Fibromyalgia – Runner’s Chronic Fatigue Syndrome

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Etymology

The word “fibromyalgia” derives from New Latin word “fibro” meaning “fibrous tissues”, the Greek word “myo” meaning “muscle”, and the Greek word “algos” meaning “pain”.

The synonymous terminology “polymyalgia rheumatica” derives from the Greek word “poly” meaning “multiple, many”, the Greek word “myo” meaning “muscle”, the Greek word “algos” meaning “pain”,and the Greek word “rheuma” meaning “flux, discharge from the body”.

Symptoms-of-fibromyalgia

Definition

Fibromyalgia (FM), polymyalgia rheumatica, chronic fatigue syndrome, or central sensitization syndrome is a musculoskeletal medical condition characterized by widespread chronic pain which increases in response to added local pressure. It’s also known as chronic fatigue syndrome but the term is actually a misnomer. Chronic fatigue syndrome is a stress-related disorder that oftentimes accompanies fibromyalgia.

Fibromyalgia is currently being studied and there’s a considerable amount of controversy about the diagnosis, classification, and treatment of fibromyalgia. It is estimated that the disorder affects 2-8% of the global population and females are twice as vulnerable as males. Such statistics are constant in different parts of the world.  More than 5 million Americans over the age of 18 have been diagnosed with the condition. Most importantly, between 80%-90% of them are women. While men and children can also be diagnosed with the disorder, women seem to be more likely to develop the disorder. Most people are diagnosed during middle age and very rarely at birth.

Fibromyalgia symptoms

  • Chronic pain, both acute and dull
  • Chronic tiredness that may affect the quality of life
  • Nerve pain and other types of chronic pain
  • Long-term and short-term memory impairment (fibrofog)
  • Insomnia
  • Restless leg syndrome
  • Muscle spasms, twitches, and problems with the jaw joints and muscles.
  • Bowel and/or bladder dysfunction
  • Neurological dysfunctions such as local numbness, tingling (paresthesias)
  • Sensory dysfunctions such as increased sensitivity to noise, light, or temperature
  • Depression
  • Anxiety
  • Posttraumatic stress disorder
  • Comorbidity (one or more co-occurring additional diseases or disorders)

Symptoms-of-fibromyalgia

The musculoskeletal problems consist of muscle, fascia, bone, tendon, joint, and/or ligament pain which increases when pressure is applied to the area (allodynia). These tender points areas are relatively predictable. They’re regularly around joints and muscles. Also, in most cases, it’s not the actual joint that hurts but the surrounding tissue (fascia) and muscles.

Usually, the pain is felt all over the body and can vary in both severity and form. The pain can be tender, throbbing, aching, sore, gnawing, and/or burning. Pain can also be consistent or inconsistent and can travel through the body. Moreover, the muscles and bones feel weak, tender to the touch, stiff, especially in the morning which last from 15 minutes to a couple of hours, depending on the case.

Cognitive dysfunctions aka. fibrofog

Chronic tiredness or chronic fatigue is another common symptom in people with fibromyalgia and it’s usually compared to the flu or working long hours with insufficient sleep. Severe cases can disturb daily activities and can cripple the patient’s life quality.

Both long and short term memory is impacted in various degrees in people with polymyalgia rheumatica. Other cognitive dysfunctions related to the so-called fibrofog include diminished attention span, incoherent thought process, diminished processing speed, multitasking capabilities, and diminished overall performance.

Due to the exhausting nature of the illness, depression and anxiety may occur in suffering people.

Comorbidity

Comorbidity is also common in people with fibromyalgia. Prevalent co-occurring diseases or disorders include chronic myofascial pain syndrome, non-dermatomal diffused neuropathy,  bowel disturbances, bowel syndrome, genitourinary symptoms, interstitial cystitis, headaches, dermatological disorders, myoclonic twitches, symptomatic hypoglycemia, temporomandibular joint dysfunction, and 20-30% of patients with rheumatoid arthritis or systemic lupus erythematosus also have fibromyalgia.

