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Fibromyalgia (Holistic)

About This Condition

Fibromyalgia—an unsolved mystery—is a complex syndrome with no known cause or sure cure. According to research or other evidence, the following self-care steps may be helpful.
  • Exercise

    Low-intensity exercise (like walking or swimming) is the best known treatment

  • Address your stress

    Reducing stress and unpleasant emotions may also reduce symptoms

  • Try 5-HTP

    100 mg of the supplement 5-hydroxytryptophan three times a day may ease symptoms

  • Check out SAMe

    800 mg of the supplement S-adenosyl-l-methionine a day may help symptoms

About

About This Condition

Fibromyalgia is a complex syndrome with no known cause or cure. Its predominant symptom is pain in the fibrous tissues, muscles, tendons, and ligaments, although other symptoms may be experienced.

Research has demonstrated that the axis connecting the three glands primarily responsible for the stress response (hypothalamus, pituitary, adrenals) may be dysfunctional in people with fibromyalgia.1 Inflammation of the involved structures is generally absent in fibromyalgia.

Of the estimated three to six million people2 affected by this disorder in the United States, the vast majority are women between 25 and 45 years of age.

Symptoms

Trigger-point pain at characteristic locations is the defining symptom of fibromyalgia. The most commonly affected locations are on the occiput (nape of the neck), the neck itself, shoulders, trunk, low back, and thighs. Other symptoms may also be experienced, including fatigue, chest pain, low-grade fever, swollen lymph nodes, insomnia, frequent abdominal pain, irritable bowel syndrome, and depression.3

Healthy Lifestyle Tips

Low-intensity exercise may improve fibromyalgia symptoms. People with fibromyalgia who exercise regularly have been reported to suffer less severe symptoms than those who remain sedentary.4 , 5 , 6 In a controlled trial, a program consisting of two 25-minute exercise classes plus two educational sessions per week for six weeks resulted in immediate and sustained improvement in walking distance, fatigue, and well-being in a group of people with fibromyalgia;7 however, no reductions in pain, anxiety, or depression were seen. In a more recent controlled trial, a 35-minute exercise program in a warm pool once a week for six months, coupled with counseling sessions, led to improvements in hand-grip strength and endurance, as well as to reductions in pain, distress, depression, and anxiety.8 The results of this trial, and other similar trials, suggest that underwater exercise training, in combination with a counseling intervention, should be considered by people with fibromyalgia.

Holistic Options

Stress is believed by some researchers to be capable of aggravating fibromyalgia symptoms. Stress-reduction techniques, such as meditation, have proven helpful in preliminary research.9

Acupuncture may be useful for short-term relief of fibromyalgia symptoms. In one preliminary trial, acupuncture produced a significant decrease in pain and point tenderness along with related biochemical changes measured in the fibromyalgia patients’ blood.10 Another uncontrolled trial used electroacupuncture (acupuncture with electrical stimulation) treatment in people with fibromyalgia who were unresponsive to conventional medical therapies. After an average of seven treatments per person, 46% claimed that electroacupuncture provided the best relief of symptoms when compared to all other therapies, and 64% reported using less medication for pain relief than prior to electroacupuncture.11 A double-blind trial compared fake acupuncture to electroacupuncture and reported significant differences in improvement in five of eight outcome measurements among people with fibromyalgia.12 Short-term pain reduction in people with fibromyalgia has been reported in other studies, some of which were at least partially controlled; however, long-term benefits have never been investigated in a controlled clinical trial.13 Long-term controlled trials are necessary to conclusively determine whether acupuncture is a useful treatment for fibromyalgia.

Joint manipulation, chiropractic, and related treatments may be helpful for relieving some of the symptoms of fibromyalgia. A preliminary study14 found that almost half of people with fibromyalgia who received chiropractic care had “moderate to good” improvement. A small preliminary trial15 evaluated the effect of four weeks of chiropractic treatment (three to five times per week) consisting of soft tissue massage, stretching, spinal manipulation, and general advice and information. Treatment resulted in a significant decrease in pain and an increase in range of neck movement, but there was no improvement in tender points or in ability to function in daily life. Another preliminary trial16 evaluated a longer treatment period (30 sessions) consisting of spinal manipulation and deep pressure massage to tender points in the muscles. More benefit was reported by this study, as 60% of the patients experienced significant pain reduction, reduced sensed of fatigue, and improved sleep. These benefits persisted one month after the treatment was completed. People who did not feel better after 15 treatments were not likely to benefit from this type of treatment. No controlled research has evaluated manipulation therapies for fibromyalgia.

