© by Elizabeth Lee Vliet MD and Kathy Kresnik
Fibromyalgia, or fibromyositis as it was called at the beginning of my career, is a diffuse muscle pain syndrome with perhaps a hundred or more causes. Fibromyalgia is much more common in women, although men do also develop fibromyalgia for some of the same reasons we see this pain syndrome happen in women. 80% of women patients are between the ages of 30 and 50, the same time frame women begin the transition into perimenopause and menopause. You’d think that statistic would lead doctors to check ovarian hormones as part of a fibromyalgia evaluation! But sadly that doesn’t get done, and important endocrine connections contributing to muscle and myofascial pain get missed. Many nutritional and vitamin deficiencies, as well as infectious and inflammatory conditions, also contribute to the pain in fibromyalgia, but doctors rarely check those laboratory studies either.
Once the FDA approved the anticonvulsant Lyrica as a treatment for Fibromyalgia, the diagnosis of Fibromyalgia increased exponentially because doctors now had an easy Rx medicine to use. Sadly, most patients now are diagnosed mainly on symptoms and given the medicine prescription. Rarely do patients get a more thorough and comprehensive diagnostic workup for the causes that might be better treated with natural and targeted approaches such as nutraceuticals, vitamins, the right kind of physical therapy, photobiomodulation, and other modalities. There are also many targeted and safer prescription medicines with fewer side effects than antidepressants and anticonvulsants, such as Lyrica, that are widely used as “band-aids” for symptom relief of pain.
It is no wonder that patients struggling with the diffuse pain of Fibromyalgia are seeking alternative, more natural approaches for relief. I have done a great deal of work with pain patients, including Fibromyalgia, since my specialty training at Johns Hopkins in the early 1980s and since then. In my two-part Health Tip on Fibromyalgia, I describe in more detail what it is, and explain the often overlooked causal connections, and then give you an integrated approach to treatment that include safer Rx medicines and more natural solutions to this complex and frustrating syndrome for both patients and physicians alike.
Fibromyalgia Syndrome (abbreviated FMS) is the name for persistent, diffuse, aching pain affecting the muscles and connective tissue (fibrous tissues of the body) including your tendons and ligaments. It’s a condition that has been described in medical writings going back to Hippocrates in ancient Greece, who called it “myalgia.” In modern times, it’s had several different names: myofascial pain syndrome, myositis, fibrositis, fibromyositis, mylagia.
FMS is difficult to diagnose on objective physical findings. There are no consistent lab abnormalities or objective measures of inflammation or even actual damage to the muscles to evaluate. Doctors saw it as something vague and psychosomatic because its symptoms came and went, the pain was hard to localize, and there were no objective changes in the body when the person experienced pain. Since FMS has been difficult to pin down, it has long been viewed by with skepticism and disparagement, and patients often sent off to see psychiatrists for “psychosomatic pain.”
In 1990 fibromyalgia was recognized as the legitimate disorder and given standard diagnostic criteria. A FMS diagnosis is now based upon the presence of persistent pain or achiness at multiple body sites and the presence of positive painful trigger points at 11 of the 18 classic sites.
For additional details, I devoted an entire chapter to FMS in my first book, Screaming To Be Heard – Hormone Connections Women Suspect and Doctors Ignore.
Glaring trends pop out when we look at statistics on who gets FMS: Up to 80% of patients are women between the ages of 30 and 50. FMS does happen in men about 20% of the time, and can occur in adolescence, but is much less common in men and younger patients.
NOTE: FMS is now also much more common in patients who have gotten the COVID shots and boosters, which causes muscle and nerve inflammation and damage to blood vessels and nerve fibers.
Hallmark features of Fibromyalgia I described in my book, Screaming to Be Heard :
- Widespread pain, generalized stiffness and soreness, often worse in the morning
- Increase pain in neck, trunk and hips
- Restless, fragmented sleep and insomnia, sleep apnea, and restless leg syndrome
- Exquisite tender points where muscles and tendons meet
- Numbness, burning or cold sensations in muscles and or extremities
- Diminished energy, marked fatigue that doesn’t improve with sleep
- Mood changes: irritability, liability, depression
- Alterations in memory and concentration known as “brain fog”
- Increased sensitivity to temperature, light, sound, and smell
- Headaches, including migraines and tension-type headaches
- Other symptoms: Overactive bladder, decreased exercise endurance, dry eyes, and digestive problems such as irritable bowel syndrome, constipation, and diarrhea.
- Women with fibromyalgia may experience more severe menstrual pain.
