Natural Ways To Fight Fibromyalgia

Fibromyalgia (FM) is a chronic condition characterised by widespread pain, tenderness and stiffness. Other common symptoms include fatigue, sleep disorders and psychological problems.1 The cause of the syndrome is uncertain, and its treatment can be challenging.

Did you know?


Fibromyalgia (FM) is one of the most common causes of chronic widespread musculoskeletal pain, with most studies finding that 2 to 4 percent of people have fibromyalgia.1,2

 


Most patients diagnosed with fibromyalgia report a wide range of additional physical and psychological symptoms3, such as fatigue, cognitive disturbances1, irritable bowel syndrome4, anxiety, depressive disorders5 and rheumatic diseases.6


Fibromyalgia should be suspected in patients who have suffered chronic pain for at least three months without another identified cause. The diagnosis is symptom-based:7

  • Widespread tenderness: 6 or more pain sites from a total of 9 possible sites
  • Moderate to severe sleep problems, OR
  • Fatigue

Symptoms include soft tissue pain and tenderness, without inflammation, in muscles, ligaments and tendons.1

 

The Facts:


Risk factors

  • Risk factors that predispose, trigger and sustain fibromyalgia symptoms may be biological, psychological and social. Examples include:
    • Genes: First-degree relatives of patients with fibromyalgia are eight times more likely to develop the syndrome.8,9
    • Lifestyle factors, such as obesity and physical inactivity10
    • Low socioeconomic status11
    • Psychological and physical stress12
    • Sleep disturbances10
    • Work stress, such as high workload, workplace bullying and limited opportunities to make decisions13
    • Trauma, e.g. motor vehicle accidents14
    • Exposure to war, catastrophic events and persecution 15
    • Physical and sexual abuse in childhood and adolescence16
    • Somatic diseases, such as rheumatoid arthritis11
    • Infections, such as Epstein-Barr virus (glandular fever), Lyme disease, Q fever and viral hepatitis.17

Triggers

  • In a susceptible individual, a trigger can produce a chronic, dysfunctional stress response, which changes the way the central nervous system interprets pain messages.18
  • Fibromyalgia is often triggered by physical or psychological stressors. US and Australian studies found that 79 percent19 and 88.7 percent20 of fibromyalgia patients identified physical or psychological stressors as potential triggers for the development of their symptoms. 

Vitamin D deficiency

  • In 2003, a landmark study of 150 fibromyalgia-type patients, aged 10 to 65 years, showed vitamin D deficiency in 93% of the patients.21

What can we do about it?


Although medications are regularly offered for symptom relief in fibromyalgia, their effects are generally quite modest.22


The 3 best-studied drug-free therapies are: education, cognitive behavioural therapies, and exercise.1


The greatest benefit seen is improved function, a major treatment goal for treating chronic pain.23,24


Education

  • Ideally, treatment should involve you and your doctor, as well as other health care professionals, like physiotherapists or mental health experts.
  • Fibromyalgia is a real illness and your pain is not "all in your head”.
  • Fibromyalgia is not a degenerative or life-threatening condition; however, treatment for pain and fatigue is slow and challenging. Symptoms may come and go, but some level of pain and fatigue is generally present, so it is important to have realistic expectations about managing your fibromyalgia.
  • Most people with fibromyalgia will learn how to manage their condition, and will go on to lead full, active lives.

 


Cognitive Behavioural Therapy (CBT)

  • Cognitive–behavioural therapies offer long-term benefits for pain, mood and function. Other psychological therapies like acceptance and commitment therapy and mindfulness-based stress reduction are showing promising results, but require further study.25–28
  • It is vital to address any depression and anxiety, which often occur together in fibromyalgia, as they can significantly impact wellbeing and block improvements in overall health.
  • Stress management techniques are also vital, and have been found to improve pain-related behaviours, physical function and confidence in their own abilities, when combined with other CBT skills and coping strategies, like planning and pacing to avoid fatigue.29 

 


Exercise

  • Regular exercise improves pain, fatigue and sleep disturbance in patients with fibromyalgia.30 It is important, however, to start any regular exercise program gradually to build up tolerance levels.
  • There is no ‘best’ form of exercise and all types of exercise may be considered.  Land and aquatic exercises appear equally effective.31
  • A hydrotherapy pool is a good place to start an exercise regimen, as the warmth of the water and relative weightlessness relieves symptoms while the resistance provides a gentle workout. A review of 10 studies showed that hydrotherapy (median of 4 hours over 14 weeks) reduced pain in participants.32
  • Research has shown that resistance training can significantly improve pain and function.33
  • Aerobic exercise, in particular, reduces fibromyalgia symptoms and improves physical capacity.34

Additional resources

  • Vegetarian diet
    • Increasing antioxidant intake through a vegetarian diet has been shown to have positive results on rheumatic and fibromyalgia patients.35,36
  • Vitamin D supplementation:
    • Vitamin D supplementation is an effective, low-cost treatment with minimal side effects.
    • A study of women with fibromyalgia, who were also vitamin D deficient, showed that taking vitamin D supplements over a 20-week period significantly reduced their pain levels.37

Summary:

Although fibromyalgia can negatively impact overall quality of life, treatments are available. An approach that involves combining multiple different types of intervention into an organised treatment program is usually best. Being physically active will not cause harm or long-term muscle damage, and it can help improve pain and function.