What causes fibromyalgia?

Fibromyalgia is under investigation since 1990 when it was first defined. The exact causes and biological pathways are still unknown, but the scientific consensus suggests a combination of genetic factors and environmental factors such as trauma, infections, and psychological stress which may trigger certain processes in the central nervous system. Genetics and external environmental factors seem to account for a 50-50% responsibility in causing fibromyalgia.

Studies have suggested that the chronic pain results because the biological pain processing pathways are functioning abnormally. In lay-mans terms, the increased volume and sensibility of neurons causes a hyper-excitability of the pain processing pathways while lowering the activity of inhibitory pain pathways in the brain, thus causing a distorted pain experience. Some of these neurochemical abnormalities also regulate sleep, mood, and energy levels. Furthermore, during sleep, the brain experiences abnormal activity similar to day-time activities, causing interruptions in sleep, thus affecting memory and other rejuvenating processes, resulting in a fatigued individual. Such negative sleep deprivations can also affect the patient psychologically, resulting in depression and anxiety.

The exact genetical inheritance process is currently unknown, but consensus states that the genetic factor is most likely polygenic, especially in individuals with the 5-HT2A receptor 102T/C polymorphism. Studies have shown that fibromyalgia potentially linked to a genetic polymorphism in the serotoninergic, dopaminergic, and catecholaminergic systems which influence mood, energy, and pain. However, the results are far from conclusive because the same polymorphism is correlated to an array of allied diseases and disorders.

Dr. Harvey Moldofsky and his colleagues reproduced the effects of fibromyalgia in healthy males by disrupting their sleep with anomalous alpha waves – which are normal waves during arousal or wake-like states. After a couple of sessions, the test subjects began to experience common fibromyalgia symptoms such as muscle tenderness. The test subject resumed their normal sleep patterns afterward. The experiment concluded that abnormal brain activity is at least in part responsible for “neurasthenic musculoskeletal pain syndrome”, as they called it back then.

Sleep deprivation also increases pain because of the decreased IGF-1 production and human growth hormone. Such deficiencies can decrease tissue repair processes.

Both stress and traumatic experiences are thought to contribute to developing the disorder. Two studies that involved single-voxel magnetic resonance spectroscopy (1H-MRS) have reported certain metabolic abnormalities within the hippocampal complex in fibromyalgia patients. The hippocampal complex is responsible for regulating pain perception, sleep, and other cognitive functions. Some scientists suggested that since stressful conditions can alter the functions of the hypothalamic-pituitary-adrenal (HPA) axis, it is safe to conclude that stressful or traumatic situations can also trigger fibromyalgia by altering the HPA axis.

More so, stress-related disorders such as posttraumatic stress disorder, irritable bowel syndrome, chronic fatigue syndrome, and depression are frequent comorbid precipitating factors.

Smoking, drinking, other vices, obesity, sedentarism can also increase the risk of developing fibromyalgia.

no-alcohol-fibromyalgia no-junk-food-fibromyalgia no-smoking-fibromyalgia

  • Non-celiac gluten sensitivity (NCGS)

Although the studies are inconclusive, non-celiac gluten sensitivity or gluten sensitivity is thought to be an underlying cause of fibromyalgia symptoms. Patients should try to eliminate gluten and see if it benefits them.

Diagnosis

As stated before, the disorder itself is not yet fully understood, so there isn’t a foolproof diagnosis procedure yet. Nonetheless, there are a set of rules and exams that allow the exclusion of most false-positives. So, by narrowing the gap, adequate treatment can be developed for as much symptom relief as possible, as the disorder cannot be completely cured.

A lacking objective diagnosis procedure is also due to the fact that the disorder varies a lot in different patients, meaning that not all cases are identical which requires a more subjective examination, rather than a fully standardized one. The debate between what should be viewed as fundamental diagnostic criteria and whether an objective diagnosis is conceivable is rather fierce in the medical and scientific community.