When I treated FMS patients and took careful histories of when the onset of symptoms occurred, and another glaring trend appeared: for the majority of my patients, the FMS began following some event that typically is associated with a significant decrease in ovarian hormone levels, or damage to testicular testosterone production in men. I think the hormonal connections in both men and women is crucially significant and most doctors never check it.
The Hormone Connection: Common times of FMS onset in women:
- Postpartum (particularly if the pregnancy was after the age of 35)
- Perimenopause, associated with sleep changes
- 3 to 5 years after tubal ligation
- 2 to 3 years after hysterectomy even if the ovaries were not removed in the surgery
- A period of sustained major stresses or illnesses which interrupt menses for several months
- Younger women with chronic anorexia, bulimia, or a combination of the two eating disorders that suppress ovarian hormone production.
- Younger women and men with vegetarian, high soy diets or who drink alcohol or use marijuana regularly since all of these factors decrease estradiol and testosterone production in both men and women.
Standard Medication Treatment:
- FDA-approved prescription medications for fibromyalgia: There are only three: pregabalin (Lyrica, an anticonvulsant, the most common one, although Gabapentin is also used), duloxetine (an SSRI antidepressant, brand name Cymbalta), milnacipran (an SNRI antidepressant, brand name Savella). Although anticonvulsants can help pain by calming overactive nerve cells involved in pain signaling, and improve sleep quality, (often disrupted in people with fibromyalgia), Lyrica tends to cause significant adverse side effects: fatigue/lethargy, weight gain and memory loss. Antidepressants can help decrease pain and improve mood and sleep, but also cause significant side effects similar to anticonvulsants, and more serious side effects such as suicidal thoughts—particularly in children and young people.
- Pain Relievers: Acetaminophen and nonsteroidal anti-inflammatory drugs—including ibuprofen, diclofenac and naproxen offer temporary relief for some people. Most guidelines do not recommend them due to limited effectiveness and potential side effects.
- Muscle relaxants: Cyclobenzaprine may be prescribed to reduce pain and support restful sleep. Other muscle relaxants have not been shown to be effective for fibromyalgia.
A Comprehensive Integrated Approach:
Fibromyalgia is a multifactorial syndrome of with multiple causes, not just one etiology, and it causes widespread chronic pain, and other physical and psychological manifestations. I found early on in my career that pain patients, especially those struggling with Fibromyalgia, need a comprehensive and integrated approach to diagnosis of the overlooked causes, develop targeted treatments for those causes, and then an integrated medication, nutraceutical, dietary, exercise and lifestyle approach to achieve optimal pain reduction, improved sleep and mood, improved physical fitness and psychological resilience. Pain-killers, antidepressants and anticonvulsants alone are not the answer, and over time, lead to more side effects and poorer quality of life.
It only makes sense that the management of this syndrome would require a multidisciplinary approach combining both appropriate, targeted Rx pharmacological and natural, nonpharmacological strategies, including the endocrine (hormone) therapies doctors ignore that are often abnormal. The approach I have used now for forty years addresses this multi-faceted approach to help relieve the multiple conditions typically present with fibromyalgia:
- Physically unfit muscles
- An associated sleep disorder
- Metabolic abnormalities, including vitamin and nutrient deficits
- Immunologic abnormalities
- Vascular changes (such as Raynaud’s Syndrome)
- Abnormally low levels or serious imbalance in reproductive hormones: estradiol, testosterone, DHEA, etc.
- Neuroendocrine changes (thyroid dysfunction, abnormal prolactin, decreased Somatomedin-C, increased cortisol, etc.)
- Situational stressors
- Trauma, falls, whiplash injuries, which are common triggers
Part I: Nutraceutical Approaches
I will discuss hormone, lifestyle, and specific food dietary strategies in Part II next week. Today I wanted to focus on the overlooked vitamin and mineral deficiencies that I have found in my patients over the years, along with hormone problems, in doing more careful lab studies of my pain patients, especially FMS patients. Now, we see more and more studies making this connection I found many years ago. A 2020 review stated that an imbalance of dietary components, including minerals and vitamins, can play a critical role in the development of FMS. Some of the key nutritional findings that need to be included in treatment options:
- Low Vitamin D – 40% or more FMS patients have a vitamin D deficiency, which is associated with diffuse chronic muscle pain, depression, and anxiety. One recent study confirmed what I have seen in my practice for decades: after an 8 week course of vitamin D supplementation, patients receiving the supplements showed significant improvement in fibromyalgia pain scores, which correlated with improved vitamin D serum levels.
- B Complex vitamin deficits: all of the B vitamins play a role in sleep and pain management pathways and nerve function, but in particular, B12, B1 (thiamine), B3 (niacin) and B6 (pyridoxine) are often deficient in patients with FMS and other pain syndromes. These vitamins are crucial for healthy nerve, muscle, sleep, mood, and pain regulation, and easy to replace with proper diet and supplements IF people know they have a deficiency! But you have to ask your doctor to check your B vitamin levels.