 

References

1.        Clauw DJ. Fibromyalgia: A clinical review. JAMA - J Am Med Assoc. 2014;311(15):1547-1555. doi: 10.1001/jama.2014.3266

2.        Queiroz LP. Worldwide Epidemiology of Fibromyalgia. Curr Pain Headache Rep. 2013;17(8):356. doi:10.1007/s11916-013-0356-5

3.        Häuser W, Zimmer C, Felde E, Köllner V. Was sind die kernsymptome des fibromyalgiesyndroms? Umfrageergebnisse der Deutschen Fibromyalgievereinigung. Schmerz. 2008;22(2):176-183. doi:10.1007/s00482-007-0602-z

4.        Henningsen P, Zipfel S, Herzog W. Management of functional somatic syndromes. Lancet. 2007;369(9565):946-955. doi:10.1016/S0140-6736(07)60159-7

5.        Fietta P, Fietta P, Manganelli P. Fibromyalgia and psychiatric disorders. Acta Biomed l’Ateneo Parm. 2007;78(2):88-95. doi:10.1097/00130561-199605000-00018

6.        Atzeni F, Sallì S, Benucci M, Di Franco M, Casale R, Alciati A, et al. Fibromyalgia and arthritides. Reumatismo. 2012;64(4):286-292. doi:10.4081/reumatismo.2012.286

7.        Arnold LM, Bennett RM, Crofford LJ, Dean LE, Clauw DJ, Goldenberg DL, et al. AAPT Diagnostic Criteria for Fibromyalgia. J Pain. 2019;20(6):611-628. doi:10.1016/j.jpain.2018.10.008

8.        Ablin JN, Cohen H, Buskila D. Mechanisms of Disease: Genetics of fibromyalgia. Nat Clin Pract Rheumatol. 2006;2(12):671-678. doi:10.1038/ncprheum0349

9.        Arnold LM, Hudson JI, Hess E V, Ware AE, Fritz DA, Auchenbach MB, et al. Family Study of Fibromyalgia. Arthritis Rheum. 2004;50(3):944-952. doi:10.1002/art.20042

10.      Mork PJ, Nilsen TIL. Sleep problems and risk of fibromyalgia: Longitudinal data on an adult female population in Norway. Arthritis Rheum. 2012;64(1):281-284. doi:10.1002/art.33346

11.      Wolfe F, Häuser W, Hassett AL, Katz RS, Walitt BT. The development of fibromyalgia - I: Examination of rates and predictors in patients with rheumatoid arthritis (RA). Pain. 2011;152(2):291-299. doi:10.1016/j.pain.2010.09.027

12.      Van Houdenhove B, Egle U, Luyten P. The role of life stress in fibromyalgia. Curr Rheumatol Rep. 2005;7(5):365-370. doi:10.1007/s11926-005-0021-z

13.      Kivimäki M, Leino-Arjas P, Virtanen M, Elovainio M, Keltikangas-Jarvinen L, Puttonen S, et al. Work stress and incidence of newly diagnosed fibromyalgia: Prospective cohort study. J Psychosom Res. 2004;57(5):417-422. doi:10.1016/j.jpsychores.2003.10.013

14.      McLean SA, Diatchenko L, Lee YM, Swor RA, Domeier RM, Jones JS, et al. Catechol O-methyltransferase haplotype predicts immediate musculoskeletal neck pain and psychological symptoms after motor vehicle collision. J Pain. 2011;12(1):101-107. doi:10.1016/j.jpain.2010.05.008

15.      Ablin JN, Cohen H, Eisinger M, Buskila D. Holocaust survivors: The pain behind the agony. Increased prevalence of fibromyalgia among Holocaust survivors. Clin Exp Rheumatol. 2010;28(6 SUPPL. 63).

16.      Häuser W, Kosseva M, Üceyler N, Klose P, Sommer C. Emotional, physical, and sexual abuse in fibromyalgia syndrome: A systematic review with Meta-Analysis. Arthritis Care Res. 2011;63(6):808-820. doi:10.1002/acr.20328

17.      Buskila D, Atzeni F, Sarzi-Puttini P. Etiology of fibromyalgia: The possible role of infection and vaccination. Autoimmun Rev. 2008;8(1):41-43. doi:10.1016/j.autrev.2008.07.023

18.      Becker S, Schweinhardt P. Dysfunctional neurotransmitter systems in fibromyalgia, their role in central stress circuitry and pharmacological actions on these systems. Pain Res Treat. 2012;2012:741746. doi:10.1155/2012/741746

19.      Bennett RM, Jones J, Turk DC, Russell IJ, Matallana L. An internet survey of 2,596 people with fibromyalgia. BMC Musculoskelet Disord. 2007;8:27. doi:10.1186/1471-2474-8-27

