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Published On: Thu, Sep 19th, 2013

Fibromyalgia: Causes & Treaments

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FibromyalgiaFibromyalgia: Causes & Treaments

By Gene Bruno, MS, MHS (Dean of Academics, Huntington College of Health Sciences)

According to the American College of Rheumatology, fibromyalgia is a common condition that is associated with widespread aching, stiffness and fatigue, and originates in muscles and soft tissues. People with fibromyalgia are found to have multiple tender points in specific muscle areas.

Most individuals complain of aching and stiffness in areas around the neck, shoulders, upper back, lower back and hip areas. Many patients have no underlying disorders while others who develop fibromyalgia may have conditions such as rheumatoid arthritis, spinal arthritis or Lyme disease. Some people have symptoms of irritable bowel syndrome, tension headaches and numbness or tingling of the extremities. Depression is also not unusual in fibromyalgia patients.

This article will review causes, conventional medical treatments, and complementary medical treatments of fibromyalgia.

Causes of fibromyalgia

Researchers believe that there isn’t one single cause of fibromyalgia; rather, a number of factors may contribute. These factors may include:

  • Chemical changes in the brain – Some people with fibromyalgia appear to have alterations in the regulation of certain neurotransmitters, particularly:
  • Serotonin—which is linked to depression, migraines, and gastrointestinal distress;
  • Substance P, a brain chemical associated with pain, stress and anxiety, as well as depression.
  • Sleep disturbances – Some researchers theorize that disturbed sleep patterns may be a cause rather than just a symptom of fibromyalgia. Studies have shown abnormally low levels of a hormone called somatomedin C in the blood of people with fibromyalgia. Somatomedin C is thought to be essential for the body to rebuild itself and is secreted only during stage 4 sleep.
  • Injury – An injury or trauma, particularly in the upper spinal region, may trigger the development of fibromyalgia in some people. An injury may affect the central nervous system, which might trigger fibromyalgia.
  • Infection – Some researchers believe that a viral or bacterial infection may trigger fibromyalgia. Although no single viral or bacterial agent has been implicated, it may be that a number of such agents are capable of triggering fibromyalgia. Another possibility is that fibromyalgia may involve the reactivation of the immune response to previous viral infections. In other words, the immune system may be fighting the “ghosts” of past viral infections. This model was originally presented in an article published in the Lancet entitled “Cause and Prevention of Postinfectious and Postvaccinal Neuropathies in Light of a new Theory of Autoimmunity.” In this model, the basic hypothesis is that three requirements must be met to induce the disease state:
  • There must be an antigen present which is the same as or similar to some fragment of self tissue. We can call this the primary lesion.
  • There must be a second antigen which is chemically complementary to the first antigen.
  • Both antigens must be present and immunologically active in the host at the same time.

The presence of the second complementary antigen probably confuses the immune system and causes an inappropriate response to the first antigen. Once this process is triggered, it becomes self-sustaining due to the inflammation and tissue damage which occurs. This tendency for the immune system to respond inappropriately can be called a state of immune dysregulation.

  • Abnormalities of the autonomic (sympathetic) nervous system–The autonomic nervous system is divided into the sympathetic and parasympathetic systems. The sympathetic nervous system releases norepinephrine and influences the release of epinephrine from the adrenal gland. The sympathetic nervous system also controls bodily functions that aren’t consciously controlled, such as heart rate, blood vessel contraction, sweating, salivary flow, and intestinal movements. Several studies have looked at the responses of the sympathetic nervous system in people with fibromyalgia. There are reports of reduced epinephrine responses to low blood sugar levels and exercise. Other reported abnormalities include decreased responses to cold and altered heart rate and blood pressure responses during tilt-table testing — a noninvasive procedure normally used to help diagnose a common form of fainting (syncope). During the test, the subject lies on a bed that moves from a horizontal to a vertical position while blood pressure and heart rate are monitored.
  • Changes in muscle metabolism – For example, deconditioning and decreased blood flow may contribute to decreased strength and fatigue. Differences in metabolism and abnormalities in the hormonal substance that influences the activity of nerves (neuroendocrine), may play a role.
  • Other considerations – Psychological stress and hormonal changes also may be possible causes of fibromyalgia.