Eating Right

The right diet is the key to managing many diseases and to improving general quality of life. For this condition, scientific research has found benefit in the following healthy eating tips.

Recommendation Why
Try a vegan diet
A vegan diet (includes no animal products) that is also low in salt may help women with fibromyalgia.

A vegan diet (includes no animal products) that is also low in salt may help women with fibromyalgia. In a controlled clinical trial,17 women with fibromyalgia were put on a special diet consisting only of raw foods—primarily fruits, vegetables, nuts, seeds, legumes, and cereals (such as rolled oats). The diet also contained several fermented foods, including a fermented yogurt-food made from oats, a fermented beverage made from wheat berries (called Rejuvalac), and several types of fermented vegetables, particularly cabbage. During the three-month trial, women following the therapeutic diet experienced a significant reduction in body weight, pain, morning sickness, use of painkillers, depression, and the number of sore fibromyalgia points, compared with those who continued to eat their regular diet. Due to the liberal use of nuts and seeds, this diet was not low in fat; for example, 31% of all calories came from fat. Nonetheless, the total number of calories was relatively low (less than 1,900 calories per day), which was probably responsible for the decrease in body weight.

Cut out MSG
In one report, women with fibromyalgia experienced improvement or complete resolution of their symptoms after eliminating MSG or MSG plus aspartame from their diet.

In a preliminary report, four women with fibromyalgia experienced marked improvement or complete resolution of their symptoms within months after eliminating monosodium glutamate (MSG) or MSG plus aspartame from their diet. In each case, symptoms recurred whenever MSG was ingested.18

Supplements

What Are Star Ratings?

Our proprietary “Star-Rating” system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by the medical community, and whether studies have found them to be effective for other people.

For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.

3 Stars Reliable and relatively consistent scientific data showing a substantial health benefit.

2 Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.

1 Star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.

Supplement Why
2 Stars
5-HTP
100 mg three times per day
Supplementing with 5-HTP may ease symptoms.

People with fibromyalgia often have low serotonin levels in their blood.19 , 20 , 21 Supplementation with 5-HTP may increase serotonin synthesis in these cases. Both preliminary22 , 23 and double-blind trials24 have reported that 5-HTP supplementation (100 mg three times per day) relieves some symptoms of fibromyalgia.

2 Stars
Acetyl-L-Carnitine
1,500 mg daily for ten weeks
Supplementing with acetyl-L-carnitine may improve musculoskeletal pain, depression, and general health in people with fibromyalgia.

In a double-blind trial, supplementation with acetyl-L-carnitine in the amount of 1,500 mg per day for ten weeks was significantly more effective than a placebo in improving musculoskeletal pain, depression, and general health in people with fibromyalgia.25

2 Stars
SAMe
800 mg daily
Supplementing with SAMe may increase serotonin levels in the blood and help relieve symptoms.

Intravenous SAMe (S-adenosylmethionine) given to people with fibromyalgia reduced pain and depression in two double-blind trials;26 , 27 but no benefit was seen in a short (ten-day) trial.28 Oral SAMe (800 mg per day for six weeks) was tested in one double-blind trial and significant beneficial effects were seen, such as reduced pain, fatigue, and stiffness, and improved mood.29

1 Star
Coenzyme Q10
Refer to label instructions
In a preliminary trial, headaches and overall symptoms in people with fibromyalgia significantly improved after supplementing with coenzyme Q10.
In a preliminary trial, supplementing with coenzyme Q10 (100 mg three times per day for three months) resulted in significant improvements in headaches and overall symptoms in patients with fibromyalgia.30 In another study, cellular levels of CoQ10 were significantly lower in women with fibromyalgia than in healthy women. In the same study, ten women with fibromyalgia received 300 mg of CoQ10 per day for three months. Significant improvements were seen in symptoms such as fatigue, pain, depression, and anxiety.31 Placebo-controlled trials are needed to confirm these preliminary observations.
1 Star
Magnesium
Refer to label instructions
A preliminary trial found that a combination of magnesium and malic acid might lessen muscle pain in people with fibromyalgia.

