Fibromyalgia

Definition 

Fibromyalgia is a chronic disorder characterized by widespread musculoskeletal pain, fatigue, and issues with sleep, memory, and mood. Researchers believe that fibromyalgia affects how the brain and spinal cord process both painful and non-painful signals, amplifying painful sensations. The onset of symptoms can follow physical trauma, surgery, infection, or significant psychological stress, though sometimes symptoms develop gradually without a clear triggering event. Women are more likely than men to develop fibromyalgia, and it often coexists with conditions such as tension headaches, TMJ disorders, irritable bowel syndrome, anxiety, and depression.

Repeated nerve stimulation is thought to cause changes in the brain and spinal cord of those with fibromyalgia, leading to increased levels of pain-signaling chemicals and a heightened sensitivity to pain. Although there is no cure, symptom management is possible through medications, exercise, relaxation techniques, and stress reduction measures.

Key statistics:

• Approximately 2-4% of the world’s population suffers from fibromyalgia, with an estimated 4 million adults in the U.S. being diagnosed each year. 
• 9 out of 10 people diagnosed with fibromyalgia in the U.S. are women.
• 50% of those with fibromyalgia have difficulty performing daily activities.
• 30-40% of fibromyalgia sufferers are forced to quit work or change jobs because of their condition.
• On average, a fibromyalgia patient uses 3-4 drugs daily to control symptoms.
• The average hospitalization rate for those suffering from the disorder is once every three years.
• Those with fibromyalgia are 3-4 times more likely to suffer from depression.

Gut Dysfunction

Traditionally Fibromyalgia was considered a joint and muscle illness. However, emerging research reveals that multiple organs and body systems are at play including the brain, spinal cord and digestive system.  

• As high as 50% of patients with fibromyalgia have functional dyspepsia (indigestion) with no known cause.
• Between 30–70% of fibromyalgia patients have irritable bowel syndrome (IBS). 
• Roughly 33% of IBS patients meet the diagnostic criteria for fibromyalgia.
• Approximately 73% of fibromyalgia patients report gastrointestinal (GI) symptoms (compared to only 37% of those with osteoarthritis).
• One study that examined 42 patients with fibromyalgia found that 100% of participants had small intestinal bacterial overgrowth (SIBO).
• Another study found that 70% of those with fibromyalgia had intestinal permeability (leaky gut). Significantly, 12 out of the 28 patients with leaky gut had no gut symptoms, which could explain why the role of the gut is often overlooked in those with fibromyalgia.

Causes / Risk Factors

• Research points to gut health issues (microbiome imbalance, SIBO, leaky gut) as a possible cause
• Hereditary/Genetic: Fibromyalgia tends to run in families.  There may be certain genetic mutations that make one more susceptible to developing the disorder.  Or inherited factors such as gut microbiome composition (via vaginal births), toxins or infections (via maternal transfer in utero) could play a role.
• Inflammation from immune dysregulation; illness or stress can drive elevated chemokines and cytokines released by immune cells which trigger inflammation.
• Environmental factors may play a role including; foods sprayed with herbicides (e.g. containing glyphosate) or antibiotic use which both harm the gut microbiome.
• Infections: Certain viral and bacterial infections appear to trigger or aggravate fibromyalgia.
• Physical or emotional trauma: a traumatic physical event or prolonged psychological stress or PTSD.
• Fibromyalgia is diagnosed more in women than in men.
• Other illnesses: Individuals with osteoarthritis, rheumatoid arthritis or lupus are more likely to develop fibromyalgia.

Symptoms & Signs

• Widespread and/or abnormal pain
• Fatigue
• Cognitive difficulties (brain fog, memory and learning problems)
• Unrefreshing sleep
• Digestive issues

Fibromyalgia often coexists with other conditions, such as:

• IBS
• Anxiety/Depression
• Lupus
• Osteoarthritis/Rheumatoid arthritis
• Postural tachycardia syndrome (POTS)
• Migraine and chronic headaches
• Chronic fatigue syndrome / Myalgic encephalomyelitis (CFS/ME)
• Interstitial cystitis
• Temporomandibular joint disorders

Diet and Lifestyle Considerations for Fibromyalgia

• Mild exercise
• Improving sleep habits
• Deep breathing exercises
• A healthy diet focused on healing the gut
• Avoid foods, medications and chemicals that irritate the gut
• Eat fermentable fibers and foods (kefir, sauerkraut, etc)
• Eat glycine-rich foods (fish, dairy products, tougher cuts of meat) and bone broth
• Give thought to a probiotic and/or prebiotic supplement
• Treat intestinal pathogens, such as parasites, if present
• Manage stress (through mindfulness, meditation, biofeedback, etc…)
• Aim for at least 7-8 hours of sleep per night

Integrative Treatments Overview

It is recommended that a patient consult a certified practitioner to assess their symptoms and case history and explore their individual needs.

There is no standard treatment for fibromyalgia. It often involves a lot of trial and error and most people end up with a combination regimen of medications, therapies, supplements, and lifestyle changes.

• Certain medications may be prescribed for fibromyalgia, including antidepressants, anti-seizure drugs, painkillers, muscle relaxants, and sleep drug.
• Specialist therapies that can help alleviate symptoms include talk therapy (CBT), physical therapy and occupational therapy.
• Mindfulness Meditation and Meditative movement therapies may provide relief of some symptoms (e.g. Yoga, tai chi).
• Massage therapy, specifically a type of therapy called myofascial release, may lead to improvement in symptoms.
• Biofeedback may improve physical functioning, pain, and mood.
• Acupuncture may be effective.

Nutritional & Environmental Medicine Overview

• Gut-healing protocols guided by a Functional practitioner (leaky gut, SIBO, dysbiosis)
• Medical cannabis
• Common supplements used in treating people with fibromyalgia include 5-HTP, Acetyl-L-carnitine, CoQ10, L-theanine, Magnesium malate, Melatonin, Omega-3, Rhodiola rosea, SAMe, Turmeric, Vitamin B12, and Vitamin D. Vitamin D may be especially effective at reducing pain in people with fibromyalgia who also have a vitamin D deficiency.

Mindd Foundation gratefully acknowledges the contribution of Metagenics in supplying the Definition, Causes and Diet & Lifestyle Considerations for this page.