Since any combination of the aforementioned factors may play a role in the etiology of fibromyalgia, a multifaceted treatment approach may be necessary. First, let’s examine conventional medical treatments.

Conventional medical treatments

Despite the prevalence of fibromyalgia, no drugs have been developed or approved specifically for its treatment. However, researchers are currently studying at least two drugs to treat the condition’s multiple symptoms. In clinical trials, interferon alpha (Veldona) shows promise as a treatment for fibromyalgia pain and stiffness. Another drug, pregabalin, has been show to ease pain, promote sleep, and relieve fatigue.

Until these or similar drugs are approved, doctors prescribe a wide variety of medications to treat specific symptoms of fibromyalgia. For example, because sleep disturbance is common in fibromyalgia, some of the most effective drugs are those that promote restful sleep. But traditional sleep aids aren’t necessarily the answer. Many doctors and patients find that some antidepressants, including tricyclic antidepressants, as well as benzodiazepines can promote deep, restorative sleep when taken at bedtime. Also, the selective serotonin reuptake inhibitors (SSRIs) may be taken along with the tricyclics to increase energy.

Muscle relaxants and other medications may be used to decrease muscle pain and spasms experienced by many people with the condition, and a seizure medication called gabapentin (Neurontin) may ease the leg pain, numbness, and tingling sensations that come with the condition.

In addition to the drugs included in this chart, people with fibromyalgia may also benefit from pain-relievers such as NSAIDs and analgesics.

Although these drugs are the most common, there are many different medications that have been used to treat fibromyalgia. Individual clinicians may try a “hit and miss” method with fibromyalgia patients until they find the right combination that seems to work for each individual.

Complementary medical treatments

Serotonin modulators: l-tryptophan, 5-HTP, & Hypericum perforatum

Evidence from multiple sources supports the concept of decreased flux through the serotonin pathway in fibromyalgia patients. Serotonin substrate supplementation, via L-tryptophan (1,500 mg daily), or 5-hydroxytryptophan (5-HTP, 100 mg three times daily), has been shown to improve symptoms of depression, anxiety, insomnia, and somatic pains in a variety of patient cohorts. Identification of low serum tryptophan and serotonin levels may be a simple way to identify persons who will respond well to this approach.i ii iii iv

The clinical evidence is overwhelming in favor of Hypericum perforatum (St. John’s Wort, 300 mg, three times daily) as a relatively risk-free antidepressant which is suited for the treatment of mild to moderate depression. This alone may be beneficial for fibromyalgia patients with this type of depression. Of particular interest is one of Hypericum’s mechanisms of action. Namely a primary mechanism of action seems to be that it increases serotonin levels, much by the same mechanism of action that Prozac® exerts.v Such an increase may be beneficial for fibromyalgia patients in any case. In addition, Hypericum has demonstrable antiviral propertiesvi, another potential benefit for fibromyalgia patients.

Comments: The use of serotonin-like substrates plays a correcting role in aforementioned chemical changes in the brain relating to serotonin. In addition, the improvement in quality sleep that is likely to occur from supplementation may also help correct the abnormally low levels of a somatomedin C. Similar effects may be realized from the SSRI properties of Hypericum. Also, the antiviral properties of hypericum may help address the aforementioned role that infection may play in fibromyalgia.


Many practitioners have recognized that true progress will not be made in the treatment of fibromyalgia until the correction of the sleep disturbances first takes place. Hence it is not surprising that researchers have tested melatonin supplementation on fibromyalgia patients in a preliminary trial. The results were that when 3 mg of melatonin was given at bedtime, there was a reduction in tender points, and an improvement in sleep and other measures of disease severity, (though pain and fatigue improved only slightly).vii

Comments: Although melatonin is not a serotonin substrate, it is part of the same biochemical process involved in initiating sleep. Consequently, it may also help correct the abnormally low levels of somatomedin C.

