Naturopathic treatment of fibromyalgia goes beyond pain control.


Fibromyalgia is a complex disorder traditionally diagnosed and treated by rheumatologists. The diagnosis is often made on exclusionary grounds, meaning that other diseases are ruled out, and then the label or diagnosis of fibromyalgia is given. Often fibromyalgia points or fibromyalgia pressure points are used to help confirm the diagnosis when no other cause of symptoms can be found. There are many options for natural fibromyalgia treatment, depending on what contributing factors or disorders are found.

 

Diagnosing Fibromyalgia 

Fibromyalgia points and fibromyalgia pressure points

·        Occiput: suboccipital muscle insertion at the base of the skill

·         Low cervical: C5-C7 in between the joints at the muscles beside the spine

·        Trapezius: midpoint of the upper trapezius, where people often get "massages" or "shoulder rubs"

·        Supraspinatus: at the top of the inner triangle of the scapula

·        Gluteal: upper outer quadrants of buttocks

·        Greater trochanter: right behind what many people feel as the "hip bone" but is actually the greater trochanter

·        Second rib: where the ribs come into contact with the breast bone

·        Lateral epicondyle: an inch down from the outside elbow bone

·        Knee: inner fat pad up from the joint line

 

The above points are used, and if other medical causes are excluded, then usually we look for at least 11 of the fibromyalgia points to be tender when palpated gently. The second conventional criteria for a fibromyalgia diagnosis is that the pain has had to be widespread for at least 3 months.

 Newer criteria published in 2016 are published at: https://www.sciencedirect.com/science/article/pii/S0049017216302086

Some of the conditions that should be ruled out or assessed for include hypothyroidism, rheumatoid arthritis, lupus, polymyalgia rheumatica, cardiac and gastrointestinal problems, chronic infections.

Functional diagnosis of fibromyalgia

There is often some level of dysfunction that I have found in my Vancouver fibromyalgia patients. This usually includes thyroid disorders, adrenal hypo-functioning (adrenal fatigue), increased body burden of toxins (including heavy metals and/or solvents), multiple chronic infections, and occasionally nutritional deficiencies (notably an increased need for magnesium and B12). Furthermore, sleep if often poor.

 

Natural Fibromyalgia Treatment

Thyroid:

The hypothalamic-pituitary-thyroid axis is very important in recovering with fibromyalgia treatment. Thyroid hormone, when it acts on the cells of the body, drives the metabolic activity. In effect, it is the "furnace" of the system. With an under-functioning thyroid, or tissue resistance to thyroid hormone, the muscle cells themselves can be starving for energy as they do not produce enough ATP fuel to function optimally. Combined with the central nervous system hypersensitivity often seen in fibromyalgia, it may contribute to chronic widespread pain. Assessment involves the usually done TSH, but also blood levels of the actual hormones free T3 and free T4, as well as for sick euthyroid syndrome (measuring reverse T3 may be useful).

Adrenals:

In my experience, the hypothalamic-pituitary-adrenal axis is also important in fibromyalgia treatment. With any prolonged illness, the adrenals may be under-functioning; whether it is the sole cause of the symptoms is more debatable. Chronic fatigue is often a component of fibromyalgia, and needs to be addressed in treatment. In my experience, getting the adrenals and thyroid into check can often help. I check into adrenal function with either a 4 point salivary test to measure the cortisol pattern, or with a 24 hour urine test to measure the total daily production of adrenal hormones (may be more accurate, but much more expensive).  A first morning serum cortisol is an option as well.

Toxins:

Both heavy metals and organic solvent toxins (eg pesticides) may have the potential to make the nerves much more sensitive to stimuli. Furthermore, both heavy metals and organic solvents can poison the mitochondria in the cells, which are responsible for the production of ATP (energy source of the cell). I may recommend a pre and post provocative challenge for heavy metals (IV chelation and urine collection to see what metals are coming out) and test the organic toxins with either a urine or blood test, if the history indicates. If levels are high, then fibromyalgia treatment would likely include detoxification as part of the protocol.