A preliminary trial found that a combination of magnesium and malic acid might lessen muscle pain in people with fibromyalgia.32 The amounts used in this trial were 300–600 mg of elemental magnesium and 1,200–2,400 mg of malic acid per day, taken for eight weeks. A double-blind trial by the same research group using 300 mg magnesium and 1,200 mg malic acid per day found no reduction in symptoms, however.33 Though these researchers claimed that magnesium and malic acid appeared to have some effect at higher levels (up to 600 mg magnesium and 2,400 mg malic acid), the positive effects were not demonstrated under blinded study conditions. Therefore, the evidence supporting the use of these supplements for people with fibromyalgia remains weak and inconclusive.

1 Star
Malic Acid
Refer to label instructions
A preliminary trial found that a combination of magnesium and malic acid might lessen muscle pain in people with fibromyalgia.

A preliminary trial found that a combination of magnesium and malic acid might lessen muscle pain in people with fibromyalgia.34 The amounts used in this trial were 300–600 mg of elemental magnesium and 1,200–2,400 mg of malic acid per day, taken for eight weeks. A double-blind trial by the same research group using 300 mg magnesium and 1,200 mg malic acid per day found no reduction in symptoms, however.35 Though these researchers claimed that magnesium and malic acid appeared to have some effect at higher levels (up to 600 mg magnesium and 2,400 mg malic acid), the positive effects were not demonstrated under blinded study conditions. Therefore, the evidence supporting the use of these supplements for people with fibromyalgia remains weak and inconclusive.

1 Star
Melatonin
Refer to label instructions
In one study, supplementing with melatonin reduced tender points and improved sleep in people with fibromyalgia.

Melatonin supplementation may be useful in the treatment of fibromyalgia. In a preliminary trial, 3 mg of melatonin at bedtime was found to reduce tender points and to improve sleep and other measures of disease severity, though pain and fatigue improved only slightly.36

1 Star
Tart Cherry
80 mg anthocyanins, the equivalent of approximately 100–120 cherries, 16–24 ounces tart cherry juice blend, 1 ounce of liquid concentrate, or 400 mg of concentrate in tablets or capsules
Tart cherries contain antioxidants and anti-inflammatory substances that may reduce muscle pain.
Tart cherries contain antioxidants and anti-inflammatory substances that may reduce muscle pain,37 , 38 and double-blind research in athletes has shown pain-reducing properties of tart cherry preparations.39 , 40 In a small double-blind study, women with fibromyalgia drank 10.5 ounces twice daily of either tart cherry juice (equivalent to 100 to 120 cherries or 80 mg of anthocyanins per day) or a placebo juice for ten days prior to performing a session of intense elbow flexion exercise. While about one-third of the women reported significantly less elbow muscle pain when using tart cherry juice before exercise, the average effect in the overall group was no better than with the placebo.41
1 Star
Vitamin B1
Refer to label instructions
People with fibromyalgia may be deficient in vitamin B1. Supplementing with the vitamin may correct the deficiency and improve symptoms.

Some studies have found low vitamin B1 (thiamine) levels and reduced activity of some thiamine-dependent enzymes among people with fibromyalgia.42 , 43 The clinical significance of these findings remains unknown.

1 Star
Vitamin E
Refer to label instructions
Vitamin E was used in one early study with beneficial and sometimes dramatic results.

One early preliminary study described the use of vitamin E supplements in the treatment of “fibrositis”—the rough equivalent of what is today called fibromyalgia. Several dozen individuals were treated with vitamin E using amounts ranging from 100–300 IU per day. The results were positive and sometimes dramatic.44 Double-blind trials are needed to confirm these preliminary observations.

References

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2. Anonymous. Is fibromyalgia caused by a glycolysis impairment? Nutr Rev 1994;52(7):248–50.

