Article on Fibromyalgia - For those who prefer to dowload to the PC and read it

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Dear Group,

 

I first sent a link for this article but then felt that some of you

may prefer to read it off-line. So, here is the article without the

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Swamy

 

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Confronting Fibromyalgia

 

By Karta Purkh Singh Khalsa

 

What does it feel like to live with fibromyalgia? " Imagine last night

you drank more wine than you should have but had no water or food.

You went to bed late and got up early, feeling stiff, achy, and

tired, " says Chanchal Cabrera, a British herbalist, fibromyalgia

patient, and author of Fibromyalgia: A Journey Toward Healing (McGraw-

Hill, 2002). People with fibromyalgia feel that way all the time, she

says.

 

A truly mysterious ailment, fibromyalgia syndrome (FMS) involves

chronic widespread muscle pain and fatigue. It affects about 2

percent of all Americans and accounts for 10 to 30 percent of all

rheumatology consultations. FMS mainly afflicts people between the

ages of 35 and 55 and occurs seven to 10 times more frequently in

women.

 

And as if the pain and fatigue weren't enough, a constellation of

other symptoms often accompanies the disorder—foggy thinking, sleep

disturbances, painful menstrual cramps (dysmenorrhea), and irritable

bowel symptoms—making a clear diagnosis difficult. Although the cause

of FMS continues to elude researchers, certain stresses on the body,

such as intense exercise, illness, or a traumatic event, appear to

intensify symptoms or even bring on the condition itself.

 

" My fibromyalgia was triggered by a car accident in 1991, when I was

a healthy and fit 28-year-old, " says Cabrera, now 43 and living in

Vancouver, British Columbia. " Within minutes of the impact, my neck

and shoulders were in pain, and I had a dull headache. My slow

descent into fibromyalgia had begun. "

 

The body blows a fuse

Jacob Teitelbaum, MD, medical director of Maryland's Annapolis Center

for Effective Chronic Fatigue Syndrome/Fibromyalgia Therapies, likens

FMS to the body's " blowing a fuse " when its energy account becomes

overdrawn. This short circuit results in hypothalamus suppression,

Teitelbaum maintains. " The hypothalamus controls sleep, hormonal

function, temperature, and autonomic functions such as blood pressure

and blood flow, " he says. " The hypothalamus uses more energy for its

size than any other organ, so when there is an energy shortfall, it

goes offline first. "

 

" FMS has no single cause, " Teitelbaum says. He surmises that the

hypothalamus decreases its protective function in the face of what it

perceives as overwhelming stress, which can stem from infection,

injury, or a stressful, emotional incident. " FMS patients seem to

have genetic differences in the way their hypothalamus, pituitary,

and adrenal regulation handle stress, " he says. " As a result, the

muscles end up short of energy and in pain. "

 

Is there hope?

Mary Shomon, now an author and patient advocate in Washington, DC,

began to have symptoms of FMS at age 34, after two car accidents and

numerous other health challenges. Through a holistic approach and

alternative therapies, she finally found relief from her symptoms.

However, 11 years later she still expresses dismay about the stigma

and disbelief she encounters about fibromyalgia—particularly from the

conventional medical community.

 

" Those of us who have suffered through it know firsthand that it is a

very real condition, " Shomon says. " We didn't dream it up or develop

some psychosomatic syndrome, and we can't just think it away, buck

up, and feel better, or just `get over it' by sheer determination.

Some doctors—and even some of our families and friends—think that

fibromyalgia is psychosomatic, evidence of laziness, or is due to

some inherent emotional or character weakness. "

 

Conventional medicine has little to offer in the way of treatment,

which frustrates patients and doctors alike. Mainstream physicians

see FMS largely as an incurable condition (if they see it as a

condition at all), so they focus on relieving pain and improving

sleep—primarily with pharmaceuticals. Although both conventional and

alternative healthcare providers may suggest exercise programs to

improve muscle and cardiovascular fitness, along with relaxation

techniques to ease muscle tension and anxiety, drugs remain at the

forefront of conventional medicine's arsenal.

 

Conventional practitioners often recommend nonsteroidal anti-

inflammatory drugs (NSAIDs) like aspirin or ibuprofen for pain, and

tricyclic antidepressants to improve sleep and mood. These drugs

improve the symptoms to a certain extent but do not halt the disease.

And they come with a hefty price: NSAIDs cause bleeding in the

stomach lining and may affect kidney and liver function, particularly

when taken long-term. Antidepressants carry a host of potential side

effects, including anxiety, nausea, weight gain, and constipation.