Infection:

Multiple chronic infections causing immune dysfunction and central nervous system hypersensitization may be a component, at least in my experience.  I have a special interest in tick-borne illnesses, including lyme disease and the associated coinfections. A subset of fibromyalgia patients may improve markedly when started on treatment for lyme and the coinfections. Objective tests like lyme western blots may be helpful in this case, to differentiate patients who may benefit from antimicrobial treatment from those who supportive treatment may serve best.

Nutrients:

There is evidence that magnesium is important in fibromyalgia, as well as ribose and vitamin B12. I rarely test these levels and instead go based on clinical response to intravenous magnesium, oral ribose powder, and intramuscular methyl B12 injections. In my experience, a subset of patients with fibromyalgia experience pain reductions with these measures. 

Sleep:

Sleep is paramount in fibromyalgia treatment. Fibromyalgia patients will not be cured of their condition when sleep is restored, but both pain and energy do seem to improve in my experience. Sometimes the adrenal assessment above can give causes to dysfunctional sleep-wake cycles, and sometimes trial of medications can be useful. From the natural fibromyalgia treatment standpoint, I like nutrients like AOR Ortho Sleep, Somno Pro from Bioclinic Naturals, as well as pharma GABA and theanine, depending on the clinical picture. Drugs like amitryptiline and gabapentin can be useful, when pain is impairing sleep. Trazodone and mirtazapine in sleep dosing (not antidepressant dosing) may also be useful.

General Natural Fibromyalgia Treatments may be useful in most patients

The work up of fibromyalgia patients from a naturopathic doctor standpoint can be extensive. We assess for other conditions that may present like fibromyalgia or contribute to it’s symptoms. When we take a holistic and naturopathic view to fibromyalgia treatment, all of the systems discussed above come into play. Depending on largely clinical history, and some lab tests, one or more of the above factors may become the target of fibromyalgia treatment for any particular patient.

There are some general measures though that are most helpful in my experience for fibromyalgia patients: 

Sleep quality

-  Acupuncture

Ozone and Magnesium (Ozone stimulates improved oxygenation, helps the blood to unload oxygen to the tissues more readily, and increases the antioxidant capacity of the tissues. 4-6 sessions may be recommended, and course of treatment is generally 10-15 treatments.)

 

Rationale for Myers’ / IV Nutrient Injections (in general):

  • IV administration of nutrients can result in serum levels much higher than possible with oral administration (Okayama et al, JAMA 1987; Sydow M et al, Intensive Care Med. 1993.) 

  • Magnesium may promote smooth muscle relaxation in blood vessels and bronchial muscle (Iseri LT et al. Am Heart J. 1984)(Brunner EH et al. J Asthma. 1985.), that may be beneficial for high blood pressure, bronchial asthma, migraine headache.

  • IV administration of 7.5 g of vitamin C over an hour has been demonstrated to reduce serum histamine levels by 31% (Hagel AF et al. Naunyn Schmiedebergs Arch Pharmacol. 2013.)  This may be beneficial for allergic conditions.

  • Some nutrients may exert effects that are concentration dependent, such as anti-viral effects of vitamin C at 10-15 mg/dl (Harakeh S et al. Proc Natl Acad Sci. 1990.), only achieved through IV administration

Conditions that may be improved by Myers’ (IV vitamin/mineral) injections (personal experience as per Alan Gaby, MD; Gaby, A, Nutritional Medicine 2nd Ed.): FatigueFibromyalgia / polymyalgia rheumaticaDepression, Asthma, Migraine, Cardiovascular disease, Upper respiratory tract infection, Sinusitis, Seasonal Allergic rhinitis, Chronic urticaria, Athletic performance, Hyperthyroidism

Modified Myers’ ingredients: Magnesium, sometimes calcium, Vitamin C, B-complex, B6, B5.  Formulation may be altered to better meet patient case specifics.  This may be diluted to ~35mL with sterile water and given as an IV push, or push into 100mL saline and given a slower an IV drip.

