Fibromyalgia can be a challenging condition to live with, and patients are often frustrated by the care they receive. Fibromyalgia symptoms overlap with those of other chronic diseases, which often leads patients to see several different specialists before receiving their diagnosis.
Once diagnosed, the challenge becomes finding a treatment that offers effective symptom relief. Medications used in conventional treatment of fibromyalgia include analgesics (pain medications), anti-anxiety and anti-depressant medications, muscle relaxants, and anticonvulsants. Many times these medications provide only partial symptom improvement and often they come with unpleasant side-effects. This is a major reason why many fibromyalgia patients will seek complementary and alternative (CAM) treatment strategies at some point.
Conventional medical treatment of fibromyalgia is challenging because the pathophysiology of the condition is poorly understood at this time. The current theory is that it is a neurosensory disorder that is due to abnormal pain processing in the central nervous system (CNS). (2,4) However, fibromyalgia patients experience a wide array of symptoms that are not limited to the pain and tenderness in their muscles.
Symptoms of fibromyalgia can include the aforementioned widespread chronic pain, stiffness, fatigue, sleep problems, digestive problems, cognitive impairment, anxiety and/or depression, pelvic pain, frequent and painful urination, restless legs, headaches and migraine headaches, multiple chemical sensitivities, allergy symptoms, weight fluctuation, and dizziness and/or fainting. No wonder it is such a challenge to live with and no wonder it is such a difficult condition for conventional healthcare specialists to diagnose and treat!
A Holistic Approach
When I evaluate a patient who has fibromyalgia, I begin by considering hormone balance including thyroid health and the hypothalamic-pituitary-adrenal (HPA) axis, gut health and the immune system, environmental toxicity and detoxification pathways, and how persistent negative thought patterns contribute to negative moods (which leads to increased subjective experience of pain and other symptoms).
The endocrine (hormone) system is a complex web of feedback loops among glands that ideally maintains a delicate balance. Many factors can affect the function of the endocrine system and its hormones including nutritional deficiencies, environmental toxicity, and chronic stress. Fibromyalgia patients often suffer from all three of these issues.
Pain, itself, is known to activate the HPA axis and the sympathetic nervous system (fight or flight mechanism). This is a healthy and normal response for our bodies. Fibromyalgia patients, however, experience a maladaptive stress response. (3) This may be due to chronic pain (and/or it may contribute to chronic pain – it’s a chicken and egg situation) and eventually leads to depletion of the adrenal glands and disruption of the HPA axis. When this happens, it is commonly referred to in the CAM community as adrenal fatigue.
HPA axis dysfunction, or adrenal fatigue, manifests in several ways. From a physiologic standpoint, some authors have asserted that there are five main measurable abnormalities in HPA axis dysfunction in fibromyalgia patients which include low free cortisol in 24-hour urine samples, loss of normal circadian rhythm with elevated cortisol at night (when it should be at its lowest point), insulin-induced hypoglycemia (low blood sugar) in response to overproduction of adrenocorticotropic hormone (ACTH), and low levels of growth hormone. (4)
From a practical perspective, these changes can cause some of the troubling symptoms that fibromyalgia patients struggle with. In particular, fatigue and chronic pain can be associated with HPA axis dysfunction. Disruption of the normal circadian rhythm with elevated cortisol at night leads to difficulty sleeping because cortisol is associated with alertness. Since the circadian rhythm and function of the HPA axis are intimately connected with metabolism of the neurotransmitter serotonin, disruption of the HPA axis and decreased cortisol production can lead to decreased serotonin in the central nervous system. This can contribute to symptoms of anxiety and depression.
Last but not least, fibromyalgia patients may experience disruption of their hypothalamic-pituitary-thyroid (HPT) axis, perhaps due to HPA axis disruption. (5) It is known that fibromyalgia patients have elevated thyroperoxidase antibodies (anti-TPO) compared to people without fibromyalgia. (6) This can mean that patients may have normal thyroid stimulating hormone (TSH) test results according to lab reference ranges but upon more thorough thyroid testing and analysis from a functional medicine perspective they may have a pattern of suboptimal function of the thyroid gland and/or elevated anti-TPO antibodies. This can contribute to weight gain, fatigue, and symptoms of depression.
The good news is that HPA axis dysfunction, circadian rhythm disruption, and thyroid function can be easily tested and effectively treated with natural medicines. A 24-hour salivary adrenal hormone test can determine your pattern of disruption and guide effective treatment strategies using nutrition, lifestyle changes, nutritional supplements and botanical medicines that are appropriate to your specific situation. A blood test for thyroid hormones and thyroid antibodies can enable your provider to determine what, if any, nutritional or supplemental interventions would be helpful to support thyroid health and function.
Gut Health and Immune System
It’s no coincidence that many fibromyalgia patients are initially or concurrently diagnosed with irritable bowel syndrome (IBS) or dyspepsia (indigestion). From a naturopath’s perspective, the health of the digestive system has everything to do with the health of the immune system and the body overall.
A large portion of the immune system is located within the digestive tract, so the health of the digestive system greatly affects the immune system. Problems can arise as a result of chronic stress, poor diet choices, imbalances in the microorganisms in the gut, and decreased production of stomach acid and digestive enzymes. When the digestive system becomes irritated and inflamed, a condition that is commonly referred to as leaky gut develops.
The theory behind leaky gut is that irritation and inflammation of the digestive tract lead to gaps between cells lining the gut that are big enough for large molecules to fit through. (7) In a normal, healthy digestive system only very tiny molecules of fully digested food are allowed to pass from the digestive tract into the blood. When large molecules pass through, they are perceived as foreign invaders by the immune system and the immune system becomes activated in an inappropriate way. This can lead to a wide variety of seemingly unconnected symptoms, many of which are common in fibromyalgia patients.