And, at the end of the day, they don't alleviate the disease or

provide any hope for long-term relief. In contrast, a new breed of

alternative practitioners, including Teitelbaum, thinks that FMS can

be cured. They aim to get at the core issues and turn the disease

around with alternative therapies.

 

The search for sleep

Sleep is a primary concern for anyone with FMS. Ninety percent of

patients awaken multiple times a night, and even if they make it

through the night, they rarely sleep deeply enough to feel

rejuvenated. Other symptoms may disrupt sleep as well, such as

restless legs syndrome (twitchy, cramping legs that cause pain and

sleeplessness), irritable bladder, and nocturnal myoclonus (jerky

muscles).

 

Scientists have long known that fibromyalgia involves " disregulated

sleep physiology, " or alpha rhythm disturbances occurring during the

night and resulting in light, unrefreshing sleep. " If you don't get

eight to nine hours sleep at night, your pain will simply not go

away, " says Teitelbaum. " Deep sleep is when you make growth hormones,

recharge your batteries, and get rid of pain, " he explains.

Teitelbaum's first line of defense against disturbed sleep is L-

theanine (it must be the " L " form). He advises 200 mg at bedtime.

 

" L-theanine is fantastic, " Shomon says. " With L-theanine, I can sleep

without waking up groggy. " Teitelbaum also recommends low-dose

melatonin—a maximum of 0.5 mg per night—to encourage a normal sleep

cycle. Because sleep is so critical to healing, Teitelbaum may

occasionally prescribe sleeping pills, but only as a last resort.

 

For Cabrera, sleeping and healing went hand-in-hand: " Melatonin

really helped give me a deep, long sleep. " After her diagnosis,

Cabrera had to quit work and pretty much rested and slept for a

year. " I slept 12 to 14 hours per night, plus naps, " she says. " I

still use melatonin every night, but now I take a small dose of 0.3

mg. " Cabrera has to watch herself closely, however. " With less than

ideal sleep even for one night, some FMS symptoms will return, but I

now can reverse them right away, " she says.

 

A new sugar for energy

But no matter how much they rest, people with FMS never seem to have

enough energy. That's not surprising, since research shows FMS

sufferers have lower levels of ATP (the body's cellular energy

molecule) along with a lowered ability to make it. But exciting new

research with FMS patients shows that supplementing with D-ribose

(often just called ribose), the body's cellular fuel, can help the

body replenish ATP.

 

A natural sugar, ribose occurs in all living cells. " Ribose is the

key building block for making energy, " says Teitelbaum. " In fact, the

main energy molecules in your body are made of ribose, plus B

vitamins and phosphate. " Our bodies acquire ribose through diet—

brewer's yeast has a rich supply—and the body also makes it from

glucose in food. This is a slow process, however, that cannot always

keep up with the energy lost in daily activities, so it may take

several days to restore the lost ATP—and possibly much longer for

those who suffer with FMS.

 

Scientists know that supplemental ribose can reduce muscle pain,

stiffness, and exercise fatigue; that people tolerate it well; and

that it has no side effects. Armed with this knowledge, Teitelbaum

conducted a recent and very promising ribose study in FMS patients.

They took 5 grams of ribose three times a day, for an average of 28

days. In just 12 days, 66 percent of those taking ribose had

significant improvement in energy, sleep, mental clarity, and pain

intensity, with a 44 percent average increase in energy and an

overall 30 percent increase in well-being. Although the study is

preliminary, with results this positive, look for additional research

on ribose soon.

 

A different kind of cocktail

Could a simple injection cure FMS? As it turns out, one nutrient

concoction just might. The Myers Cocktail (named for John Myers, the

physician who invented it), an intravenous micronutrient treatment

containing magnesium, calcium, vitamin B complex, and vitamin C, has

been used to treat fibromyalgia for 20 years. Like ribose, these safe

nutrients promote cellular energy production and pump up ATP

production, according to a study published in Alternative Medicine

Review. " We have good clinical success with this treatment to reduce

pain and promote detoxification, " says Virginia Hadley, RN,

nutritionist at the Tahoma Clinic in Kent, Washington.

