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. Treating fibromyalgia in Vancouver, I have only very rarely found cases where some other contributing cause was not found (see below).
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.
Usually the diagnoses to rule out or assess for also include hypothyroidism, rheumatoid arthritis, lupus, polymyalgia rheumatica, cardiac and gastrointestinal problems.
Functional diagnosis of fibromyalgia
There is almost always some level of dysfunction that I have found in my Vancouver fibromyalgia patients. This usually includes thyroid disorders, adrenal hypofunctioning (adrenal fatigue), increased body burden of toxins (including heavy metals and solvents), multiple chronic infections, and occasionally nutritional deficiencies (notably an increased need for magnesium and B12). Furthermore, sleep seems to be poor in the majority of patients.
Natural Fibromyalgia Treatment
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 underfunctioning thyroid, or more commonly, 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. This can lead to a build up of lactic acid in the tissues, causing fibromyalgia like pain. Combined with the central nervous system hypersensitivity often seen in fibromyalgia, it can lead to chronic widespread pain. Assessment involves the usually done TSH, but also blood levels of the actual hormones free T3 and free T4. I also have patients check their oral temperature. Sometimes a clinical trial of low dose active thyroid hormone, T3, to raise the temperature can be done to see if symptoms improve as well.
The hypothalamic-pituitary-adrenal axis is also very important in fibromyalgia treatment. With any prolonged illness, you can expect the adrenals to be underfunctioning; whether it is the sole cause of the symptoms is more debatable (I have this rarely to be the case). Chronic fatigue is often a component of fibromyalgia as well, and needs to be addressed in treatment. Often getting the adrenals and thyroid into check can help this tremendously. I check this with either a 4 point saliva test to measure the cortisol pattern, or with a 24 hour urine test to measure the total daily production of adrenal hormones (more accurate, but much more expensive).
Both heavy metals and organic solvent toxins (eg pesticides) can 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). Usually I test with 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 eithe ra urine or blood test, if the history indicates. If levels are high, then fibromyalgia treatment must include detoxification as part of the protocol.
Multiple chronic infections causing immune dysfunction and central nervous system hypersensitization is a major component, at least in my local Vancouver fibromyalgia patients. I have a special interest in tick-borne illnesses, including lyme disease and the associated coinfections. I have seen fibromyalgia patients improve markedly when started on treatment for lyme and the coinfections. Usually objective tests like lyme western blots are helpful in this case, to differentiate patients who may benefit from antimicrobial treatment from those who supportive treatment may serve best.
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. Usually about 50% of patients with fibromyalgia get at least 30-40% relief in pain with these measures. Further, ATP fuel from www.researchednutritionals.com (a combination of fats that helps to repair mitochondrial production of ATP for energy) seems to benefit both fatigue and pain in patients.
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. 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 (very useful) and theanine, depending on what the clinical picture looks like. Drugs like amitryptiline and gabapentin can be useful, when pain is impairing sleep. Trazodone and mirtazapine in sleep dosing (not antidepressant dosing) can also be useful.
General Natural Fibromyalgia Treatments that hep most patients
The work up of fibromyalgia patients from a naturopathic doctor standpoint is extensive. We do rule out and diagnose other conditions, but when we take a wholistic 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 becomes the mainstay of fibromyalgia treatment for any particular patient. There are some general measures though that are helpful for most fibromyalgia patients:
- Sleep quality
- Prolozone: injections of ozone and homeopathics into trigger points in the muscle and subcutaneously over areas of pain. This increases oxygen delivery to the tissues and improves the antioxidant capacity of the muscles injected
- Ozone and Magnesium: I find great success in probably 2/3rds of my fibromyalgia treatments when ozone majorautohemotherapy (ozone treatment of the blood) is done. Ozone stimulates improved oxygenation, helps the blood to unload oxygen to the tissues more readily, and increases the antioxidant capacity of the tissues. Usually most patients find some improvement after 4-6 sessions, and course of treatment is generally 10-15 treatments.
- Growth Hormone: there is newer evidence that up to 20% fibromyalgia patients are deficient in growth hormone. I have not had to use this hormone much in most of my fibromyalgia patients, as usually we can get good improvement with the above approach. However, there was a randomized controlled trial of growth hormone in which 120 patients were given either growth hormone or placebo for 12 months (rather, the placebo group got placebo for 6 months then growth hormone for 6 months). All patients were also treated with standard amitryptiline, antidepressants, and opioids for pain. In 57% of the growth hormone group, and only 37% of the placebo group, It's a little confusing as evaluation was only done at 12 months, so some in the placebo group may have been starting to improve because of the growth hormone.
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. 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.