The Multicenter Criteria Committee of the American College of Rheumatology developed in 1990 was the first elaborated diagnosis criteria for fibromyalgia, and although a revised criteria came in 2010, it’s beneficial to also be knowledgeable of the first one in putting the final diagnosis:

  • Pain for more than 3 months that affected all four quadrants of the body. (valid)
  • 18 designated tender points (revised)

Fibromyalgia-tender-points

This subcriteria has been revised because fibromyalgia patients may experience pain elsewhere. However, the existence of tender points is a valid symptom which must be taken into consideration.
The American College of Rheumatology approved a revised diagnostic criteria in 2010 which bases its examinations on the so-called widespread pain index (WPI) and symptom severity scale (SS).

  • WPI refers to 19 general areas of the body in which the patient has experienced pain in the last two weeks. The patient must indicate in which areas has he experienced pain in the last two weeks, no matter the severity of the pain. Each area equates to a point for a total of 19 points. Areas:Left shoulder girdle
    Right shoulder girdle
    Left upper arm
    Right upper right
    Left lower arm
    Right lower arm
    Left hip (buttock, trochanter)
    Right hip (buttock, trochanter)
    Left upper leg
    Right upper leg
    Left lower leg
    Right lower leg
    Left jaw
    Right jaw
    Chest
    Abdomen
    Upper back
    Lower back
    Neck

SS refers to a 0 to 3 severity scale for each of the following categories: fatigue, walking, cognitive symptoms, and the number of somatic symptoms. Each category has to be evaluated by the patient using a scale from 0 to 3 for a total of 12 points (4*0 to 3=0 to 12)
0=no problem
1=mild
2=moderate
3=severe

If WPI ≥ 7 and SS ≥ 5 OR WPI 3 to 6 and SS ≥ 9 then the first condition is met. For a conclusive result, 2 more conditions should be met on top of the WPI and SS score:

A. That symptom have been present at a similar level for at least three months (confirmation of chronic symptoms);
B. That no other diagnosable disease or disorder otherwise can explain the symptoms (exclusion of false-positives);

So, in order to confirm the existence of fibromyalgia, the patient has to score positive in the following:

1. WPI ≥ 7 and SS ≥ 5 OR WPI 3 to 6 and SS ≥ 9
2. Symptoms have been present at a similar level for at least three months (confirmation of chronic symptoms)
3. No other diagnosable diseases, disorders, or other alternative cause that can otherwise explain the symptoms (exclusion of false-positives)

Recent research suggests treating the disorder in a multidimensional order. Due to the complexity of the disorder, multiple factors should be always taken into account when analyzing a case:

  • Somatic symptoms
  • Psychological factors
  • Psychosocial factors

For the latter two, the Hospital Anxiety and Depression Scale (HADS) questionnaire can prove helpful in determining the level of depression and anxiety of a patient. The questionnaire was developed in 1983 by psychiatrists A. S. Zigmond and R. P. Snaith. It consists of 14 items, seven refer to anxiety and seven to depression, and every item has a severity scale from 0 to 3. The questionnaire was specifically designed as a tool to evaluate the patient’s state of mind and use the information on top of a somatic symptom analysis for stress-related diseases and disorders.

Questionnaire items
Anxiety:
1. I feel tense or wound up
2. I get a sort of frightened feeling as if something bad is about to happen
3. Worrying thoughts go through my mind
4. I can sit at ease and feel relaxed
5. I get a sort of frightened
6. I feel restless and have to be on the move
7. I get sudden feelings of panic
Depression:
8. I still enjoy the things I used to enjoy
9. I can laugh and see the funny side of things
10. I feel cheerful
11. I feel as if I am slowed down
12. I have lost interest in my appearance
13. I look forward with enjoyment to things
14. I can enjoy a good book or radio or TV program

Scoring the questionnaire

Every item is scored 0 to 3 depending on the severity and adds up to a total of 0 to 42 points (maximum of 21 points for anxiety and max. 21 points for depression).