 

Yale researchers recently tested the Myers Cocktail on a group of 40

patients ages 18 to 75 in a double-blind, placebo-controlled,

randomized trial. They gave one injection a week for eight weeks

through a large syringe containing 37 ml (about 7 teaspoons) of

nutrient solution. The mixture was injected slowly over about 20

minutes. The yet-to-be-published study measured tender points,

depression levels, and quality of life. " This three-month pilot study

showed significant improvements in all pertinent outcome measures

with the Myers Cocktail and none with the placebo solution, " reports

David L. Katz, MD, associate clinical professor of epidemiology and

public health at Yale University. The study participants still had

less pain a month after the last injection. " Our results strongly

suggest that Myers Cocktail may well offer therapeutic benefit in

fibromyalgia. In the interim, we will continue to offer it to our

patients, " says Katz.

 

Take a little needling

Many people with FMS get hooked on acupuncture, and for good reason.

Numerous studies show the positive benefits of acupuncture for pain

relief. One landmark study appeared in the June 2006 Mayo Clinic

Proceedings. This randomized, controlled trial, led by David P.

Martin, MD, an anesthesiologist from the Mayo Clinic College of

Medicine in Rochester, Minnesota, reports on 50 FMS patients, half of

whom received acupuncture; the remaining 25 received sham

acupuncture, which involved needles inserted at non-therapeutic

points. After just six treatments spread over three weeks, the

acupuncture patients reported significant improvement in symptoms,

particularly fatigue and anxiety, lasting up to seven months. One

month after treatment, those treated with " true " acupuncture had less

fatigue and fewer anxiety symptoms than the sham acupuncture group.

 

Exercise more, stress less

A regular, gentle, exercise routine stands out as indispensable for

FMS—to increase flexibility and reduce pain and stress. The severe

pain that usually accompanies FMS makes it difficult for many

sufferers to begin and maintain an exercise program. That's why

programs with gentle stretches and movements, such as therapeutic

yoga, Pilates, and t'ai chi, are often a good fit for FMS patients.

 

Shomon finds tremendous relief with Pilates. " My body was often a

knot of aches and pains—especially in my neck, shoulders, and lower

back, " she says. " But I started Pilates for two one-hour sessions a

week. It was life-changing. Gradually, I gained strength, my constant

body pain faded, and I was able stop my daily doses of ibuprofen. "

Shomon has been doing Pilates for about four years and says she

rarely has body pain.

 

Yoga also eases muscle pain and stiffness. In a six-week randomized

pilot study, researchers looked at a yoga program modified for FMS

chronic back pain. The program improved balance and flexibility and

diminished disability and depression.

 

Electrical help

Then there's some shocking news. According to Carolyn McMakin, a

chiropractor in Portland, Oregon, and an active proponent of

microcurrent therapy, electricity can help zap FMS. Microcurrent

therapy increases the rate of healing for injuries and fractures and

controls muscle pain. According to McMakin, delivering microamperage

(50 to 100 microA) electrical current to a patient increases ATP

concentrations up to fivefold in the body.

 

Electricity can relieve pain in other ways, too. Transcutaneous

electrical nerve stimulation (TENS), which first appeared in

scientific literature around 1975, relieves pain by sending low-

voltage electrical signals to nerves with a battery-powered device.

TENS, used mainly by physical therapists but also by some MD pain

specialists, is thought to work because the electricity stimulates

the nerves in an affected area and scrambles normal pain signals. It

also may help the body produce natural endorphins. One 2005 study

looked at 218 chronic pain patients. After receiving TENS twice a

week for six weeks, the patients had substantial improvement in

disability and pain, which they maintained at a six-month follow-up

exam.

 

While everyone hopes for a cure for FMS, that magic bullet that puts

an end to the disease, all these different therapies and a number of

lifestyle adjustments make the disease manageable. " People must

change their lifestyles to make any progress, " Cabrera

says. " Fibromyalgia involves a host of factors and an internal

complex of concerns. Even though I am an herbalist, and I know herbs

help, the entire answer doesn't lie in substances. "

 

And Shomon adds, " There's clearly no conventional medical cure or

just one surefire treatment. What seems to work the best is a

combination of customized tactics that focuses on ensuring quality

sleep, reducing pain, increasing flexibility, improving metabolism,

and reducing stress. "

 

Do You Have It?

Although an official diagnosis of fibromyalgia involves identifying

pain and tender-point sites (see illustrations on pages 68 and 69),

below are the most common symptoms associated with this disorder.

 

Signs and Symptoms ....................................Percentage of

Patients

• Widespread pain............................................90 to 100

• Tender points.................................................90 to

100

•

Fatigue...........................................................90

to 100

• Cognitive impairment ( " fibro-fog " ).......................70 to 90

• Sleep disturbances..........................................70 to 90

• Dysmenorrhea (painful menstruation)...............70 to 90

• Irritable bowel symptoms............................... 50 to 70