Fibromyalgia affects about 7.7% of women and 4.9% of men in the United States. The prevalence increases with age and affects individuals between 20 to 55 years old. This condition causes generalized chronic widespread musculoskeletal pain and fatigue. Varying mental and cognitive issues such as anxiety and brain fog can also be common in fibromyalgia. Currently, there is no cure or specific diagnostic test for fibromyalgia, making diagnosing and treating this condition difficult.
Functional medicine can help assess underlying contributing factors to fibromyalgia and manage the associated symptoms. This article will discuss a comprehensive review of fibromyalgia. It will discuss the possible causes, symptoms, diagnostic criteria, and various treatment approaches for managing fibromyalgia, including functional medicine approaches.
What is Fibromyalgia?
Fibromyalgia is a complex pain condition characterized by chronic widespread musculoskeletal pain. As of today, this condition is considered a neurosensory disorder where people affected by fibromyalgia are not able to process pain in the brain. Along with causing widespread pain throughout the body, it can also cause fatigue, sleep disturbances, cognitive issues, and multiple somatic symptoms. While there's currently no cure for fibromyalgia, there are various treatments available to help manage certain symptoms and improve quality of life. Individuals with fibromyalgia should work closely with qualified healthcare practitioners to develop a treatment plan that's tailored to each individual and addresses their needs and goals.
Symptoms of Fibromyalgia
There are many symptoms associated with fibromyalgia. The symptoms range from chronic pain throughout the body to various other psychosomatic symptoms, which are physical issues aggravated by mental factors. Fibromyalgia can cause pain on both sides of the body. The pain can start in the upper body and spread. Patients may feel symptoms such as sore muscles or achy joints along with numbness and tingling. Fatigue is also a common symptom of fibromyalgia, especially upon waking.
With this condition, even small activities can aggravate the pain or make the fatigue worse. However, prolonged sitting or lying can also make the symptoms worse, making managing the symptoms more difficult. Patients can also experience cognitive issues such as trouble thinking or remembering. This is sometimes called "fibro fog." Anxiety or depression may also be concurrent symptoms. Other symptoms may include headaches and digestive problems like irritable bowel syndrome (IBS) or gastroesophageal reflux disease (GERD). In addition, patients may also experience dry eyes, trouble breathing, difficulty swallowing, and heart palpitations.
It's imperative to note that the symptoms of fibromyalgia can vary between individuals and may come and go over time. If you're experiencing any of the mentioned symptoms, make sure to consult a knowledgeable healthcare practitioner to determine the underlying root cause and develop a treatment plan to manage or address these symptoms.
What Causes Fibromyalgia?
The exact causes of fibromyalgia are still not known and not yet fully understood. Currently, it is thought to be a combination of genetic, environmental, and psychological factors. Research shows that fibromyalgia is caused by an imbalance in the body's central nervous system, which affects the neural pathways of pain signals. This imbalance can lead to a heightened sensitivity to pain.
Genetics may be another cause, as this condition tends to run in families. However, the genetic factors are still unknown. Other considerations of causes include environmental factors such as infections, trauma, or stress. For example, physical or emotional trauma may trigger the symptoms of fibromyalgia in some people. Infections such as viral or bacterial illnesses may also trigger symptoms.
As of the current understanding, the pathophysiology of fibromyalgia involves how the brain processes pain. People with fibromyalgia can become extra sensitive to feeling pain all over their bodies, which can lead to emotional and mental issues. Researchers have found imbalances in neurotransmitters such as serotonin, dopamine, norepinephrine, and glutamate which can be associated with increased sensitivity to pain.
Women are more likely to get fibromyalgia, and hormonal changes throughout the menstrual cycle can also affect fibromyalgia symptoms in women. While the precise causes of fibromyalgia are not fully understood yet, further research is needed to understand the exact underlying causes of this condition.