Treatment for chronic fatigue syndrome

 

MEDICAL MASSAGE

Treatment includes therapy, medication, and improving lifestyle in terms of diet, sleep, and exercise. Treatment consists mainly of symptom management. There isn’t a universally accepted treatment for the disorder, so the patient has to seek whatever works best for him in improving the quality of life.

Medicine

fibromyalgia-drugs

The three most used drugs to treat/manage fibromyalgia are Pregabalin, Duloxetine, and Milnacipran. These drugs are prescription-based and you should always thoroughly consult with your doctor before taking them. Make sure your doctor knows everything about your lifestyle, diet, vices, medical history, current medication or supplementation etc. It’s is vital that your doctor knows everything about you because some of these drugs may interact with certain substances which can pose a substantial health risk. Speak clearly with your doctor and don’t forget that you’re covered by the doctor-patient confidentiality clause!

  • Pregabalin

Pregabalin (brand names Lyrica, others) is an anticonvulsant and neuropathic pain agent. It’s used to reduce seizures, nerve pain, and anxiety.

Commonly reported side effects of pregabalin include ataxia, infection through contamination, impaired vision, diplopia, vertigo and dizziness, tiredness,  weight gain, incoherent speech and thoughts, headaches, tremors, fringe edemas, neuropathy, amblyopia, twitching, and increased appetite.

An estimated total of 638 drugs are known to interact with pregabalin. Also, alcohol may increase some side-effects.

There are 5 disease interactions with pregabalin including depression, peripheral edema, angioedema, PR interval prolongation, and creatine kinase elevation.

  • Duloxetine

Duloxetine (brand names Cymbalta, others) is a selective serotonin and norepinephrine reuptake inhibitor antidepressant (SSNRI). It affects brain chemicals that may be unbalanced in people with depression.

Commonly reported side effects of duloxetine include constipation, diarrhea, dizziness, drowsiness, hypersomnia, asthenia and fatigue, insomnolence, nausea, headache, sedation, xerostomia, anxiety, erectile dysfunction, excitability, stress, vomiting, anorexia, decreased libido and appetite, abdominal pain, hyperhidrosis, restlessness, and restless leg.

An estimated total of 1067 drugs are known to interact with duloxetine. Also, caffeine and alcohol may increase some side-effects.

There are 10 disease interactions with duloxetine which include liver and renal disease, mania, depression, glaucoma, hyponatremia, hypertension, urinary tract obstruction, seizures, and hyponatremia.

  • Milnacipran

Milnacipran (brand names Ixel, Savella, Dalcipran, Toledomin) is a serotonin–norepinephrine reuptake inhibitor (SNRI) used in the clinical treatment of fibromyalgia.

Commonly reported side effects of milnacipran include headaches, hot flashes, nausea, hypertension, palpitations, constipation, vomiting, insomnia, dizziness, increased heart rate, skin rashes, heightened pulse, xerostomia, increased serum aspartate aminotransferase, increased serum alanine aminotransferase, and hyperhidrosis.

A total of 717 drugs are known to interact with milnacipran. Also, alcohol may increase some side-effects.

There are 9 disease interactions with milnacipran which include hypertension, seizures, urinary tract obstruction, mania, depression, liver and renal disease, hyponatremia, and glaucoma.

  • Amitriptyline

Amitriptyline (brand names Amitrip, Elavil, Levate, other) is a tricyclic antidepressant which has many uses including migraine prevention, neuropathic pain treatment, postherpetic neuralgia, and insomnia.

Commonly reported side effects of milnacipran include vertigo, migraines, weight gain, confusion and delirium, anxiety, agitation, sinus tachycardia, orthostatic hypotension, loss of libido, impotence, QT-interval prolongation, nightmares, and insomnia.

An estimated total of 1094 drugs are known to interact with amitriptyline. Also, alcohol may increase some side-effects.

There are 22 disease interactions with amitriptyline which include seizures, recovery of myocardial infarction, anticholinergic agents, cardiovascular disease, cardiovascular problems, pheochromocytoma, bone marrow suppression, depression, diabetes, liver and renal disease, schizophrenia, bipolar disorder, alcohol addiction, glaucoma, bipolar disorder screening, hyper or hypoglycemia, tardive dyskinesia, neutropenia, thyroid disorders, urinary retention, and liver or renal disease.

