May 30, 2014

Virender Sodhi, MD(Ayurved), ND

Fibromyalgia (FM) is a considered a physical and mental disorder, that has no known cause in conventional medicine. It is characterized by chronic, widespread pain, sleep disturbances, and fatigue.[1] Fibromyalgia (FM) has also been associated with cognitive problems that affect the memory, motor function, and decision making processes of the brain. Among psychological disorders, patients with fibromyalgia has high incidence of depression, anxiety, obsessive-compulsive disorder, and post-traumatic stress disorder.[2] Symptoms of fibromyalgia tend to affect normal function of individuals; they can also lead to missing work, disability, and hospitalizations[1]. Some common symptoms of Fibromyalgia are[3]:

  • Morning stiffness
  • Tingling and numbness of hands and feet
  • Headaches, including migraines
  • Irritable bowel syndrome
  • Sleep disturbances
  • Cognitive problems with thinking and memory
  • Painful menstrual periods and other pain syndromes

Fibromyalgia disorder affects over 5 million Americans. It is seven times more prevalent among women compared to men, which indicates towards sex-based vulnerability. However, the incidence of fibromyalgia among men and children is progressively increasing. Most people are diagnosed when they are middle aged. The older the person is, the great chance of developing fibromyalgia.[1]

Common health conditions that have been associated with development of fibromyalgia[5]:

  • Stressful or traumatic events, such as car accidents, PTSD, etc.
  • Repetitive injuries.
  • Viral infections, Lyme’s disease, mononucleosis, etc.
  • Obesity
  • Genetic predisposition
  • Other chronic conditions like Lupus (SLE), rheumatoid arthritis, chronic fatigue syndrome, etc.

The widespread pain experienced in Fibromyalgia is believed to be due to increased sensitivity of the nerves. People with Fibromyalgia react strongly to stimuli that general public would not find painful.[1] Research into physiology has begun to reveal that Fibromyalgia is a disease of the body and mind. Trauma to the body like infections, repetitive injuries, emotional distress, etc. lead to initiation of pain sensitivity. Individuals with physical trauma like car-accidents, especially neck and spine injuries related to whip-lash, have a high chance developing fibromyalgia and other pain hypersensitivity.[12,13] However, in the patients with Fibromyalgia, the sensitivity of pain is augmented to disproportionately high levels. These individuals become sensitive to wide range of stimuli, including: heat, cold, electricity, as well as touch, brightness of light, and loudness of sounds.[4]This picture of generalized “hyper-sensitivity” indicates that nervous system is affected in the early stage of the disorder.

Neurobiological studies and brain imaging studies are revealing the deficiencies of brain function that are underlying the symptoms of fibromyalgia. Present studies show that there is a prominent imbalance in the brain-chemistry of the individuals with Fibromyalgia. Specifically; neurotransmitters that promote pain and sensitivity in the body are elevated, while the group of inhibitory neurotransmitters is depleted.[4]

Depleted inhibitory neurotransmitters

Elevated stimulatory neurotransmitters

Norepinephrine Substance P
SerotoninGlutamate
Dopamine Nerve Growth factor
GABA
Cannabinoids
Adenosine

For many centuries, clinicians have known that pain inhibits pain, a phenomenon known as “counter-irritation”. Recent physiological understanding tells us that such inhibition is diminished among patients with fibromyalgia due neurotransmitter imbalance.

Besides pain, problems with sleep and cognitive function are also a prominent aspect of Fibromyalgia picture. Among individuals with Fibromyalgia, normal sleep seems to be affected by intrusion of alpha brain wave activity[6]; the alpha waves are associated with a wakeful state of mind. Therefore, patients often have difficulty going to sleep and staying asleep. This sleep deprivation contributes to fatigue and impairment of cognitive function. High levels of substance P, a neurotransmitter that contributes to pain sensation, has also been associated with sleep deprivation in animal studies.[7] The sleep problem is also aggravated by depletion of serotonin, a neurotransmitter which is essential for promoting normal sleep.

Brain imaging also indicates towards loss of neurons, indicated by depletion of “gray matter” in various regions of the brain[6]. This contributes to the imbalance of the neurochemistry among Fibromyalgia patients. Thus, it seems that almost all symptoms fibromyalgia that affect the body originate from altered nerve function. It is not clearly understood what alters brain function, but there are some clear and useful clues available.

Fibromyalgia and inflammation

Fibromyalgia has a peculiarly high correlation with autoimmune diseases. There is a significant relationship between fibromyalgia and following conditions[8]:

Autoimmune Condition

Percentage of people with Fibromyalgia

Systemic Lupus erythematous 65%
Rheumatoid Arthritis 57%
Psoriatic Arthritis 24%
Autoimmune Thyroiditis 31%/td>

Autoimmune diseases are a result of abnormal activation of the immune system. When activated, inflammation serves as the main assault weapon for the immune system. Fibromyalgia is not always associated with autoimmune lab markers, therefore it cannot be called an autoimmune disease. However, the high correlation of fibromyalgia with autoimmune diseases indicates towards the role of inflammation in manifestation of the disease.

