Fibromyalgia is a complex disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, poor memory and mood issues. It is currently not considered an autoimmune disease but has many similarities to systemic inflammatory conditions, including autoimmune disorders. Researchers believe that fibromyalgia amplifies painful sensations by affecting the way your brain processes pain signals.
Women are much more likely to develop fibromyalgia than are men. Many people who have fibromyalgia also have tension headaches, temporomandibular joint (TMJ) disorders, irritable bowel syndrome, sleep disturbances, anxiety and depression.
Symptoms sometimes begin after a physical trauma, surgery, infection or significant psychological stress. In other cases, symptoms gradually accumulate over time with no apparent single triggering event.
Symptoms of fibromyalgia include:
- Widespread pain. The pain associated with fibromyalgia often is described as a constant dull ache of muscles and joints.
- Fatigue. People with fibromyalgia often have difficulty sleeping and awaken tired, even after sleeping for long periods of time. Sleep is often disrupted by pain, and many patients with fibromyalgia have other sleep disorders, such as restless legs syndrome and sleep apnea.
- Cognitive difficulties. Many people with this condition report “brain fog”, a mental condition which impairs the ability to focus, pay attention and concentrate on mental tasks.
- Gastrointestinal complaints. Many people with fibromyalgia also have gastrointestinal problems such as constipation, diarrhea, irritable bowel sydrome with abdominal cramping and/or small intestinal bacterial overgrowth.
- Other health conditions. Many people who have fibromyalgia also may experience depression, anxiety, headaches, and sleeping disorders.
Doctors don’t know what causes fibromyalgia, but it most likely involves a variety of factors working together. Some of the potential causative factors that have been studied include:
- Central nervous system problems. Several symptoms reported by fibromyalgia patients—including amplified pain, impaired concentration, attention, and memory and fatigue—suggest that the central nervous system may be involved in the pathophysiology of the syndrome. Researchers have investigated a central nervous system (CNS) link to fibromyalgia but have been unable to identify a causal link.
- Chronic pathogenic infections. Some people develop fibromyalgia after suffering from a viral, bacterial or other pathogenic infection. Therefore, some researchers believe that certain viruses or other pathogens might trigger the disorder. Suspicious viruses include Epstein-Barr virus (EBV), human herpes virus 6 (HHV-6) and other viruses. Some bacterial species that can become chronic and have been associated with fatigue and other symptoms are Borrelia, Bartonella and Babesia.
- Toxicity and compromised hepatic detoxification. Some research suggests that toxic exposures to environmental chemicals and heavy metals may play a role in the development of fibromyalgia. Studies suggest an association with increased levels of heavy metals and other toxins in patients with fibromyalgia and improvement in symptoms when the elimination of these toxins is supported via hepatic detoxification pathways.
- Mitochondrial dysfunction. The mitochondria are the “power-houses” of the cells which provide the energy needed to fuel cellular processes and efficient ATP production is required for tissue and organ health. However, the mitochondria are very vulnerable to oxidative stress which can impair mitochondrial production of ATP. Impaired ATP production by the mitochondria has been associated with fibromyalgia and is believed to be due to excessive oxidative stress and insufficient antioxidant enzyme activity.
- Immune system dysfunction. The immune system of people with fibromyalgia appears to be dysfunctional. There is often chronic inflammation as a result of other problems such as chronic infections, compromised hepatic detoxification, oxidative stress and mitochondrial dysfunction.
- Hormonal imbalances. Hormonal imbalances are common in people with fibromyalgia, particularly with the hypothalamic-pituitary-adrenal (H-P-A) axis. The adrenal glands are responsible for producing corticosteroids, such as cortisol, which are important in regulating immune responses, glucose levels and the sleep-wake cycle, among other functions.
Conventional Treatment of Fibromyalgia
In general, conventional treatment for fibromyalgia includes medications that focus on managing the symptoms of fibromyalgia, including pain, depression and sleeping disorders.
Medications used in the treatment of fibromyalgia include:
- Pain relievers. Over-the-counter pain relievers such as acetaminophen (Tylenol®, others), ibuprofen (Advil®, Motrin IB®, others) or naproxen sodium (Aleve®, others) are often used. In other cases, stronger prescription pain reliever such as tramadol (Ultram®, Conzip®) may be used.
- Antidepressants. Duloxetine (Cymbalta®) and milnacipran (Savella®) may help ease the pain and fatigue associated with fibromyalgia.
- Sleep medications. Amitriptyline is often used to decrease pain and promote sleep.
- Anti-seizure drugs. Medications designed to treat epilepsy are often useful in reducing certain types of pain. Gabapentin (Neurontin®, Gralise®) is sometimes helpful in reducing fibromyalgia symptoms, while pregabalin (Lyrica®) was the first drug approved by the Food and Drug Administration to treat fibromyalgia.
Functional Medicine Management of Fibromyalgia
A comprehensive approach to the management of complex conditions such as fibromyalgia must take into consideration many aspects of health, including gut barrier integrity and imbalances of gut flora, liver detoxification capacity and toxic burden, hormone imbalances, energy production capacity, nutrient status and most importantly, immune imbalances which promote inflammatory states. More specifically, Functional Medicine approaches fibromyalgia by supporting normal physiology of the organ systems which become imbalanced in this condition and may contribute to the development and progression of this condition.
There are several areas of management of fibromyalgia in the Functional Medicine approach:
- Assessing for and eliminating pathogenic infection and supporting immune health
- Restoring normal gut barrier integrity, digestion and gut microbial balance
- Supporting liver detoxification processes and decreasing toxic load
- Supporting restoration of hormone levels, including adrenal hormones involved in the sleep-wake cycle
- Supporting restoration of brain neurotransmitters and neurotransmitter function responsible for mood, cognition and pain perception
- Supporting energy production by the mitochondria, the “power-houses” of the body’s cells
- Restoring healthy levels of nutrients in cases of nutritional deficiencies