Myers’ injection safety: Generally well tolerated by most patients in our experience.  Dr Alan Gaby has had no adverse reactions in approximately 15,000 treatments when administered with caution and respect (Gaby, Alan. Nutritional Medicine, 2nd Ed.)  Extra caution should be taken in potassium depleting conditions and medications (e.g. taken potassium depleting medications; states of low potassium: potassium depleting diuretics, beta agonists, glucocorticoids, diarrhea, vomiting, malnourishment), as IV magnesium can potentially worsen low blood potassium levels (can increase risk of digoxin induced cardiac arrhythmias). Lower nutrient doses may be used in mild to moderate renal insufficiency. The Myers’ injection often causes a sensation of heat (from magnesium.)  Low blood pressure and excessive heat may be associated with rapid injection, and higher dose of magnesium.  Lower magnesium doses and slower injections (e.g. IV drip) may be indicated for those with lower blood pressure.  Anaphylactic reactions to thiamine (B1) have been reported in the medical literature on the rare occasion.  The Myers’ injection tends to be hypertonic (concentrated), thus tenderness, burning sensation at the injection site, vein irritation, phlebitis is possible.  Often repositioning the needle in the vein or further diluting nutrients can help reduce or eliminate pain or irritation.  Myers’ injection given as an IV drip (in 100cc of saline tends to be less hypertonic/concentrated).

 

Ozone therapy safety (major autohemotherapy): A survey done in Germany of close to 5 million ozone treatments showed an accident rate of 7 serious incidents, all associated with direct IV injection of the gas (not done in our clinic).  There is a slight possibility of allergy to heparin, though this is a commonly used blood thinner. Some patients do not like the site of their own blood, but they quickly become accustomed to this.

In our experience, the most frequently seen (but still rare) side effect is dizziness/vasovagal/fainting reaction due not at all to the volume of the blood, but rather the needle experience as well as seeing the blood. Possible but extremely rare complications may include soft tissue infection (as with any injection / blood draw), or vein inflammation and clots.

One recent case study has been published on ozone therapy where a single patient with kidney failure had high blood potassium and subsequent arrhythmia. The authors had concluded that the ozone therapy (which looked to be done 9 days in a row) was to blame, but this is not at all clear. The authors did not think that red cell breakdown was responsible for the high blood potassium, but that is the only mechanism that would make sense if the ozone was done daily. Theoretically low grade red cell breakdown would release potassium, and if the treatment is overdone and the kidneys can not excrete this could accumulate.

Photoluminescence therapy (ultraviolet blood irradiation) was used extensively in the 30's to 40's before the advent of antibiotics and the vaccine for polio.  It has an extensive safety and efficacy record. For a great summary of this treatment, buy the book "Into the Light" at www.drdouglass.com.  An online article also available is “The Cure that time forgot” which summarizes much of the published experience.  Potential side effects of ultraviolet blood irradiation are similar to those mentioned above for ozone therapy/major autohemotherapy.

 

If you are a patient interested in this approach to fibromyalgia treatment, please call the office at 604 275 0163 to schedule an appointment with Dr Eric Chan (ND). Do let the receptionist know that it is for fibromyalgia and possibly lyme disease, so she will know it is a complex case and book enough time.

 

 

Reference: Fibromyalgia, nutrient deficiency, heavy metals

 

Bjørklund G, Dadar M, Chirumbolo S, Aaseth J. 2018. Fibromyalgia and nutrition: Therapeutic possibilities? Biomed Pharmacother. 2018 Jul;103:531-538.

 

 

 

References: Acupuncture for Fibromyalgia

 

Uğurlu FG, Sezer N, Aktekin L, Fidan F, Tok F, Akkuş S. 2017. The effects of acupuncture versus sham acupuncture in the treatment of fibromyalgia: a randomized controlled clinical trial. Acta Reumatol Port. 2017 Jan-Mar;42(1):32-37.

