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Fibromyalgia originally was called “muscular rheumatism” until 1976 when the current term was coined. Since it was found primarily in women, modern medicine often dismissed it as a psychological issue. Finally in 1987 it was recognized as a real, physical condition.
It is characterized by widespread and persistent muscle pain across many areas of the body. In addition, pain can be variable and influenced by seasonal changes and low physical activity levels. Fatigue even with minimal exertion is common as are sleep disturbances and cognitive dysfunction (“fibro-brain”).
After all of the years of research the reasonable cause of fibromyalgia is INFLAMMATION as the result of an interplay between the immune and nervous systems! 70% of our immune system lives in the bowels and 90% of all neurotransmitters are made in the bowels. Bowel issues are a common symptom in fibromyalgia…maybe the bowels are a major player.
Traditional Medicine
This approach has been to continue to assume that fibromyalgia has a neurologic cause and so\ most medications focus on brain chemistry. Antidepressants, monoamine reuptake inhibitors, serotonin and dopamine receptor antagonists, gabapentin, opioids, and cannabinoids are the foundation of this approach. The main goals are to affect sleep, depression and fatigue. As effective as these medications can be, they do not address the underlying cause.
New Directions
Inflammation is considered to be the central element in fibromyalgia and the gut may be where this inflammation begins. There is a complex interface between gut microbiota, the bowels and systemic inflammation resulting in elucidating the pathophysiology of fibromyalgia. Most recently, fecal transplantation from fibromyalgia patients into germ-free mice induces pain hypersensitivity but that transplantation from healthy individuals does not reproduce pain hypersensitivity.
The bacteria in fibromyalgia patients are characterized by certain bacterial species like Flavonifractor, Parabacteroides and Faecalibacterium. These imbalances promote the synthesis of pain-enhancing amino acids and when coupled with an altered gut microbiota there is in increased intestinal permeability. This leads to an inflammatory cascade affecting pain signals.
Current Anti-Inflammatory Strategies
Without going into all of the research, the bottom line is that anti-inflammatories like ibuprofen and pain medications like acetaminophen simply do not work long-term.
Interestingly dietary modifications now regarded as first-line treatments…excellent safety profiles and long-term benefits. I have been recommending dietary changes for my fibromyalgia patients for decades and having good success including reduced pain, fatigue, and gastrointestinal challenges.
Exercise, particularly aerobic and strength training programs have been shown to be effective in reducing pain, improving sleep, helping fatigue, and depression. However not all fibromyalgia patients may be able to initiate a consistent exercise program but any form of exercise can help.
Herbs and Supplements
The list of herbs and supplements purported to reduce inflammation is legion. Whether or not they have a benefit on fibromyalgia is often speculative and claims unsupported by anything more than an opinion.
Mind-Body Therapies
Stress is a major player in fibromyalgia. Stress also has a profound effect on the bowels, increases inflammation and negatively impacts the immune system and healing. There is robust medical research on stress reducing therapies impacting the symptoms of fibromyalgia.
Mind-Body therapies include:
- Massage
- Meditation
- Guided imagery
- Hypnosis
- Energy-based therapies
- Reiki
- Qigong
My Approach
I have been treating patients with fibromyalgia for 30+ years (I’m pretty old 😊). I do not just throw a few medications at the patient and say to follow up in 6 months.
I incorporate therapeutic approaches that address the bowels, muscle pain, personal stress, diet, sleep, anxiety and fatigue. Fibromyalgia is the result of many levels of imbalance and medications alone are woefully inadequate.
Fibromyalgia is not a genetic disease. It is the result of the body and mind responding to the physical and mental environment it finds itself in. Change the environment and the body responds appropriately…it heals…and if you or someone you know has fibromyalgia…you/they can heal too!
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