My strategy for rehabilitating the digestive system generally involves the following steps:
- Identify and temporarily remove foods to which the patient reacts. This can be done through a food allergy elimination diet. There are also blood tests available to assess food reactions.
- Provide targeted supplementation to calm inflammation in the digestive tract and help the gut lining to rebuild.
- Eradicate any inappropriate microbes from the digestive system and supplement with a high potency probiotic.
- Supplement digestive enzymes as needed.
Testing is available to determine how well your food is digested, what microorganisms are living in your digestive system, and to which foods, if any, your immune system reacts. The goal is rehabilitation of the digestive system such that highly restrictive diets and long lists of supplements are not needed long-term.
Environmental toxicity is a suggested contributor to fibromyalgia symptoms, although the mechanism has not been clearly elucidated by research. (8) Toxin exposure happens to all of us on a daily basis, although some people have more significant exposure due to their work or home environments. Toxin exposure can overwhelm the ability of the liver, kidneys, and digestive system to break down and eliminate toxins.
When toxins are not effectively eliminated, several problems occur. The immune system can become inappropriately activated as it reacts to some toxic molecules as though they were foreign invaders. This can lead to widespread symptoms of inflammation. Some toxins are structurally similar to our hormones and can disrupt the feedback mechanisms of our endocrine systems, our hormone levels, and the response of our tissues. Some toxins can interfere with our nervous system function. Some can be stored in our fat tissue.
When the liver becomes overwhelmed by the burden placed on it by excessive toxin exposure, it is less able to effectively break down and eliminate our own hormones and metabolic waste products. This can lead to further hormone disruption and inflammation.
Detoxification or cleansing programs that are well designed can help improve liver, kidney, and digestive system toxin elimination. These usually involve diet modification, nutrient and botanical supplementation, and lifestyle changes for a period of 10-28 days or more. I also offer a gentle and very effective type of detoxification support that is called biotherapeutic drainage and involves combination homeopathic medicines.
It is theorized that negative mood states (anger, anxiety, and depression) contribute to worsened fibromyalgia symptoms. The way we think affects neurotransmitter levels and hormone balance. We only have to try imagining a frightening situation or remembering a painful life experience or thinking of a loved one to know how our thoughts affect our emotions and our physical experience. Studies of patients with fibromyalgia who undergo cognitive behavioral therapy or mindfulness based therapies show improvement in symptoms. (9, 10)
In this vein, I work with my patients using natural mood support strategies including nutrition and lifestyle changes, nutritional supplements, botanical medicines, homeopathy, and acupuncture as appropriate. I help them to learn new strategies for coping with stress and unpleasant life experiences. I also refer them for counseling if needed.
As with all of my patients, my goal in working with fibromyalgia patients is to help them learn how they can help themselves so that they need me less over time. I want them to know for themselves how to listen to what their bodies are telling them and adjust what they are doing accordingly. Using a natural and holistic approach to fibromyalgia, or any health condition, is not an easy or quick fix. Anyone who tells you differently is trying to sell you something. You have to be willing to put in the time and effort to learn about yourself, learn about your body, and push yourself out of your routine and comfort zone. The rewards of a life with symptoms you know how to control, less pain, and more joy are well worth it.
- Yunus MB. Fibromyalgia and overlapping disorders: the unifying concept of central sensitivity syndromes.Semin Arthritis Rheum. Jun 2007;36(6):339-56. [Medline].
- Gracely RH, Petzke F, Wolf JM, Clauw DJ. Functional magnetic resonance imaging evidence of augmented pain processing in fibromyalgia. Arthritis Rheum. May 2002;46(5):1333-43. [Medline].
- Griep EN, Boersma JW, de Kloet ER. Altered reactivity of the hypothalamic-pituitary-adrenal axis in the primary fibromyalgia syndrome. J Rheumatol. Mar 1993;20(3):469-74. [Medline].
- Crofford LJ. Neuroendocrine aspects of fibromyalgia. J Musculoskelet Pain. 1994;2:125-33.
- Tsigos C, Chrousos GP. Hypothalamic-pituitary-adrenal axis, neuroendocrine factors and stress. J Psychosom Res. 2002 Oct;53(4):865-71.
- Suk JH, Lee JH, Kim JM. Association between thyroid autoimmunity and fibromyalgia. Exp Clin Endocrinol Diabetes. 2012 Jul;120(7):401-4. doi: 10.1055/s-0032-1309008. Epub 2012 Apr 27.
- Odenwald MA, Turner JR. Intestinal permeability defects: is it time to treat? Clin Gastroenterol Hepatol. 2013 Sep;11(9):1075-83. doi: 10.1016/j.cgh.2013.07.001. Epub 2013 Jul 12.
- De Luca C, Scordo G, Cesareo E, Raskovic D, Genovesi G, Korkina L. Idiopathic environmental intolerances (IEI): from molecular epidemiology to molecular medicine. Indian J Exp Biol. 2010 Jul;48(7):625-35.
- Bernardy K, Klose P, Busch AJ, Choy EH, Häuser W. Cognitive behavioural therapies for fibromyalgia. Cochrane Database Syst Rev. 2013 Sep 10;9:CD009796. [Epub ahead of print]
- Lakhan SE, Schofield KL. Mindfulness-based therapies in the treatment of somatization disorders: a systematic review and meta-analysis. PLoS One. 2013 Aug 26;8(8):e71834. doi: 10.1371/journal.pone.0071834.