Fibromyalgia

Also indexed as: Fibromyositis, Fibrositis, Myofascial Pain Syndrome, Myofibrositis, Primary Fibromyalgia Syndrome

What you need to know

Fibromyalgia—an unsolved mystery—is a complex syndrome with no known cause or sure cure. According to research or other evidence, the following self-care steps may be helpful:

Exercise
Low-intensity exercise (like walking or swimming) is the best known treatment

Address your stress
Reducing stress and unpleasant emotions may also reduce symptoms

Try 5-HTP
100 mg of the supplement 5-hydroxytryptophan three times a day may ease symptoms

These recommendations are not comprehensive and are not intended to replace the advice of your doctor or chemist. Continue reading the full fibromyalgia article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and lifestyle changes that may be helpful.

About fibromyalgia

Fibromyalgia is a complex syndrome with no known cause or cure. Its predominant symptom is pain in the fibrous tissues, muscles, tendons, and ligaments, although other symptoms may be experienced.

Research has demonstrated that the axis connecting the three glands primarily responsible for the stress response (hypothalamus, pituitary, adrenals) may be dysfunctional in people with fibromyalgia.¹ Inflammation of the involved structures is generally absent in fibromyalgia.

Of the estimated three to six million people² affected by this disorder in the United States, the vast majority are women between 25 and 45 years of age.

Product ratings for fibromyalgia

Rating	Nutritional Supplements	Herbs
	5-HTP Acetyl-L-carnitine SAMe	Chlorella
	Magnesium Malic acid Melatonin Ribose Vitamin B1 Vitamin E
See also: Homoeopathic Remedies for Fibromyalgia
Reliable and relatively consistent scientific data showing a substantial health benefit. Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit. For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

What are the symptoms?

Trigger-point pain at characteristic locations is the defining symptom of fibromyalgia. The most commonly affected locations are on the occiput (nape of the neck), the neck itself, shoulders, trunk, low back, and thighs. Other symptoms may also be experienced, including fatigue, chest pain, low-grade fever, swollen lymph nodes, insomnia, frequent abdominal pain, irritable bowel syndrome, and depression.³

Dietary changes that may be helpful

A vegan diet (includes no animal products) that is also low in salt may help women with fibromyalgia. In a controlled clinical trial,⁴ women with fibromyalgia were put on a special diet consisting only of raw foods—primarily fruits, vegetables, nuts, seeds, pulses, and cereals (such as rolled oats). The diet also contained a few fermented foods, including a fermented yoghurt-food made from oats, a fermented drink made from wheat berries (called Rejuvalac), and a few types of fermented vegetables, particularly cabbage. During the three-month trial, women following the therapeutic diet experienced a significant reduction in body weight, pain, morning sickness, use of painkillers, depression, and the number of sore fibromyalgia points, compared with those who continued to eat their regular diet. Due to the liberal use of nuts and seeds, this diet was not low in fat; for example, 31% of all calories came from fat. Nonetheless, the total number of calories was relatively low (less than 1,900 calories per day), which was probably responsible for the decrease in body weight.

In a preliminary report, four women with fibromyalgia experienced marked improvement or complete resolution of their symptoms within months after eliminating monosodium glutamate (MSG) or MSG plus aspartame from their diet. In each case, symptoms recurred whenever MSG was ingested.⁵

Lifestyle changes that may be helpful

Low-intensity exercise may improve fibromyalgia symptoms. People with fibromyalgia who exercise regularly have been reported to suffer less severe symptoms than those who remain sedentary.⁶ ⁷ ⁸ In a controlled trial, a programme consisting of two 25-minute exercise classes plus two educational sessions per week for six weeks resulted in immediate and sustained improvement in walking distance, fatigue, and well-being in a group of people with fibromyalgia;⁹ however, no reductions in pain, anxiety, or depression were seen. In a more recent controlled trial, a 35-minute exercise programme in a warm pool once a week for six months, coupled with counselling sessions, led to improvements in hand-grip strength and endurance, as well as to reductions in pain, distress, depression, and anxiety.¹⁰ The results of this trial, and other similar trials, suggest that underwater exercise training, in combination with a counselling intervention, should be considered by people with fibromyalgia.

Other therapies

Low-impact exercise programmes to improve aerobic fitness, stretching techniques to relax tense muscles, and cognitive therapy for coping with stress and emotional disorders are recommended treatments.

Vitamins that may be helpful

In a double-blind trial, supplementation with acetyl-L-carnitine in the amount of 1,500 mg per day for ten weeks was significantly more effective than a placebo in improving musculoskeletal pain, depression, and general health in people with fibromyalgia.¹¹

People with fibromyalgia often have low serotonin levels in their blood.¹² ¹³ ¹⁴ Supplementation with 5-HTP may increase serotonin synthesis in these cases. Both preliminary¹⁵ ¹⁶ and double-blind trials¹⁷ have reported that 5-HTP supplementation (100 mg three times per day) relieves some symptoms of fibromyalgia.