Differential Diagnosis for Fibromyalgia Patients
Fibromyalgia has many nonspecific symptoms that can mimic other conditions, and currently, there is no "gold standard" for diagnosing this condition. Therefore it is important to evaluate other possible conditions before the diagnosis of fibromyalgia. Screening for other pain disorders such as IBS, chronic fatigue syndrome (CFS), and migraines should be considered to distinguish these conditions from fibromyalgia. Some other considerations should be psychiatric or mood conditions like anxiety or depression, as these are often associated with fibromyalgia.
Some other common differentials that should be ruled out include polymyalgia rheumatica, spondyloarthritis, inflammatory myopathy, systemic inflammatory arthropathies, and hypothyroidism. A thorough history, physical exam, and lab evaluations can help differentiate fibromyalgia from other conditions.
Functional Medicine Labs to Test for Root Cause of Fibromyalgia
Fibromyalgia is a complex condition that is challenging to diagnose due to its nonspecific symptoms. Currently, there is no definitive test available to diagnose fibromyalgia, and diagnosis relies on a combination of physical exams, patient history, and lab evaluations. Healthcare professionals rely on a combination of clinical examination, patient history, and laboratory tests to reach a diagnosis.
The ACR (American College of Rheumatology) published diagnostic criteria in 1990 and 2010. Tender points are not used any longer as a criterion for diagnosis of fibromyalgia. In 2010 the ACR used two scales, the Widespread Pain Index (WPI) and the Symptom Severity (SS) Scale, to diagnose the condition. The WPI is a list of 19 painful areas that patients report whether they hurt. The SS scale has two parts. Part SS2a evaluates the severity of fatigue, waking unrefreshed, and cognitive symptoms, and part SS2b is a checklist of 41 symptoms. Patients have to say whether or not they have these symptoms. The SS score ranges from 0 to 12 and is the combined score of SS2a and SS2b. To diagnose fibromyalgia, one of these two conditions must be fulfilled: a WPI ≥ 7 and SS ≥ 5, or a WPI between 3 and 6 and SS ≥ 9. Symptoms are required to be present for a minimum of 3 months, and a doctor should be assessing the patient. In 2016, there were proposals to update these criteria, but it is still not accepted by ACR.
Diagnosing fibromyalgia also involves ruling out other potential causes. Blood testing may be ordered to screen for rheumatoid arthritis, lupus, or other autoimmune conditions. Additionally, diagnostic imaging studies such as X-rays or MRIs may be performed to exclude other musculoskeletal disorders.
There are several functional medicine lab tests that can be used to evaluate symptoms and ways to manage fibromyalgia. These functional labs include:
Comprehensive Metabolic Panel (CMP)
The CMP test evaluates the body's overall metabolism and checks for imbalances in electrolytes, liver and kidney function, and blood sugar levels. Imbalances in electrolytes can lead to muscle cramps which can be a symptom associated with fibromyalgia.
Nutrient deficiencies have been associated with fibromyalgia, such as B12, Vitamin D, and Magnesium. For example, patients with fibromyalgia have been found to have decreased levels of Vitamin D, which can contribute to pain and fatigue. This micronutrient test can assess these different nutrient levels.
Thyroid Hormone Panel
Thyroid hormones regulate metabolism and energy levels. Imbalances of thyroid hormones can cause fatigue, muscle pain, and other symptoms associated with fibromyalgia.
Urine Organic Acids Test (OAT):
The OAT test evaluates the metabolic function and can help identify symptoms associated with fibromyalgia, including fatigue, mitochondrial dysfunction, mood disorders, chronic stress, anxiety, and other cognitive issues. This test also evaluates neurotransmitter levels that may be impacting symptoms.
It's important to note that functional medicine lab tests should be used along with a thorough medical history and physical exam and other diagnostic tests as needed, including the ACR criteria.