3. Wolfe F, Ross K, Anderson J, Russell IJ. Aspects of fibromyalgia in the general population: Sex, pain threshold, and FM symptoms. J Rheumatol 1995;22(1):151–5.

4. Wilke W. Fibromyalgia: Recognizing and addressing the multiple interrelated factors. Postgrad Med 1996;100(1):153–70.

5. Carette S. Fibromyalgia 20 years later: What have we really accomplished? J Rheumatol 1995;22(4):590–4.

6. Mengshail AM, Komnaes HB, Forre O. The effects of 20 weeks of physical fitness training in female patients with fibromyalgia. Clin Exp Rheumatol 1992;10:345–9.

7. Gowans SE, deHueck A, Voss S, Richardson M. A randomized, controlled trial of exercise and education for individuals with fibromyalgia. Arthritis Care Res 1999;12:120–8.

8. Mannerkorpi K, Nyberg B, Ahlmen M, Ekdahl C. Pool exercise combined with an education program for patients with fibromyalgia syndrome. A prospective, randomized study. J Rheumatol 2000;27:2473–81.

9. Kaplan KH, Goldberg DL, Galvin-Naduea M. The impact of a meditation-based stress reduction program on fibromyalgia. Gen Hosp Psychiatry 1993;15:284–9.

10. Sprott H, Franke S, Kluge H, Hein G. Pain treatment of fibromyalgia by acupuncture. Rheumatol Int 1998;18:35–6.

11. Waylonis GW. Long-term follow-up on patients with fibrositis treated with acupuncture. Ohio State Med J 1977;73:299–302.

12. Deluze C, Bosia L, Zirbs A, et al. Electroacupuncture in fibromyalgia: results of a controlled trial. BMJ 1992;305(6864):1249–52.

13. Berman BM, Ezzo J, Hadhazy V, Swyers JP. Is acupuncture effective in the treatment of fibromyalgia? J Fam Pract 1999;48:213–8.

14. Wolfe F. The clinical syndrome of fibrositis. Am J Med 1986;81(Supp 3A):7–14.

15. Blunt KL, Moez HR, Rajwani MH, Guerriero RC. The effectiveness of chiropractic management of fibromyalgia patients: a pilot study. J Manipulative Physiol Ther 1997;20:389–99.

16. Hains G, Hains F. Combined ischemic compression and spinal manipulation in the treatment of fibromyalgia; a preliminary estimate of dose and efficacy. J Manipulative Physiol Ther 2000;23:225–30.

17. Kaartinen K, Lammi K, Hypen M, et al. Vegan diet alleviates fibromyalgia symptoms. Scand J Rheumatol 2000;29:308–13.

18. Smith JD, Terpening CM, Schmidt SOF, Gums JG. Relief of fibromyalgia symptoms following discontinuation of dietary excitotoxins. Ann Pharmacother 2001;35:702–6.

19. Fava M, Rosenbaum JF, MacLaughlin R, et al. Neuroendocrine effects of S-adenosyl-L-methionine, a novel putative antidepressant. J Psychiatr Res 1990;24:177–84.

20. Bell KM, Potkin SG, Carreon D, Plon L. S-adenosylmethionine blood levels in major depression: changes with drug treatment. Acta Neurol Scand 1994;154(suppl):15–8.

21. Bell KM, Potkin SG, Carreon D, Plon L. S-adenosylmethionine blood levels in major depression: changes with drug treatment. Acta Neurol Scand 1994;154(suppl):15–8.

22. Puttini PS, Caruso I. Primary fibromyalgia syndrome and 5-hydroxy-L-tryptophan: a 90-day open study. J Int Med Res 1992;20:182–9.

23. Moldofsky H, Warsh JJ. Plasma tryptophan and musculoskeletal pain in non-articular rheumatism (“fibrositis syndrome”). Pain 1978;5:65–71.

24. Caruso I, Sarzi Puttini P, Cazzola M, Azzolini V. Double-blind study of 5-hydroxytryptophan versus placebo in the treatment of primary fibromyalgia syndrome. J Int Med Res 1990;18:201–9.