  • Cyclobenzaprine

Cyclobenzaprine (brand names Amrix, Flexeril) is a muscle relaxant which blocks pain nerve impulses to your brain and it’s used to relieve skeletal muscle spasms and acute pain.

Commonly reported side effects of cyclobenzaprine include tiredness, xerostomia, and drowsiness.

An estimated total of 731 drugs are known to interact with cyclobenzaprine. Also, alcohol may increase some side-effects.

There are 12 disease interactions with Cyclobenzaprine including cerebrovascular disease and insufficiency, intraocular hypertension, dehydration, glaucoma, gastrointestinal obstruction, urinary retention, hyperthyroidism, cardiovascular disease, hypotension, and myocardial infarction.

  • Fluoxetine

Fluoxetine (brand names Prozac, Sarafem, Rapiflux, Selfemra) is a selective serotonin reuptake inhibitors (SSRI) antidepressant.

Commonly reported side effects of fluoxetine include dyspepsia, asthenia, diarrhea, tremor, anxiety, anorexia, skin rash, dizziness, insomnia, drowsiness, nausea, nervousness, migraines, tremors, xerostomia, decreased appetite, diaphoresis, nausea, and insomnia.

An estimated total of 1065 drugs are known to interact with fluoxetine. Also, alcohol may increase some side-effects.

There are 12 disease interactions with fluoxetine which include diabetes, depression, glaucoma, hyponatremia, QT interval prolongation, seizures, liver disease, platelet function, mania, renal disease, weight loss, and siadh.

  • Paroxetine

Paroxetine (brand names Brisdelle, Paxil, Paxil CR, Pexeva) is a selective serotonin reuptake inhibitors (SSRI) antidepressant.

Commonly reported side effects of paroxetine include diarrhea, drowsiness, dizziness, constipation, asthenia, ejaculatory and erectile dysfunctions, male and female genital tract disease, insomnia, migraines, delayed ejaculation, decreased or loss  of libido, diaphoresis, infection, blurred vision, xerostomia, lack of focus, orgasm disturbance, tremors, visual disturbance, vasodilatation, nightmares, anxiety, loss of appetite, yawning, and paresthesia.

An estimated total of 885 drugs are known to interact with paroxetine. Also, alcohol may increase some side-effects.

There are 11 disease interactions with paroxetine including bone and liver diseases, glaucoma, mania, renal dysfunction, depression, seizures, platelet function, weight loss, hyponatremia, and siadh.

  • Sertraline

Sertraline (brand names Zoloft) is a selective serotonin reuptake inhibitors (SSRI) antidepressant.

Commonly reported side effects of sertraline include migraines, diarrhea, drowsiness, dizziness, fatigue, dyspepsia, nausea, tremors, decreased libido, diaphoresis, impotence, xerostomia, paresthesia, anorexia, abdominal pain, anxiety, vomiting, hypouricemia, malaise, and restlessness.

An estimated total of 1044 drugs are known to interact with sertraline. Also, alcohol may increase some side-effects.

There are 10 disease interactions with sertraline which include liver and renal disease, weight loss, hyponatremia, depression, glaucoma, mania, platelet function, seizures, and siadh.

  • Venlafaxine

Venlafaxine (brand name Effexor) is an antidepressant in a group of drugs called selective serotonin and norepinephrine reuptake inhibitors (SSNRIs).

Commonly reported side effects of venlafaxine include migraines, anxiety, nausea, vertigo, drowsiness, asthenia, constipation, diarrhea, anorgasmia, loss of appetite, anorexia, delayed ejaculation, impotence, xerostomia, diaphoresis, abdominal pain, impaired vision, hypertension, tremors, vomiting, dyspepsia, increased serum cholesterol, vasodilatation, pharyngitis, abnormal dreams, flatulence, and yawning.

