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Treatment of Fibromyalgia  

I have fibromyalgia. Is there anything I can do to treat it?

Yes. Although some mainstream medical literature may state that no specific "cure" for fibromyalgia has been found yet, many lifestyle practices and various types of treatments for fibromyalgia are available to assist in reducing your symptoms and help in improving your quality of life.

Remember that the types, duration, and intensity of symptoms of fibromyalgia vary with different patients. Symptoms of fibromyalgia may be similar to those of a related condition, chronic fatigue syndrome (CFS).

First and foremost, if you are experiencing widespread muscle pain and fatigue that seem unrelated to your activities, are long-lasting, or are preventing you from engaging in and enjoying your everyday life, consult your integrative medical physician, rheumatologist, or other healthcare professionals who believe in the diagnosis of fibromyalgia, understand the symptoms of the condition, and are experienced in diagnosing and managing fibromyalgia in many people. Also, working with a psychologist or psychiatrist can be very helpful in the management of fibromyalgia.

Do not accept labels for your condition, but rather, seek to change the causative factors that may have contributed to fibromyalgia. Many treatments for fibromyalgia are available that can help you lead and enjoy a full life. Choices of treatments for fibromyalgia include a variety of lifestyle practices (e.g., exercise), psychological therapies, nutritional supplements, and medical therapies.

Healthy lifestyle choices for fibromyalgia patients include:[1, 2]

• Focusing on necessary and enjoyable activities at home and work. When possible, choose a career that you enjoy and feel is emotionally rewarding. If you worked prior to having fibromyalgia, try to continue some form of work, rather than completely ceasing working. Participate in a hobby that you enjoy, rather than completely stopping all activity at home. Never let yourself become a victim of the fibromyalgia process. Better outcomes have been observed in fibromyalgia patients who engage in some activities. Therefore, stay as active as is possible for your wellbeing.

• Pacing yourself in performing an even level of necessary and enjoyable activities at home and work is a very important part of managing fibromyalgia. Working with an integrative medical physician or alternative healthcare practitioner who can help you plan your activity schedule is recommended.

• Slowing down and reducing participation in less important activities. Be able to say,"no," without feeling guilty, if saying,"yes," would mean that you would have to overexert yourself.

• Initially reducing physical activity, and then gradually and steadily increasing the amount of exercise. A graduated exercise program can promote blood circulation, help prevent or reduce muscle weakness and muscle pain that otherwise could result from prolonged inactivity. Furthermore, exercise can help increase range of motion. Do not let yourself be labeled as "ill." Engage in levels of daily activity that let you be comfortable, but keep "pushing the envelope." Helpful exercise practices include proper posture, stretching, walking, tai chi, yoga, pilates, swimming, water aerobics, and biking. You may choose to work with a physical therapist or personal trainer to assist in the gradual increase of your level of physical activity.

• Getting adequate sleep. Helpful sleeping habits include allowing yourself sufficient hours of sleep at night, going to bed at the same time every night, waking up at the same time every morning, and restricting yourself from taking too long or many naps during the day. To learn proper sleep techniques, consider working with a therapist.

• Avoiding excessive physical and emotional stress. If you have modified your routine to improve your health, learn to feel good, not guilty, about it. Every day, give yourself time for relaxing. Performing relaxation exercises (e.g., deep breathing exercises) can be helpful.

• Eating a healthy, balanced diet, consisting of an adequate amount of protein, carbohydrates, and fats. Approximately one-third of your caloric intake should come from proteins, one-third from carbohydrates, and one-third from fats. Enjoy fresh, organic vegetables and fruits.

• Avoiding consuming foods containing high levels of sugar. Examples of foods to avoid are candy, fruit juices, dried fruits, and processed foods. Limiting your intake of sugar can reduce inflammation, block the growth of Candida (yeast) in your body, and decrease fatigue.

• Avoiding eating foods that contain yeast (e.g., leavened bread and cake) or fungi (e.g., blue cheese). Avoidance of foods containing yeast or fungi can decrease the amounts of these microbes introduced into your body.