Conventional Treatment for Fibromyalgia
Treatment considerations for fibromyalgia should include non-medication options such as nutritional planning and other integrative approaches as well as medications. Some patients may benefit from non-medication therapies alone, while others may need to use both. Some conventional treatments include antidepressants and anticonvulsants. These include amitriptyline, duloxetine, milnacipran, gabapentin, and pregabalin. The FDA has approved three different drugs for the treatment of fibromyalgia. The approved drugs are pregabalin, duloxetine, and milnacipran. In some cases, specialty consultations with rheumatologists and psychiatrists may be recommended. Treatment for fibromyalgia should be personalized to the individual and take into account the patient's specific symptoms.
Functional Medicine Treatment Protocol for Fibromyalgia
Fibromyalgia is a chronic disorder that is challenging to treat. It often requires a comprehensive and personalized approach that considers the patient's individual symptoms and underlying health conditions. Functional medicine treatment protocols for fibromyalgia focus on approaches from a holistic perspective. They include mental and emotional support, personalized nutrition, clinically relevant supplements, and lifestyle modifications. Functional medicine usually involves utilizing a combination of approaches. One example is applying the use of supplements for reducing pain, improving mood, and increasing energy levels while incorporating a healthy diet rich in anti-inflammatory foods to help reduce inflammation.
Other functional medicine approaches for fibromyalgia include using integrative therapies, including acupuncture, massage therapy, and cognitive-behavioral therapy. Acupuncture has been found to be helpful and effective in decreasing pain and improving the quality of life in fibromyalgia patients. Massage therapy can also be valuable in reducing pain and improving mood. Cognitive-behavioral therapy (CBT) can help patients to develop coping strategies and manage stress, which can contribute to improved symptoms.
It's important to note that functional medicine treatments should be tailored to the patient's specific unique needs. A functional medicine practitioner can work with the patient to create an individualized plan that addresses their individual symptoms and underlying health conditions.
Therapeutic Diet and Nutrition Considerations for Fibromyalgia Patients
Diet plays an essential role in reducing symptoms associated with fibromyalgia. It's important to eat a nutritious, well-balanced diet that includes a variety of nutrient-dense foods. One dietary approach that has been shown to be effective in managing fibromyalgia symptoms is the Mediterranean diet. This diet emphasizes whole, plant-based foods such as fruits, vegetables, whole grains, and legumes. It also includes healthy fats, including olive oil and omega-3s found in fish, nuts, and seeds. This diet is low in processed and sugary foods and is rich in antioxidants and anti-inflammatory compounds, which can help reduce pain and inflammation in the body.
Other dietary changes that can be helpful for people with fibromyalgia include reducing or eliminating caffeine, as this can interfere with sleep and exacerbate symptoms. Additionally, some people with fibromyalgia may be sensitive to certain foods, like gluten or dairy, and may benefit from eliminating these foods from their diet.
It's important to work with an integrative medicine practitioner to develop a personalized nutrition plan that meets individual needs and preferences. Keeping a food diary to help track symptoms and identify any potential triggers can also be useful.
Supplements Protocol for Fibromyalgia Patients
Supplements can be helpful in managing fibromyalgia symptoms as a functional medicine approach. Fibromyalgia is a complex condition that can have multiple contributing factors. For example, nutrient deficiencies can contribute to symptoms such as fatigue, pain, and inflammation. Supplements can help address these imbalances and improve symptoms related to fibromyalgia.
Melatonin can help regulate sleep patterns. Studies show that taking melatonin may improve sleep quality and reduce pain for people with fibromyalgia. It is recommended to take 3-5 mg per day at night for 6 to 8 weeks.
SAMe is naturally made in the body and is involved in many biochemical processes. It has been shown to improve pain, fatigue, mood, musculoskeletal, or neurocognitive dysfunction. The recommended dose is 800 mg twice per day for six weeks for fibromyalgia.
Magnesium is a critical mineral that's involved in many bodily functions, including nerve and muscle functions. Magnesium supplements may help reduce pain and improve sleep quality in people with fibromyalgia. The recommended dose to improve muscle function is 300 mg (Mg citrate) per day for 6 weeks.
