromyalgia sufferers standard treatment plus a placebo, while 23 others received standard therapy plus a homeopathic microdose of poison ivy (Rhus tox). The homeopathic medicine provided significantly greater pain relief.

And Finally…

Because other illnesses can cause symptoms that might be mistaken for fibromyalgia, doctors typically order tests to rule out such conditions as lupus, hypothyroidism, intestinal parasites, Lyme disease, and the various forms of arthritis.

Once your doctor is confident that you have fibromyalgia, some prescription drugs might help: pain relievers, and such medications as cyclobenzaprine (Flexeril), a muscle relaxant, or sleeping pills, or antidepressants.

Antidepressants, in particular, have shown considerable benefit. Chronic pain can be very depressing, and mood elevation often contributes to pain relief. At Newton-Wellesley Hospital in Massachusetts, scientists gave 19 fibromyalgia sufferers one of the following treatments: the antidepressant, Prozac (fluoxetine); another antidepressant, Elavil (amitriptyline); both drugs; or a placebo. Both antidepressants produced significant relief of fibromyalgia pain and tenderness. The two drugs together produced greater relief than either one by itself. Antidepressant therapy also provided some relief from fatigue and improved sleep.

But drugs alone rarely bring complete relief. Your doctor might refer you to a pain clinic that combines drug treatment with the lifestyle and complementary therapies discussed throughout this Chapter.

In June of 2007, The U.S. Food and Drug Administration approved Lyrica (pregabalin), the first drug to treat fibromyalgia, a disorder characterized by pain, fatigue and sleep problems. Lyrica is manufactured by New York-based Pfizer Inc.

Lyrica reduces pain and improves daily functions for some patients with fibromyalgia.

The most common side effects of Lyrica include mild-to-moderate dizziness and sleepiness. Blurred vision, weight gain, dry mouth, and swelling of the hands and feet also were reported in clinical trials. The side effects appeared to be dose-related. Lyrica can impair motor function and cause problems with concentration and attention. FDA advises that patients talk to their doctor or other health care professional about whether use of Lyrica may impair their ability to drive.

Lyrica already is approved for treating partial seizures, pain following the rash of shingles and pain associated with diabetes nerve damage (diabetic neuropathy).