 

Iannuccelli C, Guzzo MP, Atzeni F, Mannocci F, Alessandri C, Gerardi MC, Valesini G, Di Franco M. 2017. Pain modulation in patients with fibromyalgia undergoing acupuncture treatment is associated with fluctuations in serum neuropeptide Y levels. Clin Exp Rheumatol. 2017 May-Jun;35 Suppl 105(3):81-85. Epub 2017 May 31.

 

Vas J, Santos-Rey K, Navarro-Pablo R, Modesto M, Aguilar I, Campos MÁ, Aguilar-Velasco JF, Romero M, Párraga P, Hervás V, Santamaría O, Márquez-Zurita C, Rivas-Ruiz F. 2016. Acupuncture for fibromyalgia in primary care: a randomised controlled trial. Acupunct Med. 2016 Aug;34(4):257-66.

 

 

 

References: Acupuncture for Headaches, Pain

 

Mayrink WC1, Garcia JBS2, Dos Santos AM2, Nunes JKVRS3, Mendonça THN2.2018. 2018. Effectiveness of Acupuncture as Auxiliary Treatment for Chronic Headache. J Acupunct Meridian Stud. 2018 Oct;11(5):296-302.

 

Linde K, Allais G, Brinkhaus B, Fei Y, Mehring M, Shin BC, Vickers A, White AR. 2016. Acupuncture for the prevention of tension-type headache. Cochrane Database Syst Rev. 2016 Apr 19;4:CD007587.

 

Linde K, Allais G, Brinkhaus B, Fei Y, Mehring M, Vertosick EA, Vickers A, White AR. 2016. Acupuncture for the prevention of episodic migraine. Cochrane Database Syst Rev. 2016 Jun 28;(6):CD001218.

 

Nielsen A. 2017. Acupuncture for the Prevention of Tension-Type Headache (2016). Explore (NY). 2017 May - Jun;13(3):228-231.

 

Yin C, Buchheit TE, Park JJ. 2017. Acupuncture for chronic pain: an update and critical overview. Curr Opin Anaesthesiol. 2017 Oct;30(5):583-592.

 

Lin YC, Wan L, Jamison RN. 2017. Using Integrative Medicine in Pain Management: An Evaluation of Current Evidence. Anesth Analg. 2017 Dec;125(6):2081-2093.

 

 

 

References: Myers’, Intravenous vitamin/mineral injections (general)

 

Gaby AR. 2002. Intravenous nutrient therapy: the "Myers' cocktail". Altern Med Rev. 2002 Oct;7(5):389-403.

 

Ali A, Njike VY, Northrup V, Sabina AB, Williams AL, Liberti LS, Perlman AI, Adelson H, Katz DL. 2009. Intravenous micronutrient therapy (Myers' Cocktail) for fibromyalgia: a placebo-controlled pilot study. J Altern Complement Med. 2009 Mar;15(3):247-57.

 

Okayama H, Aikawa T, Okayama M, Sasaki H, Mue S, Takishima T. 1987. Bronchodilating effect of intravenous magnesium sulfate in bronchial asthma. JAMA. 1987 Feb 27;257(8):1076-8.

 

Rowe BH, Bretzlaff JA, Bourdon C, Bota GW, Camargo CA Jr. 2000.  Magnesium sulfate for treating exacerbations of acute asthma in the emergency department. Cochrane Database Syst Rev. 2000;(2):CD001490.

 

Sydow M, Crozier TA, Zielmann S, Radke J, Burchardi H. 1993. High-dose intravenous magnesium sulfate in the management of life-threatening status asthmaticus. Intensive Care Med. 1993;19(8):467-71.

 

Harakeh S, Jariwalla RJ, Pauling L. 1990. Suppression of human immunodeficiency virus replication by ascorbate in chronically and acutely infected cells. Proc Natl Acad Sci U S A. 1990 Sep;87(18):7245-9.