- Vitamin C and Vitamin E deficiencies- Antioxidants can play a beneficial role in the management of muscle pain syndromes to reduce the damage of pain-causing reactive oxygen species (ROS) and other inflammatory pain-causing chemical messengers. Antioxidants also help maintain cerebellar functions, memory, emotional balance, and help decrease pain-causing systemic inflammation. Low levels of vitamin E were found in FMS patients compared to healthy controls in several studies, and again these studies fit with what I have been seeing in my medical practice.
- Magnesium deficiency, imbalance with calcium excess– almost all FMS patients in my medical practice have been deficient in magnesium in the diet and don’t tend to take magnesium supplements. Recent studies showed a decrease in intracellular magnesium levels in FMS patients. Magnesium deficiencies were associated with low grade inflammation, muscle weakness and paresthesia (abnormal sensation) –all typical symptoms of FMS. Low dietary magnesium intake has been correlated with worsening pain thresholds in FMS patients. I think Magnesium is one of the nonpharmacological supplements with the highest potential for improvement in fibromyalgia patients, and I have recommended it for forty years.
- Iron – There has consistently been a link between low iron stores (measured by the ferritin blood test) and muscle pain syndromes. Long before people become anemic due to iron deficiency, low ferritin (iron stores) will cause difuse muscle aches, fatigue and sleep disturbance. I check ferritin in all my patients, at least once a year. My fibromyalgia patients over the years have improved significantly in muscle pain and quality of sleep when ferritin is restored to levels between 90 and 120 with iron supplementation.
- Probiotics – Increasing evidence, especially following the microbiome damages of the COVID shots, indicates that FMS patients have significant abnormalities in the gut microbiome. Mixed species probiotics, such as those in the Truth for Health Foundation store, can have a profound impact to improve healthy gut microbiome and reduce muscle pain, improve energy, and sleep quality. One pilot study investigating the effect of a multi species probiotic also showed improved cognition, particularly impulsive choice and decision making in patients diagnosed with FMS.
- Fish Oil – Rich in omega-3 fatty acids fish oil shows pain-relief properties due to its anti-inflammatory actions that help reduce pain and fatigue. I have found that a complete essential fatty acid supplement, such as our TruOmega Pure™ with all three essential fatty acids (not the usual two in most products) formulated to be better absorbed and fewer unwanted GI effects, offers significant reduction in inflammatory muscle pain. Studies have shown that fish oils also help improve cardiovascular risks, peripheral neuropathy and can improve cognitive function as well. a 2024 study using high doses of omega-3 showed positive effect on fibromyalgia pain relief.
- Extra virgin olive oil (EVOO) contains a high concentration of phenolic compounds with many health benefits including antioxidant activity linked to its ability to protect DNA, proteins and lipids from damage caused by exposure to reactive oxygen species (ROS). ROS are produced by oxidative stress, and are markedly increased in FMS patients. In a clinical trial investigating the effect of EVOO compared to refined olive oil, the authors reported a statistically significant improvement on the patients’ Fibromyalgia Index Questionnaire and improved mental health status.
- Other Nutraceuticals – Deficiencies in amino acids such as valine, leucine, isoleucine and tryptophan are associated with worse FMS symptoms. That’s one of many reasons I recommend our TruAmino™ Complex to help reduce muscle pain and improve muscle function and building healthy muscle tissue. Botanical antioxidant supplements such as chlorella, coenzyme Q10, ginkgo biloba, L-carnitine, Acetyl L-Carnitine (ALCAR), S-Adenosylmethionine and creatine have also shown some benefits for fibromyalgia patients, improving symptoms such as muscle pain, fatigue, morning stiffness and quality of life.
I encourage you to ask your doctor to check for these deficiencies that cause worsening FMS pain, or if your doctor won’t order them, go on-line to one of the patient self-order, self-pay sites (such as Quest Diagnostics or LabCorp) and find out your vitamin levels. Then consider ordering our high quality, made-in-the-USA, CGMP antioxidant and anti-inflammatory vitamins, minerals and probiotics to add to your pain management plan. The following, along with other products, are available at the Truth for Health store: www.TruthforHealth.org OR www.ShopTruthforHealth.com
- TruBio D3™
- TruC + Flav™
- TruVitamin E™
- TruMagnesium™
- TruZinc™
- TruMulti V™ with Iron
- TruAmino™ Complex
- TruProbiotic™ Daily
- TruOmega Pure™
|
|