Aloe vera, saccharides, wild yam and vitamin/mineral complex

In an uncontrolled clinical trial, fifty subjects with a physician diagnosis of fibromyalgia (FM) and/or chronic fatigue syndrome (CFS) consumed nutritional supplements including freeze-dried aloe vera gel extract; a combination of freeze-dried aloe vera gel extract and additional plant-derived saccharides; freeze-dried fruits and vegetables in combination with the saccharides; and a formulation of Dioscorea (Wild Yam) complex containing the saccharides and a vitamin/mineral complex. All subjects in this study had received some form of medical treatment prior to taking the nutritional supplements, but none with enduring success. Nutritional supplements resulted in a remarkable reduction in initial symptom severity, with continued improvement in the period between initial assessment and the follow-up nine months later.viii

Comments: Aloe may be addressing the problem of fibromyalgia from two directions. First, saccharides in Aloe have previously exhibited antiviral and immunopotentiating properties. This may help address the role that infection may play. Also, enzymes in Aloe produce anti-inflammatory and analgesic effects by inactivating bradykinin, a vasodilator involved in immune chemistry. Likewise, Dioscorea has anti-inflammatory and antirheumatic properties, and has a history of traditional use for rheumatoid arthritis and muscular rheumatism.

Calcium and magnesium

Some patients with fibromyalgia were observed to have high hair calcium and magnesium levels compared with healthy subjects. [High hair levels of these minerals is indicative of low corresponding tissue levels.] Because of this, and because supplementing calcium and magnesium to fibromyalgia subjects reduced the number of tender points detected by digital palpation, a study was conducted to see if patients with fibromyalgia have significantly higher hair calcium and magnesium levels than their healthy counterparts. The results of the study were that patients with fibromyalgia did indeed have significantly higher calcium and magnesium levels than the control subjects. The authors of this concluded that calcium and magnesium supplements may be indicated as an adjunctive treatment of fibromyalgia.ix

In addition, other research has revealed that individuals with fibromyalgia had a lower average bone mineral density than matched controls and a higher incidence of osteoporosis in subjects 51-60 years of age. The authors of the study indicated that “early detection and implementation of appropriate nutritional supplementation (calcium/vitamin D), resistive and weight bearing exercise, and specific bone mineral enhancing pharmacological therapy may be indicated in pre, peri, and postmenopausal subjects.”x Clearly, the findings in this study are consistent with the need for calcium and magnesium supplementation as indicated in the previous study.

Comments: In addition to supplementing with calcium and magnesium in order to prevent subclinical deficiencies and prevent osteoporosis, there may be value in supplementing with soy isoflavones so to assist in building bone density.

Vitamin B12

A study on 12 women who had both fibromyalgia and chronic fatigue syndrome were found to have increased homocysteine levels in the cerebrospinal fluid. This study found a significant positive correlation between the increased homocysteine levels and fatiguability, and that the levels of vitamin B12 in cerebrospinal fluid also correlated significantly with fatigability. Since Vitamin B12 deficiency is associated with increased homocysteine levels, the researchers observed that the low level of vitamin B12 found in their patients probably contributed to the increased homocysteine levels.xi Consequently, supplementation of vitamin B12, which can reduce elevated homocysteine levels, may help reduce homocysteine and fatigue in patients with fibromyalgia and chronic fatigue syndrome.

Comments: Some individuals with fibromyalgia have reported that vitamin B12 injections really seemed to help reduce fatigue. An alternative to injections are the use of sublingual vitamin B12 tablets which have been shown to increase blood serum levels of vitamin B12 by 90% in clinical research.xii


S-adenosyl-L-methionine (SAMe) is a natural molecule synthesized from the amino acid methionine in the presence of magnesium and adenosine triphosphate (ATP). A study of 17 fibromyalgia patients revealed a significant improvement in both pain at trigger points and depression following SAMe treatment.xiii In another study, 34 fibromyalgia patients receiving SAMe experienced improvement in pain and overall well being, although these improvements were not considered “statistically significant.”xiv

Comments: It is interesting to note that several of the symptoms that SAMe is known for treating are also present in fibromyalgia. These include inflammation, moodiness/depression, pain and migraine headaches.