ͺ Drinking lots of water. More water intake is healthier than a lower water intake.
• Restricting your intake of caffeine
• Avoiding drinking alcohol, as it acts as a depressant
• Avoiding smoking

Alternative energy therapies and physical therapies for managing fibromyalgia include:[1, 2]

• Acupressure, which involves pressure with the fingers on certain points on the skin under which travel energy pathways of the body

• Acupuncture, which involves insertion of thin needles into certain points on the skin under which travel energy pathways of the body. According to clinical studies, acupuncture may help reduce pain in people with fibromyalgia.

• Chiropractic treatment, including manipulation of the craniosacral region and the spine to increase spinal movement, restore function in the spine and joints, and reduce pain

• Osteopathic care, including manipulation of the spine to increase spinal movement, restore function in the spine and joints, and reduce pain

• Massage to help relax muscles that may be in a shortened position or experiencing spasm, to increase circulation in (and resultant increase in flow of nutrients to and elimination of metabolic byproducts from) the muscles and soft tissues, increase joint motion, stimulate production of natural substances in the body that can help reduce pain, and assist in decrease in anxiety and stress. If you are experiencing acute inflammation, however, massage therapy should be avoided.

• Other forms of therapeutic touch, including myofascial release, which involves manipulating the muscles and adjacent fibrous tissue

• Stretching exercises to help relax muscles that may be in a shortened position or experiencing spasm

• Training in posture and movement
• Bio-feedback therapies
• Regular immersion in a hot bath containing Epsom salt to relieve muscle pain and stiffness
• Application of heat or cold
• Application of ultrasonic waves
• Application of mild electrical stimulation
• Energy therapies
• Deep breathing exercises
• Meditation

Consultation with a counselor (an M.F.T. therapist), a clinical psychologist or psychotherapist (Ph.D. or Psys.D.), or a psychiatrist (M.D. or D.O.) can be very helpful in the management of fibromyalgia. Psychological approaches to dealing with psychological problems associated with fibromyalgia include:[1, 2]

• Counseling to provide emotional support, help you develop coping skills, and assist in your overcoming depression
• Cognitive-behavioral therapy, which strives to raise your confidence in your own capabilities and provides you with tools to assist you in handling stressful situations
• Behavior therapy, involving learning to change one’s behavior, may help treat problems such as depression
• Joining a fibromyalgia patient support group
• Self-hypnosis

In consultation with an integrative medical physician experienced in managing fibromyalgia, various conditions, such as "leaky gut" syndrome and Candida (yeast) infections that may be present in fibromyalgia patients, can be evaluated. Then an appropriate nutritionally therapeutic program, which can include such approaches as anti-inflammatory effects and hormonal balancing, can be initiated. The following nutritional approaches for management of fibromyalgia can be considered:[2]

• Supplements that have anti-fungal activity, including inhibiting the growth of Candida (yeast)
• Supplements containing echinacea, essential fatty acids, ginseng, whey protein (which contains lactoferrin) and extract of licorice (which contains glycyrrhizin) to stimulate the immune system in inhibiting the growth of viruses otherwise responsible for chronic infection
• Supplements containing bilberry extract (which is rich in anthocyanins), curcumin, carotenoids, and chlorophylls to suppress growth of Epstein-Barr virus responsible for chronic infection
• Supplements containing antioxidants to stimulate the action of the immune system against infections and protect against inflammation
• Supplements containing bromelain, cumin, DHEA, tumeric, fish oil containing docosahexaenoic acid, and borage oil containing gamma-linolenic acid to lower the levels of inflammatory molecules
• Supplements containing cetyl myristoleate to lower the level of inflammatory molecules and decrease symptoms of fibromyalgia
• Supplements containing vitamin B6, vitamin B12, folic acid, and trimethylglycine (TMG) to reduce the level of homocysteine and, thereby, lessen fatigue
• Supplements containing the amino acid, L-carnitine, to help increase energy metabolism and reduce fatigue
• Supplements containing methylsulfonylmethane (MSM) to lower the level of inflammatory molecules and decrease pain
• Supplements containing melatonin, which has antioxidant activity, improves sleep, and reduces pain
• Supplements containing malic acid to reduce muscle pain of fibromyalgia
• Supplements containing S-adenosyl methionine (SAME) to decrease pain in fibromyalgia and associated depression
• Supplements containing digestive enzymes to improve digestion and the absorption of nutrients and reduce symptoms of leaky gut and irritable bowel syndrome
• Herbal supplements specifically formulated to treat symptoms of fibromyalgia
• Supplements containing the amino acid, L-theanine to decrease anxiety and aid in relaxation of the mind
• Supplements containing St. John’s wort, SHTP, and valerian to treat depression