Growing volume of evidence is highlighting the presence of inflammation underlying fibromyalgia. Patients with Fibromyalgia tend to have higher levels of cytokines; IL-10, IL-8, and TNF-ɑ.[9,11] These cytokines are signaling molecules that activate immune cells and induce inflammatory activity, wherever they are present. These cytokines are also present at high levels in the skin of the individuals with fibromyalgia.[10] Additional studies have also shown elevated blood levels of C-reactive protein (CRP) and sedimentation rate (ESR), both of which are markers for systemic inflammation.[9] These markers indicate that inflammation in fibromyalgia is prevalent throughout the body. Fibromyalgia patients tend to have mitochondrial-dysfunction that contributes to inflammation at the cellular level.[11] Generally, inflammation raises the oxidative stress in the body that results in tissue injury. In case of fibromyalgia, the main site of inflammatory injury seems to be the nerve tissue.

The causes of such chronic low-grade inflammation are difficult to pin-point because they can be unique to each individual. This makes it essential to evaluate everyone on a case-by-case basis in order to understand what “insults” are affecting the body. These insults may include physical or emotional trauma, chronic stress, food allergies, imbalanced lifestyle, unhealthy dietary choices, obesity and many more.

Ayurvedic and Naturopathic treatment:

In our clinic at Ayurvedic, Naturopathic Medical clinic, we have been treating patients of Fibromyalgia with greater success. Body heals automatically if you create a healing environment. Body has three basic needs, air, water and food. These needs to very clean along with balance in mental, emotional and physical health. Panch Karma detoxification treatment is very unique cellular detoxification, which get rid of toxic load and creates systemic homeostasis. Combined with herbs, yoga and breathing exercise, you can put end to the miseries of Fibromyalgia. Almost 25 years ago, I saw one Physician who was Anesthesiologist by profession, came all the way from Chicago to our clinic with diagnosis of Fibromyalgia. She was treated with standard care without much benefits. She was so debilitated with pain that she took sabbatical from her work. Lab investigation revealed that her liver enzymes and ESR were elevated. She had very stressful marriage. She has irritable bowel syndrome, which is very common in patients with fibromyalgia. According to Ayurvedic medicine she had Pitta and Vata imbalances. She was advised Pitta balancing diet and behavioral modifications. She went through Panch Karma detoxification treatments. She was advised standardized extract of Ashwagandha 500 mg three times per day, Boswellia preparation and Curcumin bound to medium chain triglycerides of coconut preparations. Ashwagandha has hormonal and cortisol balancing effects, Boswellia and Curcumin has very powerful anti-inflammatory effects. To support her liver she was also put on Eclipta alba with other combination of liver supporting herbs. To help her digestion I put her on Triphla and multi strain probiotics. After first week of treatment she started to feel so much better that she stopped valium, which she has been taking regularly to go to sleep for many years. After six weeks of treatment she became a brand new person and joined her work as a Physician. Very similarly other patients have similar benefits, we also do intravenous magnesium, B-complex, vitamin B12 and mineral combinations. These IV boost up healing very fast. Patients start to feel better more quickly. Breathing exercises specially fire breath and alternate nostril breathing are very beneficial. Increased oxygenation helps push toxins out of your system. Gentle yoga with breathing exercise is also beneficial. In this exercise you sit in a chair, breath in, as you are breathing in squeeze your hands in to fist and then slowly bring them to your chest and then bend into your knees contracting your whole body and slowly exhale in contraction. Now slowly release contraction and extend your hands above your head and breathe in again and go on repeating this many times. Start with first with 5 minutes 2-3 times per day and then increase it to 10-15-20 min in few weeks. Following Ayurvedic and Naturopathic routine, you will see a renewed energy and your body will thank you for not having aches and pains.

Research and writing assistance for this article was provided by Dr. Anup Mulakaluri, ND

References

  • [1] CDC.gov; Fibromyalgia. Center for Disease Control and Prevention. Online Article: http://www.cdc.gov/arthritis/basics/fibromyalgia.htm
  • [2] Clauw DJ. Fibromyalgia: A Clinical Review. Journal of American Medical Association, 2014; Vol. 311(15), Pg. 1547-1555.
  • [3] Wolfe F, et al.; Symptoms, the Nature of Fibromyalgia, and Diagnostic and Statistical Manual 5 (DSM-5) Defined Mental Illness in Patients with Rheumatoid Arthritis and Fibromyalgia. PLoS ONE, 2014; Vol. 9(2).
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  • [11] Cordero MD, et al. Is Inflammation a Mitochondrial Dysfunction-Dependent Event in Fibromyalgia? Antioxidant and Redox Signaling, 2012; Vol 18(7), Pg. 1-9.
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