Chlorella pyrenoidosa

A double-blind, placebo-controlled, randomized clinical trial was under taken to assess the value of the dietary supplement Chlorella pyrenoidosa in treating fibromyalgia, hypertension, and ulcerative colitis. After at least two months, outcome measures revealed that Chlorella relieved symptoms, improved quality of life, and normalized body functions in patients with fibromyalgia, hypertension, or ulcerative colitis.xv

In a similar double-blind, placebo-controlled, randomized clinical study, Chlorella performed well again. A questionnaire dealing with issues of pain, anxiety, sleep, and gastrointestinal difficulties indicated that while participants were consuming Chlorella, there were steady, statistically significant improvements [p< 0.001] in scores compared to baseline. Compared to the placebo group, there was a statistically significant [p= 0.004] improvement in fibromyalgia symptoms while the subjects were taking Chlorella. The authors concluded that, “the results of this randomized, placebo-controlled, double-blind crossover study lead us to conclude that dietary Chlorella supplementation may be useful ill in relieving symptoms of FMS [fibromyalgia syndrome].”xvi

In an earlier study on fibromyalgia patients, Chlorella pyrenoidosa supplementation resulted in a statistically significant, 22% decrease in pain intensity.xvii

Comments: It is not at all clear why Chlorella should have beneficial effects in the treatment of fibromyalgia. However, scientific reports from Japan had shown that broken cell wall preparations and extracts of chlorella, when given orally or injected, promoted growth and healing and stimulated the immune system such that it protected against infection. Perhaps it is addressing the aforementioned role that infection may play in fibromyalgia. Also, inflammatory bowel disorders are not unusual in fibromyalgia. A resultant bowel infection may inhibit the absorption of nutrients, prompting deficiencies and promoting a cycle of fatigue and illness. Chlorella has also been shown to be beneficial in the treatment of such bowel disorders.

Collagen hydrolysate

Twenty fibromyalgia patients (12 with temporomandibular joint pain), participated in and completed a 90-day studyxviii to determine effects of collagen hydrolysate on symptoms of chronic fibromyalgia. Participants were evaluated initially and then at 30-, 60-, and 90-day periods. The final results indicated that the average pain complaint levels decreased significantly in an overall group average, and even dramatically with some individuals. It was concluded that patients with fibromyalgia and concurrent temporomandibular joint problems may gain symptomatic improvement in their chronic symptoms by taking collagen hydrolysate.

Comments: The material used in this study is Calorad. It is a bit of a mystery why it should have provided such significant benefits. The authors postulate that collagen hydrolysate may be one of the neurohormonal protein/amino acid complexes necessary for balanced neuroendocrine function.

Adpatogenic support: Rhodiola rosea & Panax ginseng

Following is a case study published in HerbalGram as part of the monograph on Rhodiola rosea. The authors recognized that the presentation of individual cases does not carry the weight of double-blind, placebo-controlled trials, but hope that the publication of such case studies helps to generate interest and funding for future controlled clinical trials to explore the medical applications of Rhodiola.