Also, certain homeopathic remedies (dilute extracts of substances from botanical, mineral, and animal sources) can be used to treat muscle pain and fatigue. See a homeopath, a healthcare professional experienced in homeopathy, for guidance on selection of the proper remedy and the appropriate dose for you.

Examples of homeopathic remedies that can be used to treat muscle pain include:

• Belladonna
• Calcarea carbonica
• Calcarea phosphorica
• Hypericum
• Kali phosphorica
• Magnesia phosphorica
• Natrum muriaticum
• Secale cornatum
• Sulfur

Examples of homeopathic remedies that can be used to treat fatigue include:

• Arsenicum album
• Aurum metallicum
• Carbo vegetabilis
• Conium maculatum
• Ferrum phosphoricum
• Kali phosphoricum
• Lycopodium clavatum
• Phosphorus
• Platinum metallicum
• Secale cornutum
• Sepia

If you have fibromyalgia, it is essential for you to engage in understanding fibromyalgia and not being a participant in the "medicalization" of this condition. Pharmaceutical approaches for management of inflammation and specific symptoms of fibromyalgia should be used only if symptoms have not responded adequately to other approaches taken previously. In consultation with an integrative medical physician experienced in managing fibromyalgia, medications may be considered to:[1, 2]

• Enhance the activity of the immune system to prevent the growth of microbes. Intravenous (IV) injections of vitamin C is one of the alternative medicine therapies available for this goal.
• Treat fungal infections, such as Candida (yeast) infections. Types of medications are anti-fungal agents.
• Lower the level of inflammatory cytokines. Example of medication is the prescription drug, pentoxyfilline.
• Remove toxins, including heavy metals from the body. IV chelation therapy to bind and remove heavy metals from the body is an alternative medicine approach that can be used in people with fibromyalgia.
• Treat dry eyes. A recommended type of medication is over-the-counter (OTC) eyedrops that are similar to tears, help to retain moisture in the eye, and are free of preservatives.
ͺ Relieve pain and stiffness. If mobilization therapies and nutritional supplements have not resolved symptoms, types of medications that may be used include the OTC analgesic (i.e., pain medication), acetominophen (e.g., Tylenol); the prescription analgesic, tramadol (Ultram); and the OTC nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., aspirin, ibuprofen, naproxen sodium).
• Decrease pain, improve sleep, and treat depression. If psychological therapy and nutritional supplements have not resolved sleep problems and depression, a prescription medication such as the mild narcotic (although non-addicting) antidepressant drug, buphrenorphine, may be used.
• Improve sleep. If training in sleep techniques by a therapist and nutritional supplements have not resolved symptoms, types of medications that may be used include prescription tricyclic antidepressants, such as nortriptyline (Pamelor); selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac); and sleeping pills, such as zolpidem (Ambien). Sleeping pills are prescribed only for short-term use.
• Treat depression. If psychological therapy and nutritional supplements have not resolved symptoms, types of medications that mat be used include prescription tricyclic antidepressants, such as nortriptyline (Pamelor), and selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac).

However, dietary supplements, over-the-counter (OTC) medications, and prescription medicines have potential side effects and may interfere with the effects of other medications. Consult your integrative medical physician and your other healthcare professionals for guidance on fibromyalgia therapy that is appropriate for you.


REFERENCES

1. Mayo Clinic. Fibromyalgia. 01/27/05. Accessed at www.mayoclinic.com.
2. Life Extension Foundation. Fibromyalgia. In: Disease Prevention and Treatment, 4rh ed. 2003. Hollywood, FL: Life Extension Media.



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