An estimated total of 1084 drugs are known to interact with venlafaxine. Also, alcohol and selective serotonin and norepinephrine reuptake inhibitor antidepressants (SNRIs) drugs may increase some side-effects.

There are 11 disease interactions with venlafaxine which include renal or liver disease, depression, mania, hypertension, glaucoma, hyponatremia, weight loss, urinary tract obstruction, and seizures.

  • Tizanidine

Tizanidine (brand names Zanaflex, Sirdalud, other) is a short-acting muscle relaxer and it works by blocking pain nerve impulses going to the brain.

Commonly reported side effects of tizanidine include xerostomia, tiredness, constipation, increased liver enzymes, bradycardia, drowsiness, dizziness, hypotension, and asthenia.

An estimated total of 1005 drugs are known to interact with tizanidine. Also, caffeine and alcohol may increase some side-effects.

There are 4 disease interactions with tizanidine including hypotension, psychoses, hepatotoxicity, and hypotension.

  • Gamma-hydroxybutyrate (GHB)

Gamma-hydroxybutyrate (GHB) (C4H8O3) is a central nervous system (CNS) depressant and naturally occurring neurotransmitter. It’s also a psychoactive drug aka. “club drug” or “date rape” drug. The psychoactive compound might help patients with fibromyalgia because it causes euphoria, increased sex drive, and tranquility. It might be a successful alternative drug for certain fibromyalgia patients.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

In rare, mild cases, NSAIDs may prove sufficient in reducing pain, but such cases are quite rare. Usually, nonsteroidal anti-inflammatory drugs will not suffice and will not succeed in reducing pain towards an acceptable quality of life. Also, long-term administration of NSAIDs is not advised.

  • Ibuprofen

These medications should be administered after a fiber-rich meal as to avoid rare side-effects such as gastrointestinal bleeding. Furthermore, carefully read the leaflet. Refrain if you’re suffering from asthma, conditions of the heart, kidney, or liver. It’s also sold under the brand names of Nurofen, Brufen, Advil, Motrin etc.

  • Naproxen

These medications should also be taken after a fiber-rich meal as to reduce the rare side-effects of stomach ulcers. Normally, a proton-pump inhibitor auxiliary drug is appointed alongside Naproxen for patients with past health conditions that could put them at risk. Carefully inspect the package leaflet and avoid taking them if you had duodenal ulcer, gastric ulcer, or similar conditions. It is also sold under the brand names of Naprelan, Naprosyn, Aleve, Anaprox etc.

Other medicine

  • Cannabinoids

cannabis-fibromyalgia

For many patients, cannabis aka marijuana may prove to be a superior alternative to most drugs described earlier. Studies have shown beneficial effects on some FM symptoms with reduced side-effects compared to other drugs. Research indicates that migraines, fibromyalgia, IBS and other related conditions display common clinical, biochemical, and pathophysiological patterns that suggest an underlying deficiency which can be treated successfully with cannabis. It’s recommended that the patient seeks real cannabinoids in the form of ingestible oils or vaporized material, as synthetic cannabinoids are no way near as safe or efficient and smoking the plant brings about unwanted lung damage. Cannabis helps in reducing pain, improving sleep, appetite, and acts as a natural antidepressant.

  • Human Growth Hormone

Growth hormone cycles can prove extremely beneficiary in reducing pain, spasticity, and stiffness of the muscles. It also improves sleep and can improve the fitness, recuperation, and muscle and bone mass.

  • Sodium oxybate

Sodium oxybate (contracted from γ-hydroxybutyrate and traded as Xyrem, Alcover) is a compound that is commonly prescribed with a growth hormone cycle because of its reinforcement role in producing growth hormone through improved sleep architecture. Some rare symptoms include nausea, dizziness, headache, vomiting, sleepiness, and bed-wetting.

Other rare, more severe symptoms include hallucinations, agitation, severe mental confusion, abnormal thinking, disrupted sleep, and depression. Experiencing any side-effects of the latter category should prompt an immediate stop from further medicating with sodium oxybate.