Here is the case study in its entirety: “Ms. B., a 45-year-old mental health professional, had refractory depression and fibromyalgia for 5 years. Her symptoms were completely unresponsive to multiple trials of psychotropic medication. She had a partial response to the antidepressant sertraline (Zoloft¨, a selective serotonin reuptake inhibitor, SSRI), but this was not adequate for her to do more than carry out her daily job. The addition of 600 mg/day R. rosea extract (Rosavinª) enabled her to return to normal enjoyment and full productivity in life. It took about 2 months to see these effects. After 6 months, the patient began to doubt that she needed the R. rosea and discontinued it on her own, only to relapse over the next 3 weeks. Upon reinstitution of the R. rosea, she returned to full remission and remains well 2 years later on sertraline and R. rosea.”xix

Panax ginseng is certainly considered to be a key herb for enhancing energy and performance; an important consideration for fibrymyalgia patients. Furthermore, the stress that fibromyalgia patients experience can exacerbate their condition. Panax ginseng has long been recognized as an adaptogenic herb which helps restore the body to a state of equilibrium during periods of stress.xx In addition, animal research has attributed immune system enhancing effects to Panax, and human clinical research on Panax has also demonstrated cell mediated immune function in ill individuals (HIV infection, chronic bronchitis, etc), and in healthy individuals. This may help address the aforementioned role that infection may play in fibromyalgia.

Comments: Herbal medicine practitioners often use adaptogenic herbs such as Panax ginseng or Rhodiola rosea in the treatment of fatigue-related conditions such as fibromyalgia or chronic fatigue syndrome. The rationale is that the non-specific effects of the adaptogens in helping the body adapt to the deleterious effects of stress can improve energy levels and other aspects of the disorders.

Malic acid (magnesium malate)

In recent years, evidence has accumulated to suggest that fibromyalgia may be, at least in part, the result of local hypoxia (oxygen deficiency), in the muscles. For instance, patients with fibromyalgia have low muscle-tissue oxygen, pressure in affected muscles, and to a lesser degree, the same was found in other tissues. Muscle biopsies from affected areas showed muscle tissue breakdown and mitochondrial damage. Additionally, low levels of the high energy molecules ATP, ADP, and phosphocreatine were found. It has been hypothesized that in hypoxic muscle tissue, part of energy metabolism is inhibited, reducing ATP synthesis. This stimulates a process which results in the breakdown of muscle proteins to amino acids that can be utilized to make ATP. This muscle tissue breakdown, which has been observed in muscle biopsies taken from fibromyalgia patients, is hypothesized to result in the muscle pain characteristic of fibromyalgia.xxi,xxii

Malic acid is a natural substance derived both from food sources and synthesized in the body though the citric acid cycle. Since it plays a central role in energy production, especially during hypoxic conditions, malic acid supplements have been examined for their effects on fibromyalgia. Subjective improvement in pain was observed within 48 hours of supplementation with 300-600mg magnesium and 1200-2400 milligrams of malic acid; and this improvement was lost following the discontinuation of malic acid for 48 hours.xxiii While this study also used magnesium supplements, due to the fact that magnesium is often low in fibromyalgia patients, the rapid improvement following malic acid, as well as the rapid deterioration after discontinuation, suggests that malic acid is the most important component.

Comments: 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, although the 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).xxiv

Creatine monohydrate

As mentioned in a previous paragraph, low levels of phosphocreatine were found in the fibromyalgia patients. Since supplementation with creatine monohydrate increases phosphocreatine levels, there seems to be a possibility that supplementation may also have value for fibromyalgia patients. In fact, in an open-label trialxxv conducted on 30 fibromyalgia patients, creatine monohydrate was administered as an “add-on” to existing therapies. After 8 weeks there were significant improvement in parameters reflecting severity of fibromyalgia, quality of life and sleep, disability, and pain. These results deteriorated after stopping creatine therapy.

Just this year, a 16-week, double-blind, randomized, parallel-group, placebo-controlled trialxxvi was conducted in which 28 fibromyalgia patients were randomly assigned to receive either creatine monohydrate (20 grams for 5 days divided into four equal doses, followed by 5g daily as a single dose throughout the rest of the trial) or placebo. Muscle phosphorylcreatine content, muscle function, aerobic conditioning, cognitive function, quality of sleep, quality of life, kidney function, and adverse events were assessed. The results were that the creatine group ended up with significantly higher muscle phosphorylcreatine content, and greater muscle and isometric strength than the placebo group. However, no general changes were observed in aerobic conditioning, pain, cognitive function, quality of sleep, and quality of life. Food intake remained unaltered and no side effects were reported.