 

Harakeh S1, Niedzwiecki A, Jariwalla RJ. 1994. Mechanistic aspects of ascorbate inhibition of human immunodeficiency virus. Chem Biol Interact. 1994 Jun;91(2-3):207-15.

 

Hagel AF, Layritz CM, Hagel WH, Hagel HJ, Hagel E, Dauth W, Kressel J, Regnet T, Rosenberg A, Neurath MF, Molderings GJ, Raithel M. 2013. Intravenous infusion of ascorbic acid decreases serum histamine concentrations in patients with allergic and non-allergic diseases. Naunyn Schmiedebergs Arch Pharmacol. 2013 Sep;386(9):789-93.

 

Iseri LT, French JH. 1984. Magnesium: nature's physiologic calcium blocker. Am Heart J. 1984 Jul;108(1):188-93.

 

Brunner EH, Delabroise AM, Haddad ZH. 1985. Effect of parenteral magnesium on pulmonary function, plasma cAMP, and histamine in bronchial asthma. J Asthma. 1985;22(1):3-11.

 

Sharma SK, Bhargava A, Pande JN. 1994. Effect of parenteral magnesium sulfate on pulmonary functions in bronchial asthma. J Asthma. 1994;31(2):109-15.

 

 

References: Ozone

 

Bocci V, Zanardia I, Valacchi G, Borrelli E, Travagli V. 2015. Validity of Oxygen-Ozone Therapy as Integrated Medication Form in Chronic Inflammatory Diseases. Cardiovasc Hematol Disord Drug Targets. 2015;15(2):127-38.

 

Giunta R, Coppola A, Luongo C, Sammartino A, Guastafierro S, Grassia A, Giunta L, Mascolo L, Tirelli A, Coppola L. 2001. Ozonized autohemotransfusion improves hemorheological parameters and oxygen delivery to tissues in patients with peripheral occlusive arterial disease. Ann Hematol. 2001 Dec;80(12):745-8.

 

Valacchi G, Bocci V. 2000. Studies on the biological effects of ozone: 11. Release of factors from human endothelial cells. Mediators Inflamm. 2000;9(6):271-6.

 

Inal M, Dokumacioglu A, Özcelik E, Ucar O. 2011. The effects of ozone therapy and coenzyme Q₁₀ combination on oxidative stress markers in healthy subjects. Ir J Med Sci. 2011 Sep;180(3):703-7.

 

Wu XN, Zhang T, Wang J, Liu XY, Li ZS, Xiang W, Du WQ, Yang HJ, Xiong TG, Deng WT, Peng KR, Pan SY. 2016. Magnetic resonance diffusion tensor imaging following major ozonated autohemotherapy for treatment of acute cerebral infarction. Neural Regen Res. 2016 Jul;11(7):1115-21.

 

Smith NL, Wilson AL, Gandhi J, Vatsia S, Khan SA. 2017. Ozone therapy: an overview of pharmacodynamics, current research, and clinical utility. Med Gas Res. 2017 Oct 17;7(3):212-219.

 

Molinari F, Simonetti V, Franzini M, Pandolfi S, Vaiano F, Valdenassi L, Liboni W. 2014. Ozone autohemotherapy induces long-term cerebral metabolic changes in multiple sclerosis patients. Int J Immunopathol Pharmacol. 2014 Jul-Sep;27(3):379-89.

 

 

References: Ozone and Diabetes

 

Bocci V, Zanardi I, Huijberts MS, Travagli V. 2011.  Diabetes and chronic oxidative stress. A perspective based on the possible usefulness of ozone therapy. Diabetes Metab Syndr. 2011 Jan-Mar;5(1):45-9.

 

Bocci V, Zanardi I1, Huijberts MS, Travagli V. 2014. It is time to integrate conventional therapy by ozone therapy in type-2 diabetes patients. Ann Transl Med. 2014 Dec;2(12):117.

 

Bocci V, Zanardi I, Huijberts MS, Travagli V4. 2014. Diabetes Metab Syndr. 2014 An integrated medical treatment for type-2 diabetes.  Jan-Mar;8(1):57-61.