25. Rossini M, Di Munno O, Valentini G, et al. Double-blind, multicenter trial comparing acetyl l-carnitine with placebo in the treatment of fibromyalgia patients. Clin Exp Rheumatol 2007;25:182–8.

26. Tavoni A, Jeracitano G, Cirigliano G. Evaluation of S-adenosylmethionine in secondary fibromyalgia: A double-blind study. Clin Exp Rheumatol 1998;16:106–7 [letter].

27. Tavoni A, Vitali C, Bombardieri S, et al. Evaluation of S-adenosylmethionine in primary fibromyalgia: A double-blind crossover study. Am J Med 1987;83(suppl 5A):107–10.

28. Volkmann H, Norregaard J, Jacobsen S, et al. Double-blind, placebo-controlled cross-over study of intravenous S-adenosyl-L-methionine in patients with fibromyalgia. Scand J Rheumatol 1997;26:206–11.

29. Jacobsen S, Danneskiold-Samsoe B, Andersen RB. Oral S-adenosylmethionine in primary fibromyalgia: Double-blind clinical evaluation. Scand J Rheumatol 1991;20:294–302.

30. Cordero MD, Cano-Garcia FJ, Alcocer-Gomez E, et al. Oxidative stress correlates with headache symptoms in fibromyalgia: coenzyme Q10 effect on clinical improvement. PLoS One 2012;7:e35677.

31. Cordero MD, Santos-García R, Bermejo-Jover D, et al. Coenzyme Q10 in salivary cells correlate with blood cells in fibromyalgia: improvement in clinical and biochemical parameter after oral treatment. Clin Biochem 2012;45:509–11.

32. Abraham G, Flechas J. Management of fibromyalgia: Rationale for the use of magnesium and malic acid. J Nutr Med 1992;3:49–59.

33. Russell IJ, Michalek J, Flechas J, et al. Treatment of fibromyalgia syndrome with SuperMalic: A randomized, double-blind, placebo-controlled, crossover pilot study. J Rheumatol 1995;22(5):953–7.

34. Abraham G, Flechas J. Management of fibromyalgia: Rationale for the use of magnesium and malic acid. J Nutr Med 1992;3:49–59.

35. Russell IJ, Michalek J, Flechas J, et al. Treatment of fibromyalgia syndrome with SuperMalic: A randomized, double-blind, placebo-controlled, crossover pilot study. J Rheumatol 1995;22(5):953–7.

36. Citera G, Arias MA, Maldonado-Cocco JA, et al. The effect of melatonin in patients with fibromyalgia: a pilot study. Clin Rheumatol 2000;19:9–13.

37. Traustadóttir T, Davies SS, Stock AA, et al. Tart cherry juice decreases oxidative stress in healthy older men and women. J Nutr 2009;139:1896-900.

38. Blando F, Gerardi C, Nicoletti I. Sour cherry (Prunus cerasus L) anthocyanins as ingredients for functional foods. J Biomed Biotechnol 2004;5:253-258.

39. Connolly DA, McHugh MP, Padilla-Zakour OI, et al. Efficacy of a tart cherry juice blend in preventing the symptoms of muscle damage. Br J Sports Med 2006;40:679-83.

40. Bowtell JL, Sumners DP, Dyer A, et al. Montmorency cherry juice reduces muscle damage caused by intensive strength exercise. Med Sci Sports Exerc 2011;43:1544-51.

41. Elliott DL, Kuehl KW, Jones KD, Dulacki K. Using an eccentric exercise-testing protocol to assess the beneficial effects of tart cherry juice in fibromyalgia patients. Integrative Medicine 2010;9(6):24- 29.

42. Eisinger J, Zakarian H, Plantamura A, et al. Studies of transketolase in chronic pain. J Adv Med 1992;5:105–13.

43. Eisinger J, Bagneres D, Arroyo P, et al. Effects of magnesium, high energy phosphates, piracetam, and thiamin on erythrocyte transketolase. Magnesium Res 1994;7(1):59–61.

44. Steinberg CL. The tocopherols (vitamin E) in the treatment of primary fibrositis. J Bone Joint Surg 1942;24:411–23.

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