Comments: The results of the open-label trial were good, but limited by a high dropout rate. The 16-week study showed improvements in phosphocreatine levels and muscle, but not in other parameters including pain and cognitive function. Nevertheless supplementation did have value.

Coenzyme Q10

In a small studyxxvii with five fibromyalgia patients, low coenzyme Q10 levels were detected. Patients were supplemented with 300 mg coenzyme Q10 daily, and results were evaluated using the Visual Analogical Scale of pain (VAS) and Fibromyalgia Impact Questionnaire (FIQ). The outcome was that the patients showed a statistically significant reduction on symptoms after 9 months of treatment.

Another studyxxviii examined the effect of coenzyme Q10 deficiency and supplementation in ten juvenile patients with fibromyalgia, with 67 healthy subjects serving as the control group. The patients were given 100 mg of ubiquinol, an active and well-utilized form of coenzyme Q10. The results were that the ubiquinol supplementation improved chronic fatigue scores as measured by the Chalder Fatigue Scale.

Comments: Since, as previously noted, hypoxia may play a role in fibromyalgia, and since coenzyme Q10 enhances oxygenation at the cellular level, it does make sense that this supplement may offer benefit for fibromyalgia patients. Larger studies should be done.

A combination of dietary supplements

A randomized, double-blind, placebo-controlled study published in 2001, tested whether an integrated treatment approach based on simultaneously treating chronic fatigue syndrome (CFS) and fibromyalgia symptoms would have clinical benefit. Seventy-two men and women with fibromyalgia participated. All but 3 patients had CFS. Thirty-eight patients were randomized to the active intervention and 34 to the placebo intervention. Each patient received either all active or all placebo treatments as a unified intervention. In the active treatment group, all patients received 3/10 mg melatonin orally at bedtime, 1-2 tablets of 180 mg valerian (Valeriana officinalis)/90mg melissa aka lemon balm (Melissa officinalis) combination orally at bedtime, 1 tablet daily multivitamin every morning, and 2 tablets of magnesium with malic acid 3 times a day. The active group may have also been treated with a combination of conventional pharmaceutical sleep aids, and, depending on each individual’s clinical history, received a combination of antidepressants, DHEA, testosterone, estrogen, antifungals, vitamins, steroids, antibiotics, etc. To test efficacy, patients described their overall response to treatment, answered a Fibromyalgia Impact Questionnaire, had their Tender Point Index calculated (a measure of pain), and were asked the following questions on a visual analog scale: How is your energy? Sleep? Mental clarity? Overall sense of well being? And how bad is your achiness? Patients were followed for a median duration of 101 days in the active group and 96 days in the placebo group.

At the final visit, active patients showed significant overall improvement compared to placebo group (p<.0001). Likewise, there was a significant improvement in the Fibromyalgia Impact Questionnaire, Tender Point Index, and the analog scores (p<.0001). At follow-up (mean 1.9 years after beginning treatment), the active group showed continued improvement, a benefit that persisted after some or most of the treatment had ended.xxix

Comments: Clearly- an integrated approach is likely to yield better results than just focusing on one or two supplements.

Herbal anti-inflammatory agents: Guaiacum officinale, Boswellia serrata, Tanacetum parthenium and Cimicifuga racemosa

Certain anti-inflammatory herbs may have application in the treatment of fibromyalgia. These include Guaiacum officinale, Boswellia serrata, Tanacetum parthenium and Cimicifuga racemosa.

Although not a commonly known medicinal herb in modern times, Gauiacum resin obtained from wood has a traditional history of use for rheumatoid arthritis, chronic rheumatism and gout, relieving the pain and inflammation between the attacks, and lessening their recurrence if doses are continued.xxx Today, it is still used in naturopathic medicine for these same indications.xxxi

Note: In 1530, the medication guaifenesin was originally derived from guaiacum. More on guaifenesin appears later in this document.