  • Opioids (can cause severe addiction!)

Opioid derivative drugs are very rarely prescribed to patients with fibromyalgia because they’re action system is not desirable and can cause severe addiction. Opioids are only prescribed in the most severe cases in which the patient experiences incredible amounts of pain. After opioid treatment, naltrexone may be prescribed afterward as to prevent opioid abuse, relapse, and withdrawal.

Therapy

Therapy consists of pain and symptom management through different methods. Oftentimes, there are different results for different patients, thus meaning experimenting with various therapy methods to see what works best in improving the quality of life. Some of the so-called mind-body therapies are proven to be somewhat effective. Every fibromyalgia patient should at least try them out and see if there’s any improvement.

  • Cognitive behavioral therapy (CBT)

CBT is a non-pharmacological therapy which combines psychological therapy, in-depth education of fibromyalgia, and exercise. Preliminary studies have indicated a reduced pain perception in those who attended CBT therapy sessions regularly because of hypothesized fiscal changes in the pain receptors called nociceptors. Although additional studies are needed, the effect on the patient’s psyche can be very beneficial in coping with the disorder and improving the overall quality of life.

It is important that the patient receives valid information about his disorder so he can understand it and have an active role in his treatment.

Improving sleep through various rituals and adaptations (dark room, not staring at electronic screens 1 hour before sleep etc.)
Energy management through graded-activity as to avoid fatigue crashes aka. “push-crashes”. Stretching, strengthening, and meditative sessions such as yoga, tai chi etc. But also light weight lifting sessions and cardio.

  • Psychotherapy

The CBD therapist will also have psychotherapy sessions, providing support, knowledge, and solutions, wherever possible. Furthermore, group therapy seems to yield great results.

  • Mindfulness-based cognitive therapy (MBCT)

Mindfulness-based cognitive therapy (MBCT) is a psychotherapeutic method used to prevent depression relapse. In short, the therapy focuses on recognizing and interrupting automatic cognitive processes that can trigger depressive episodes. People are taught to focus less on reacting to incoming negative stimuli. It can also work in people struggling with addictions and such.

  • Biofeedback

Biofeedback is a process in which the patient’s biological functions are paired with visual or auditive stimuli, in the hopes of a greater understanding and control of certain biological functions such as pain perception, heart rate etc. Some individuals may benefit from this type of therapy and might find a substantial pain reduction.

Movement therapy refers to the individual or group therapy sessions in which the participants dance, meditate, socialize, and so on through various practices such as yoga, tai chi etc.

yoga-fibromyalgia

  • Exercise

Exercise is very beneficial to individuals with fibromyalgia. Weightlifting, cardio, sports, and so on improve overall health, depression, physical functions, fitness, sleep, reduces pain and fatigue. Cardiovascular training, as well as aquatic training, have been proven to be extremely beneficial, although, all types of sports are recommended as it improves both physical and psychological health.

  • Occupational therapy

Occupational therapy consists of keeping the patient distracted with all kinds of tasks such as creating art, music, writing, reading, watching TV-shows, movies etc. It’s also indicated that the therapy is done in a group. Better yet if the group has other fibromyalgia patients for increased group support and camaraderie.

Diet and lifestyle are very important to your general health and rehabilitation. A plant-based diet or, better yet, a strict vegan diet will benefit you greatly, keeping inflammation to an absolute minimum and giving your body the best nutrients out there. With a plant-based diet, you’ll reduce all-cause mortality and you’ll feel better all-around with tangible improvements. Furthermore, on top of your plant-based or vegan diet, you’ll also need a proper sleep pattern and adequate hydration alongside a drastic reduction of harmful vices such as smoking, drinking, coffee etc. It’s advised you monitor your micro and macro nutrient ratio, especially when transitioning to veganism. Make sure you’re meeting your needs in terms of Calcium, B12, Vitamin D etc.

diet-fibromyalgia

Carbohydrates:

Fruits (fresh fruits first, but frozen are acceptable too, especially for food diversity)
Whole grains such as rice, rye, buckwheat, barley, maize, bread, whole wheat pasta etc.
Whole wheat flour, bread, and pasta
Vegetables such as sweet potatoes, winter squash, whole corn etc.