Vitamin D is a nutrient vital for functions like bone health and immune system function. Some studies show that people with fibromyalgia may have reduced levels of vitamin D. Vitamin D supplements may help reduce pain and improve mood. It is recommended to test for Vitamin D levels for patients with fibromyalgia. The recommended dose of Vitamin D for fibromyalgia is 2,400 IU (as D3) per day for patients with 25(OH)D levels of <24 ng/ml or 1,200 IU for patients with 24-32 ng/ml for 5 months.
5-HTP is a precursor for serotonin, a neurotransmitter involved in regulating mood, appetite, and sleep. 5-HTP supplements may help improve sleep quality, reduce pain, and improve mood in those with fibromyalgia. The recommended dose for fibromyalgia is 100 mg three times per day for one month.
St. John's Wort
St. John's Wort is a herb commonly used to treat depression. St. John's Wort supplements may help improve mood symptoms in people with fibromyalgia. Some studies show it's as effective as treating depression as an SSRI. Caution should be used if taking anti-depression medications such as SSRIs.
Omega-3 Fatty Acids
Omega-3s are fatty acids that are essential and are important for heart and brain health. Omega-3 supplements may help reduce pain and improve mood and cognition symptoms in people with fibromyalgia. The recommended dose for cognitive function is 1,000 mg (as EPA/DHA, containing >580 mg DHA) per day for adults with mild memory complaints.
It's essential to note that not all supplements and herbs may be appropriate for every person with fibromyalgia and that supplements and herbs should be used only under the careful guidance of a knowledgeable healthcare provider.
Acupuncture for Fibromyalgia Patients
Acupuncture is from Traditional Chinese Medicine, also known as TCM, and has been used for generations to treat various pain conditions. Studies show that it can help relieve many of the symptoms involving fibromyalgia. A systematic review was completed of acupuncture for fibromyalgia, and it found that it can help alleviate pain and improve sleep and quality of life.
Studies show acupuncture is effective in treating different kinds of pain conditions, including migraines and chronic musculoskeletal pain. Acupuncture works by inserting small thin needles into specific points in the body, called meridians. This stimulation can release endorphins and reduce pain. It can also help improve body circulation and blood flow. In addition, acupuncture may have a positive effect on the immune system by helping to modulate immune responses and reduce inflammation, which is often associated with fibromyalgia.
While there is no cure for fibromyalgia, acupuncture can provide symptom relief and can be part of a comprehensive protocol for managing fibromyalgia. Acupuncture can be an effective and safe addition.
When to Retest Labs
Functional medicine doctors will typically retest for labs associated with fibromyalgia after a certain period of time, depending on the patient's progress and symptoms. There is no set time frame for retesting, as each patient's case is unique and requires an individualized approach.
However, functional medicine doctors may recommend retesting after several months or up to an entire year to assess the full effectiveness of the therapies/treatment and make any necessary adjustments. Retesting may involve physical exams, blood tests, and other diagnostic procedures to evaluate the patient's pain levels, sleep patterns, mood, and overall health. By monitoring a patient's progress and making modifications to their treatment plan, functional medicine doctors aim to improve their symptoms and enhance their quality of life.
Fibromyalgia is a painful and chronic condition that is complex and involves many nonspecific symptoms. Currently, there is no specific test for fibromyalgia, and diagnosing patients can be difficult due to the nonspecific symptoms. Therefore, the diagnosis of fibromyalgia is based on a combination of clinical examination, patient history, and laboratory tests to rule in or rule out other potential causes of the patient's symptoms, along with utilizing the ACR criteria. Although there is no cure for fibromyalgia, functional medicine approaches can be helpful in managing many underlying factors that contribute to the many varying symptoms associated with this condition. Functional medicine will take into account the patient's individual needs and personalize the treatment protocols based on these specific needs. Oftentimes multiple approaches such as personalized nutrition, clinically relevant supplements, lifestyle modifications, and other therapies such as acupuncture are combined to provide a holistic and comprehensive treatment regimen. This comprehensive protocol can be valuable in improving pain, quality of sleep, and quality of life for fibromyalgia patients. It's important to work with a qualified functional medicine provider to develop an individualized plan.