Some studies have found low vitamin B1 (thiamine) levels and reduced activity of some thiamine-dependent enzymes among people with fibromyalgia.¹⁸ ¹⁹ The clinical significance of these findings remains unknown.

One early preliminary study described the use of vitamin E supplements in the treatment of “fibrositis”—the rough equivalent of what is today called fibromyalgia. A few dozen individuals were treated with vitamin E using amounts ranging from 100–300 IU per day. The results were positive and sometimes dramatic.²⁰ Double-blind trials are needed to confirm these preliminary observations.

Intravenous SAMe (S-adenosylmethionine) given to people with fibromyalgia reduced pain and depression in two double-blind trials;²¹ ²² but no benefit was seen in a short (ten-day) trial.²³ Oral SAMe (800 mg per day for six weeks) was tested in one double-blind trial and significant beneficial effects were seen, such as reduced pain, fatigue, and stiffness, and improved mood.²⁴

In a preliminary trial, supplementation with ribose in the amount of 5 grams three times per day for approximately three weeks improved energy, sleep, mental clarity, pain, and general well-being in people with fibromyalgia.²⁵ Placebo-controlled trials are needed to rule out the possibility that these improvements were due to a placebo effect. If ribose is effective for people with fibromyalgia, it may work by improving the body's capacity to produce energy.

A preliminary trial found that a combination of magnesium and malic acid might lessen muscle pain in people with fibromyalgia.²⁶ The amounts used in this trial were 300–600 mg of elemental magnesium and 1,200–2,400 mg of malic acid per day, taken for eight weeks. A double-blind trial by the same research group using 300 mg magnesium and 1,200 mg malic acid per day found no reduction in symptoms, however.²⁷ Though these researchers claimed that magnesium and malic acid appeared to have some effect at higher levels (up to 600 mg magnesium and 2,400 mg malic acid), the positive effects were not demonstrated under blinded study conditions. Therefore, the evidence supporting the use of these supplements for people with fibromyalgia remains weak and inconclusive.

Melatonin supplementation may be useful in the treatment of fibromyalgia. In a preliminary trial, 3 mg of melatonin at bedtime was found to reduce tender points and to improve sleep and other measures of disease severity, though pain and fatigue improved only slightly.²⁸

Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.

Integrated approaches that may be helpful

Stress is believed by some researchers to be capable of aggravating fibromyalgia symptoms. Stress-reduction techniques, such as meditation, have proven helpful in preliminary research.²⁹

Acupuncture may be useful for short-term relief of fibromyalgia symptoms. In one preliminary trial, acupuncture produced a significant decrease in pain and point tenderness along with related biochemical changes measured in the fibromyalgia patients’ blood.³⁰ Another uncontrolled trial used electroacupuncture (acupuncture with electrical stimulation) treatment in people with fibromyalgia who were unresponsive to conventional medical therapies. After an average of seven treatments per person, 46% claimed that electroacupuncture provided the best relief of symptoms when compared to all other therapies, and 64% reported using less medication for pain relief than prior to electroacupuncture.³¹ A double-blind trial compared fake acupuncture to electroacupuncture and reported significant differences in improvement in five of eight outcome measurements among people with fibromyalgia.³² Short-term pain reduction in people with fibromyalgia has been reported in other studies, some of which were at least partially controlled; however, long-term benefits have never been investigated in a controlled clinical trial.³³ Long-term controlled trials are necessary to conclusively determine whether acupuncture is a useful treatment for fibromyalgia.

Joint manipulation, chiropractic, and related treatments may be helpful for relieving some of the symptoms of fibromyalgia. A preliminary study³⁴ found that almost half of people with fibromyalgia who received chiropractic care had “moderate to good” improvement. A small preliminary trial³⁵ evaluated the effect of four weeks of chiropractic treatment (three to five times per week) consisting of soft tissue massage, stretching, spinal manipulation, and general advice and information. Treatment resulted in a significant decrease in pain and an increase in range of neck movement, but there was no improvement in tender points or in ability to function in daily life. Another preliminary trial³⁶ evaluated a longer treatment period (30 sessions) consisting of spinal manipulation and deep pressure massage to tender points in the muscles. More benefit was reported by this study, as 60% of the patients experienced significant pain reduction, reduced sensed of fatigue, and improved sleep. These benefits persisted one month after the treatment was completed. People who did not feel better after 15 treatments were not likely to benefit from this type of treatment. No controlled research has evaluated manipulation therapies for fibromyalgia.

References

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The information presented in Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or chemist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires September 2008.

2007-09-01