 

de Monte A, van der Zee H, Bocci V. 2005. Major ozonated autohemotherapy in chronic limb ischemia with ulcerations. J Altern Complement Med. 2005 Apr;11(2):363-7.

 

Braidy N, Izadi M, Sureda A, Jonaidi-Jafari N, Banki A, Nabavi SF, Nabavi SM5. 2018. Therapeutic relevance of ozone therapy in degenerative diseases: Focus on diabetes and spinal pain. J Cell Physiol. 2018 Apr;233(4):2705-2714.

 

 

 

References: Ultraviolet Blood Irradiation

 

Hamblin MR. 2017. Ultraviolet Irradiation of Blood: "The Cure That Time Forgot"? Adv Exp Med Biol. 2017;996:295-309.

 

Wu X, Hu X, Hamblin MR. 2016. Ultraviolet blood irradiation: Is it time to remember "the cure that time forgot"? J Photochem Photobiol B. 2016 Apr;157:89-96.

 

Kuenstner JT, Mukherjee S, Weg S, Landry T, Petrie T. 2015. The treatment of infectious disease with a medical device: results of a clinical trial of ultraviolet blood irradiation (UVBI) in patients with hepatitis C infection. Int J Infect Dis. 2015 Aug;37:58-63.

 

 

References: Chelation therapy (general chelation references)

Alessandro Fulgenzi and Maria Elena Ferrero  2019. EDTA Chelation Therapy for the Treatment of Neurotoxicity Int. J. Mol. Sci. 20(5), 1019.

Bamonti, F.; Fulgenzi, A.; Novembrino, C.; Ferrero, M.E. Metal chelation therapy in rheumathoid arthritis: A case report: Successful management of rheumathoid arthritis by metal chelation therapy. Biometals 2011.

Fulgenzi, A.; Zanella, S.G.; Mariani, M.M.; Vietti, D.; Ferrero, M.E. A case of multiple sclerosis improvement following removal of heavy metal intoxication: Lessons learnt from Matteo’s case. Biometals 2012, 25, 569–576.

Fulgenzi, A.; Vietti, D.; Ferrero, M.E. Aluminium involvement in neurotoxicity. Biomed. Res. Int. 2014, 2014,758323.  

Fulgenzi, A.; De Giuseppe, R.; Bamonti, F.; Vietti, D.; Ferrero, M.E. Efficacy of chelation therapy to remove aluminium intoxication. J. Inorg. Biochem. 2015, 152, 214–218.

Fulgenzi, A.; De Giuseppe, R.; Bamonti, F.; Ferrero, M.E.  Improvement of oxidative and metabolic parameters by cellfood administration in patients affected by neurodegenerative diseases on chelation treatment. Biomed. Res. Int. 2014, 2014.

Roussel, A.M.; Hininger-Favier, I.;Waters, R.S.; Osman, M.; Fernholz, K.; Anderson, R.A. EDTA Chelation therapy, without added vitamin C, decreases oxidative DNA damage and lipid peroxidation. Altern. Med. Rev. 2009, 14, 56–62.

Issa OM, Roberts R, Mark DB, Boineau R, Goertz C, Rosenberg Y, Lewis EF, Guarneri E, Drisko J, Magaziner A, Lee KL, Lamas GA. 2018. Effect of high-dose oral multivitamins and minerals in participants not treated with statins in the randomized Trial to Assess Chelation Therapy (TACT). Am Heart J. 2018 Jan;195:70-77.

Diaz D, Fonseca V, Aude YW, Lamas GA. 2018. Chelation therapy to prevent diabetes-associated cardiovascular events. Curr Opin Endocrinol Diabetes Obes. 2018 Aug;25(4):258-266.

Fulgenzi, A.; De Giuseppe, R.; Bamonti, F.; Ferrero, M.E. Improvement of oxidative and metabolic parameters by cellfood administration in patients affected by neurodegenerative diseases on chelation treatment.  Biomed. Res. Int. 2014, 2014.