Fibromyalgia can be debilitating but can also be managed

Dealing with fibromyalgia

Fibromyalgia is defined as diffuse pain in connective tissue and muscle, not due to trauma or overexertion.

Its cause is unknown and it’s made worse by physical or emotional stress. Fibromyalgia is estimated to affect 3% to 6% of the adult Canadians and is four to nine times more common in females than in males. It typically affects otherwise healthy young females between the ages of 25 to 50 years old. It can also affect men in the same age demographic.

Classic signs of fibromyalgia include diffuse muscle pain, insomnia and poor sleep and severe fatigue. Sore and painful muscles, tendons and ligaments can occur all over the body. Areas involved include the back, trunk, arms and legs. Heightened sensitivity and a lower pain threshold are typical in this condition.

At least 11 of 18 specific pain points over the body must be positive for a diagnosis of fibromyalgia to be considered. Also, insomnia and poor sleep quality must occur and be present at the time of a diagnosis. Inability to fall asleep and frequent awakenings lead to daytime fatigue. Fatigue and lack of energy, especially with otherwise normal exertion must occur and be present at the time of diagnosis.

Other symptoms associated with fibromyalgia can include easy bruising, burning feet and legs, muscle cramps, numbness and tingling in extremities, poor memory and concentration, headaches, anxiety and panic attacks, depression and mood swings, blurred vision, dry mouth an poor taste, poor hearing and ringing in the ears, shortness of breath, irritable bowel syndrome, heartburn and stomach spasms, fluid retention and swelling, frequent urination and irritable bladder, cold hands and feet and poor immune system function.

The exact cause of fibromyalgia is unknown. Hypotheses suggested include autonomic nervous system dysfunction, abnormal stress response, accumulation of toxins within muscles, lactic acid buildup, lack of oxygen to muscle tissue, micro-trauma to muscles and connective tissue, poor recovery and healing, viral infection, lack of restful sleep and low levels of hormones in the body.

Diagnosis of fibromyalgia should include a detailed health history, comprehensive physical exam, including pressing on pain points, and lab tests to rule out other causes of illness. Lab tests should include blood work to test a complete blood count, witch measures red blood cells, white blood cells and platelets, a chemistry panel, which typically includes liver, kidney, electrolytes, protein, acid/base levels, muscle markers, a thyroid hormone test, inflammatory markers, like c-reactive protein and erythrocyte sedimentation rate.

An autoimmune panel may be suggested including rheumatoid factor and anti-nuclear antibody test. Additionally, hormone testing may also be suggested including cortisol, testosterone, estrogen and progesterone.

Lab tests are meant to rule out other causes that may contribute to fatigue and pain like low iron or anemia, low thyroid or hypothyroidism and low vitamin B12 levels. Lab tests are generally normal in patients with fibromyalgia.

Conventional medical treatment of fibromyalgia includes prescription of analgesics like Tylenol or acetaminophen, non-steroidal anti-inflammatories or NSAIDS like ibuprofen, naproxen, diclofenac or similar drugs, muscle relaxants like methocarbamol, cyclobenzaprine or Flexeril and Baclofen.

Antidepressants that raise serotonin including fluoxetine or Prozac, citalopram or Celexa and duloxetine or Cymbalta are also recommended. Sleeping pills may be suggested including older tricyclic antidepressants like amitriptyline or Elavil.

Drugs that increase gamma amino butyric acid levels including Gabapentin or Pregabalin may also be suggested. Sleeping pills such as Zopiclone and Zolpidem may also be prescribed to help improve sleep quality for the short term.

Benzodiazepine drugs like lorazepam or Ativan, oxazepam or Serax and alprazolam or Xanax are generally frowned upon because of their habituating and addictive potential.

Physical therapy strategies for fibromyalgia include moderate aerobic exercise like bicycling, hiking and walking, light anaerobic exercise like weightlifting, gentle muscle stretching like tai chi and yoga, massage therapy, electric muscle stimulation, transcutaneous electro neural stimulation and laser therapy. Many studies have confirmed exercise and movement, although difficult and painful, helps to improve this condition as much as drug therapy.

A healthy, balanced diet including whole foods, ample vegetables and fruits and healthy proteins helps to contribute to optimal nutrition and overall well-being.

Supplements recommended include B12 and B-vitamins, calcium and magnesium. Many patients with fibromyalgia take magnesium daily, especially at nighttime to help relax muscle and promote sleep. B12 and B-complex vitamins are important for proper nerve function and energy generation.

Other supplements to help improve sleep duration and quality include melatonin, valerian, kava, GABA and l-theanine.

Herbal anti-inflammatory compounds include turmeric, ginger, Boswellia and willow bark may help reduce inflammation. Saint John’s wort works like a tricyclic antidepressant and may be beneficial to help improve moods, sleep and nerve pain. Some patients also report the use of cannabis products containing lower doses of THC and higher CBD levels help to control pain and improve sleep.

Although fibromyalgia can be a debilitating condition, there are effective strategies including diet, lifestyle, supplements, physical therapy and prescription medicines that can help improve this illness.

The information provided in this article does not, and is not intended to, constitute medical advice. All information and content are for general information purposes only.

This article is written by or on behalf of an outsourced columnist and does not necessarily reflect the views of Castanet.

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About the Author

Doug Lobay is a practicing naturopathic physician in Kelowna, British Columbia.

He graduated with a bachelor of science degree from the University of British Columbia in 1987 and then attended Bastyr College of Natural Health Sciences in Seattle, Washington, where graduated with a doctorate in naturopathic medicine degree in 1991. While attending Bastyr College, he began to research the scientific basis of naturopathic medicine. 

He was surprised to find many of the current major medical journals abounded with scientific information on the use of diet, vitamins, nutritional supplements and herbal medicines.

Doug is a member of the College of Naturopathic Physicians of British Columbia and has practiced as naturopathic family physician for more than 30 years.  He maintains a busy practice in Kelowna where he sees a wide age range of patients with various ailments.

He focuses on dietary modification, allergy testing, nutritional assessments, supplement recommendation for optimal health, various physical therapy modalities, various intravenous therapies including chelation therapy.

An avid writer, he has written seven books on various aspects of naturopathic medicine that are available on Amazon and was also a long-time medical contributor to the Townsend Letter journal for doctors and patients, where many of his articles are available to view on-line. He has also given numerous lectures, talks and has taught various courses on natural medicine.

Doug enjoys research, writing and teaching others about the virtues of natural health and good nutrition. When not working, he enjoys cycling, hiking, hockey, skiing, swimming, tennis and playing guitar.

If you have any further questions or comments, you can contact Dr. Lobay at 250-860-7622 or [email protected].

The views expressed are strictly those of the author and not necessarily those of Castanet. Castanet does not warrant the contents.

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