Proteins:

Veggies (fresh veggies as a priority, but frozen are also good)
Non-dairy milk such as almond, soy, oat, rice milk etc.
Hemp seeds (easily digested proteins, essential fats, vitamins, and antioxidants)
Lentils, beans
Nut butter
Tofu
Tempeh
Sprouted-grain bread

Fats:

Nuts and seeds
Avocado
Vegetable oils (avoid frying)
Peanut, almond, and cashew butter
Fake meats
Coconut oil

Calcium
Men and premenopausal women should consume at least 1000 mg of calcium. Postmenopausal women should consume 1200 mg of calcium. Don’t take more than 2000mg of calcium a day, in total.

Vitamin D
Men and women should consume between 600 and 800 international units (IU) of vitamin D per day. Don’t take more than 800 IU of vitamin D a day as high doses can be toxic, especially if overdosed for long periods of time.

B12 is especially important on both a vegan and non-vegan diet because it’s produced by certain bacteria and might lack in our modern foods. So monitor your intake, eat B12-fortified foods, and/or supplement.

Having healthy B12 levels is extremely important and will undoubtedly help patients with fibromyalgia!

B12 in micrograms (μg)
Age RDA                                         (μg)
0-6 months…………………..0.4
7-12 months…………………0.5
1-3 years……………………..0.9
4-8 years………………………1.2
9-13 years…………………….1.8
14+ years………………………2.4
pregnant women………….….2.6
lactating women………….….2.8

Adequate hydration is also very important because the majority of the body’s processes need water. For proper hydration, remember the 8×8 rule: drink 8 servings of 8 ounces of water a day (a total of 2L of water a day).

Sunlight
Get at least 1 hour of sunlight, every day. Continue maintaining a physically active lifestyle to encourage calcium synthesis in the body.

Improving sleep

Sleep is a very important factor as the disease is strictly related to sleep deprivement. So, getting 7-9 hours of high-quality sleep each day will drastically improve the symptoms.

sleep-fibromyalgia

Developing a constant sleep pattern is very important. Going to sleep at around the same hour as getting up might improve the sleep quality.

Sleeping in a quiet, dark, comfortable bed will also improve the sleep quality. Ask your neighbors and family members to support you in this struggle and maintain an adequate sleeping environment for you. Also, seek room insulation and AC control.

Avoid alcohol, coffee, sugar, smoking, and eating before bedtime. Also, reduce the amount of light intake before bed, especially monitor lights.

Prognosis

Although the disorder is neither degenerative nor fatal, the pain and other symptoms will most likely be chronic. Nonetheless, fibromyalgia can be managed in a successful manner and result in a high-quality life.

The economical factor in managing the disease is also very important. Research has found that 34% of fibromyalgia patients spend between $100-$1,000 each month above their insurance coverage to see a healthcare professional and get treatment.

Conclusion

Fibromyalgia or chronic fatigue syndrome is a uncurable disorder that will have to be managed for the rest of the patient’s life. Knowledgeable doctors are needed for a correct evaluation and treatment strategy. A very important principle is to not rule out anything: experiment with different drugs, therapies, and alternative medicine until the symptoms are ameliorated as much as possible. Patients respond in different ways, so don’t be afraid to try something that hasn’t worked for other people, despite some of the taboo or strangeness of some therapies. Adopt a multidisciplinary approach for fibromyalgia and always inform yourself about the disorder and newly developed therapies and technologies.

This article is an overview of fibromyalgia and you should always consult your doctor before attempting any of the aforementioned drugs or therapies.

Sources

  1. Staff Writer, Fibro Fog, Arthritis.org, May 17, 2017
  2. Staff Writer, Sleep Disorders: An Integral Component of the Fibromyalgia Syndrome, Mednet, Oct 02, 2008
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