At a symposium presented in Germany, many of the benefits of the herb Boswellia were described. Traditionally, Boswellia is used for a variety of inflammatory diseases, such as rheumatoid arthritis, osteoarthritis, and cervical spondylitis [inflammation of the vertebrae]. The main constituents are boswellic acids, which have been shown to exert anti-inflammatory effects. Boswellic acids have also been found to inhibit the synthesis of leukotrienes, inflammatory compounds associated with a number of chronic inflammatory conditions.

Corticosteroids, a type of pharmaceutical currently being used in Western medicine for the treatment of inflammation, also works by inhibiting leukotrienes and prostaglandins.

A report about one clinical investigation of the use of Boswellia in rheumatoid arthritis revealed that Boswellia was effective in reducing swelling and pain as compared to placebo, morning stiffness was reduced, patients reported cutting back on their intake of NSAIDs during the treatment period, and patients’ general health and well-being showed improvement. Boswellia was found to be effective in reducing the symptoms of rheumatoid arthritis in 50-60% of the patients involved in the investigation.xxxii -38 In addition, Boswellia has been recommended by respected herbal medicine practitioners for the treatment of fibromyalgia.xxxiii

Tanacetum parthenium, also known as feverfew, is well established for its prophylaxis and treatment of migraine, tension headache, and associated symptoms. This alone may be of value to fibromyalgia sufferers with these symptoms. In addition, extrapolations from pharmacological research suggest that this herb may have anti-inflammatory value for arthritis.xxxiv Furthermore, some clinicians have used feverfew as an anti-inflammatory in the treatment of fibromyalgia.xxxv

Comments: There are many herbal anti-inflammatory agents to choose from. I’ve listed these since they have had some limited history of clinical use for fibromyalgia.

Although Cimicifuga racemosa (Black cohosh), is not specifically anti-inflammatory, it does have anthrheumatic and anstispasmodic properties, as well as an extensive history of traditional use for arthritis, rheumatism and neuralgia. In addition, a randomized, double-blind, placebo-controlled trial with osteo- and rheumatoid arthritis patients found that a combination of Cimicifuga with willow bark, guaiacum resin, sarsaparilla, and poplar bark was statistically significant in decreasing pain.xxxvi Furthermore, modern medical herbalists have reported positive results with Cimicifuga for their fibromyalgia patients.

Branched chain amino acids

In one study, patients with fibromyalgia had significantly lower plasma concentrations of the three BCAAs (valine, leucine and isoleucine) and phenylalanine than normal controls. It is hypothesized that the relative deficiency in the BCAAs may play a role in the pathophysiology of fibromyalgia, since BCAAs supply energy to muscle and regulate protein synthesis in the muscles. The authors of the study stated, “A supplemental trial with BCAAs in fibromyalgia appears to be justified.”xxxvii

Comments: Although clinical trials have not yet been conducted using BCAAs in the treatment of fibromyalgia, there may be value in trying it out anyway given the results of the aforementioned study.

Ascorbigen & broccoli powder

Ascorbigen is the most prevalent of several dietary indoles shown to have significant physiological activity, and may be the essential component making dietary indoles beneficial. Ascorbigen is a skin-permeable form of Vitamin C formed from Indole-3-Carbinol in the presence of aqueous ascorbic acid. Ascorbigen is produced naturally in cruciferous vegetable juices when cell walls are broken through chopping, chewing, or juicing. Ascorbigen may exhibit synergy with Indole-3-Carbinol.xxxviii