20.      Guymer EK, Maruff P, Littlejohn GO. Clinical characteristics of 150 consecutive fibromyalgia patients attending an Australian public hospital clinic. Int J Rheum Dis. 2012;15(4):348-357. doi:10.1111/j.1756-185X.2012.01767.x

21.      Plotnikoff GA, Quigley JM. Prevalence of Severe Hypovitaminosis D in Patients with Persistent, Nonspecific Musculoskeletal Pain. Mayo Clin Proc. 2003;78(12):1463-1470. doi:10.4065/78.12.1463

22.      Häuser W, Walitt B, Fitzcharles MA, Sommer C. Review of pharmacological therapies in fibromyalgia syndrome. Arthritis Res Ther. 2014;16(1):201. doi:10.1186/ar4441

23.      Williams DA, Cary MA, Groner KH, Chaplin W, Glazer LJ, Rodriguez AM, et al. Improving physical functional status in patients with fibromyalgia: A brief cognitive behavioral intervention. J Rheumatol. 2002;29(6):1280-1286.

24.      Goldenberg DL, Burckhardt C, Crofford L. Management of fibromyalgia syndrome. J Am Med Assoc. 2004;292(19):2388-2395. doi:10.1001/jama.292.19.2388

25.      Perrot S, Russell IJ. More ubiquitous effects from non-pharmacologic than from pharmacologic treatments for fibromyalgia syndrome: A meta-analysis examining six core symptoms. Eur J Pain (United Kingdom). 2014;18(8):1067-1080. doi:10.1002/ejp.564

26.      Bernardy K, Klose P, Busch AJ, Choy EHS, Häuser W. Cognitive behavioural therapies for fibromyalgia. Cochrane Database Syst Rev. 2013;2017(6). doi:10.1002/14651858.CD009796.pub2

27.      Luciano J V., Guallar JA, Aguado J, Lopez-Del-Hoyo Y, Olivan B, Magallon R, et al. Effectiveness of group acceptance and commitment therapy for fibromyalgia: A 6-month randomized controlled trial (EFFIGACT study). Pain. 2014;155(4):693-702. doi:10.1016/j.pain.2013.12.029

28.      Lauche R, Cramer H, Dobos G, Langhorst J, Schmidt S. A systematic review and meta-analysis of mindfulness-based stress reduction for the fibromyalgia syndrome. J Psychosom Res. 2013;75(6):500-510. doi:10.1016/j.jpsychores.2013.10.010

29.      Bernardy K, Füber N, Köllner V, Häuser W. Efficacy of cognitive-behavioral therapies in fibromyalgia syndrome - A systematic review and metaanalysis of randomized controlled trials. J Rheumatol. 2010;37(10):1991-2005. doi:10.3899/jrheum.100104

30.      Macfarlane GJ, Kronisch C, Dean LE, Atzeni F, Häuser W, Fluß E, et al. EULAR revised recommendations for the management of fibromyalgia. Ann Rheum Dis. 2017;76(2):318-328. doi:10.1136/annrheumdis-2016-209724

31.      Bidonde J, Busch AJ, Webber SC, Schachter CL, Danyliw A, Overend TJ, et al. Aquatic exercise training for fibromyalgia. Cochrane Database Syst Rev. 2014;2014(10). doi:10.1002/14651858.CD011336

32.      Langhorst J, Musial F, Klose P, Häuser W. Efficacy of hydrotherapy in fibromyalgia syndrome-a meta-analysis of randomized controlled clinical trials. Rheumatology. 2009;48(9):1155-1159. doi:10.1093/rheumatology/kep18233.           Busch AJ, Webber SC, Richards RS, Bidonde J, Schachter CL, Schafer LA, et al. Resistance exercise training for fibromyalgia. Cochrane Database Syst Rev. 2013;2013(12). doi:10.1002/14651858.CD010884

34.      Busch AJ, Barber KAR, Overend TJ, Peloso PMJ, Schachter CL. Exercise for treating fibromyalgia syndrome. Cochrane Database Syst Rev. 2007;(4). doi:10.1002/14651858.CD003786.pub2

35.      Hänninen O, Kaartinen K, Rauma AL, Nenonen M, Törrönen R, Häkkinen AS, et al. Antioxidants in vegan diet and rheumatic disorders. Toxicology. 2000;155(1-3):45-53. doi:10.1016/S0300-483X(00)00276-6

36.      Donaldson MS, Speight N, Loomis S. Fibromyalgia syndrome improved using a mostly raw vegetarian diet: An observational study. BMC Complement Altern Med. 2001;1:7. doi:10.1186/1472-6882-1-7

37.      Wepner F, Scheuer R, Schuetz-Wieser B, Machacek P, Pieler-Bruha E, Cross HS, et al. Effects of vitamin D on patients with fibromyalgia syndrome: A randomized placebo-controlled trial. Pain. 2014;155(2):261-268. doi:10.1016/j.pain.2013.10.002

 

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Dr. Luiz Fernando SellaMD, MPH
Medical Doctor at the Federal University of Santa Catarina, Brazil, a Certified Lifestyle Medicine Physician and Health and Wellness Coach.