In one study, twelve female fibromyalgia patients were given 500mg per day of a blend containing 100mg ascorbigen and 400mg broccoli powder in a preliminary, one-month, open-label trial. This group of patients showed an average 20.1% (p=0.044) decrease in their physical impairment score and an average 17.8 % (p=0.016) decrease in their total fibromyalgia impact scores as measured by the Fibromyalgia Impact Questionnaire. The average physical impairment score two weeks post-treatment showed a significant return to near pre-treatment level (p=0.028). Analysis of ten of the patients’ average threshold pain levels at the 18 possible tender points obtained before and at the end of treatment showed a strong trend toward an increase in the mean threshold pain level (p=0.059). The authors concluded that, “The reduced sensitivity to pain and improvement in quality of life measured in this study appear to be clinically relevant, and a larger, double-blind study is warranted.”xxxix

Comments: Ascorbigen helps the body prevent absorption of toxins through the small and large intestines, and exhibits provitamin, immunostimulatory, and skin-conditioning properties. Ascorbigen’s usefulness is largely attributed to its ability to support the body’s natural metabolism of hormones and promote good estrogen (2-Hydroxyestrone).

The guaifenesin protocol

The guaifenesin protocol is based upon a specific theory on the cause of fibromyalgia, promoted by Dr. St. Amand. This theory contends that “various defective genes adversely alter the renal handling of phosphate. A miniscule retention begins at birth, and ultimately overcomes the ability of bones to tuck that element away. The resulting gradual phosphate accumulation becomes system-wide and later reaches critical levels in certain tissues. An exuberant amount of phosphate eventually enters cells mostly in the company of calcium. Together, they initiate metabolic mischief that results in the symptoms of fibromyalgia. Phosphate excesses greatly impede the formation of energy (ATP), and despite this lack, excess calcium exhorts the cell to keep working. The ensuing cellular malfunction is actually an overworking and energy-deprived syndrome.”

The purpose of using guaifenesin is to reduce these excess levels of cellular phosphates. According to St. Amand who originated this therapy, “We begin patients with 300 milligrams (one-half tablet) twice a day for one week. If they feel distinctly worse, this is their dosage and they should remain at that amount. (This suffices for 20 percent of patients.) If symptoms do not worsen, we increase to 600 mg. (a full tablet) twice daily. Another 50 percent begin reversing at this dosage. This leaves about thirty percent who will need more. For these patients, we continue to slowly raise their dose of guaifenesin until an exacerbation of symptoms begins. We must stress that worsening or new symptoms signal that reversal is underway. As the reversal progresses, better hours gradually appear, eventually cluster into days and finally weeks. Like a bouncing ball, the up-and-down symptoms slowly ease, and the palpable lumps and bumps soften, break up and clear. Every two months at the proper dose should reverse at least one year of accumulated metabolic debris. Thus, the longer the illness has been present, the more time will be needed for total reversal. Newer lesions clear first and the oldest last. (Damaged structures from whatever cause cannot be restored.)”

St. Amand also warns, “Patients and physicians who do not heed the following warning can assume treatment failure. Aspirin and other salicylates will completely block the benefit of guaifenesin as they do uricosuric gout medications. There are many natural and synthetic sources of salicylate (salicylic acid), that will block guaifenesin’s action at a kidney site. Plants manufacture salicylates in quantities that vary from crop to crop. They are stored in barks, leaves, roots, and seeds as weapons against soil bacteria and fungi. The skin and intestine easily absorb salicylates from botanical sources, such as herbal medicines or supplements, lotions, cosmetics, and even garden plants.”

Comments: The guaifenesin protocol is controversial. Some research disputes any positive effect from this therapy at all. For example, in a double blind, placebo controlled study in 1995 at the Oregon Health Sciences University on fibromyalgia patients, Dr. Robert Bennett concluded that that guaifenesin was no better than a placebo (although Dr. St. Amand is convinced that several major flaws in the study caused this failure to show guaifenesin’s effectiveness).xl Other researchers believe that a therapeutic effect may indeed exist for some fibromyalgia sufferers, but not for the reasons espoused by St. Amand. For example, Mark London of MIT suggests that guaifenesin may work by an analgesic effect which he documents in a web article addressing this issue.xli


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vi Mills S, Bone K. Principles and Practice of Phytotherapy. Edinburgh: Churchill Livingstone; 2000:542-552.

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