Fibromyalgia

The main symptoms of fibromyalgia are deep muscle pain, painful tender points, and usually morning stiffness.  Other major symptoms include:

• Fatigue
• Concentration and memory problems-brain fog or "fibro fog"
• Headaches
• Irritable bowel syndrome
• Depression
• Anxiety
• Sleep disoder
• Sometimes genitourinary symptoms including bladder pain and vulvodynia

Fibromyalgia tends to be widespread affecting the entire body rather than just 1-2 joints or muscle groups. Patients may describe their pain differently-deep, dull, throbbing, sharp or aching involving muscles, joints, ligaments and tendons.  The intensity of the pain often fluctuates. Some patients say they have recurrent flulike symptoms.

Fatigue is very commonly associated with fibromyalgia. Many patients with fibromyalgia have also been diagnosed with chronic fatigue syndrome. Patients are usually tired in the morning because of unrefreshing sleep. Although they may sleep through the night, their sleep is not restorative.

Treatments offered at this clinic:

Allergy testing and treatments.  Allergies are often the cause of fibromyalgia and associated symptoms including fatigue, pain, headaches, "irritable bowel syndrome", brain fog and depression. Keep in mind-allergies are inflammatory reactions wherever they occur. Allergic myalgia is not commonly recognized as a cause of muscle pain, although such information has been published in the medical lecture as far back as 1927. A classic description of allergic myalgia by my mentor Theron Randolph, M.D.

"Myalgia may be a specific allergic response of striated musculature; it may involve a particular segment of a given muscle, an entire muscle, regional groups of muscles or generalized muscle soreness and aching, especially upon arising the following morning after the ingestion of a specific allergenic foods the previous day.  Afflicted individuals sometime describe this generalized reaction as aching all over or liken it to the feeling of having been severely pummeled the preceding night.  Of the various localized reactions, involvement of the posterior cervical muscles, especially the trapezius and sternocleidomastoid muscles seem to occur most commonly".

Trigger point injections- also known as myofascial release based on the brilliant and pioneering work of Janet Travell, M.D.  This involves injections of procaine into specific "trigger points" commonly found in patients with fibromyalgia and chronic pain.

Neural Therapy-intradermal procaine injections usually with micro-doses of anti-inflammatory, anti spasmodic, lymphatic drainage formulas and mitochondrial enzymes.

Intravenous Myers cocktail or other micronutrient IV therapies

External Enhanced Counterpulsation (EECP) with oxygen therapy-to improve cellular oxygenation and function and mitochondrial restoration.

Hypothyroidism treatment.  Deficiencies of thyroid hormone can lead to fatigue, pain, brain fog and many other symptoms.  Therefore, it is essential to do thorough evaluation of thyroid function including TSH, free thyroxine, free T3, reversed T3 and thyroid antibodies.  Some patients have normal thyroid function yet have subclinical hypothyroidism and do respond to thyroid supplementation with careful monitoring.

Most authorities agree that pain and sleep management along with psychological support are fundamental in helping patients with fibromyalgia.  Mild exercise is often very helpful and it is very important that patients learn how to pace themselves and not push themselves beyond their capacity.

Nutritional supplements can often be helpful for fibromyalgia such as:

• 5-hydroxy tryptophan 100 mg three times daily; helps reduce pain and induce sleep

• Malic acid/magnesium-pain reduction and improved energy. Magnesium 300-600 mg/malic acid 1200-2400 mg daily total, decrease if diarrhea. (Super Malic-six tablets twice daily).
• L-carnitine 1500 mg b.i.d. to improve mitochondrial function
• Coenzyme Q10 100-300 mg-stimulate mitochondrial function.
• Acetyl l-carnitine 500 mg three times daily, improve energy and brain function

If needed- low-dose tricyclic antidepressants to help with sleep such as doxepin 5-10 mg or trazodone 50-150 mg.

Guaifenesin-safe and usually effective treatment; involves strict avoidance of salicylates, which can be very difficult.

Laboratory Testing options:

Metabolic acidosis and cellular oxygen levels-using venous blood gases; normally used to test arterial blood. Gives information about cellular metabolism and acid/alkaline balance.

Peripheral arterial tonometry (EndoPat)-detects microvascular and nitric oxide dysfunction, which leads to impaired circulation and lack of oxygen to cells, pain and fatigue.

Functional nutritional analysis (Spectra Cell)-vitamin/mineral levels.  Based on work of Dr. Roger Williams, who believed in biochemical individuality, which can detect nutritional deficiencies of immune cells for each individual.

Urine organic acid testing-to evaluate metabolic blockage, detoxification pathways and nutritional imbalances.

Prescription medications-

The fibromyalgia diagnosis fits under the category of a rheumatological condition.  Most patients with this condition consult a rheumatologist at one time or another.  In general, rheumatologists have a strong interest in helping patients with this often debilitating condition. They are quite skilled in utilizing medications I myself don't commonly prescribe such as:
•    Fluoxetine (Prozac)-antidepressant
•    Sertraline (Zoloft)-antidepressant
•    Duloxetine (Cymbalta)-antidepressant
•    Pregabalin (Lyrica) anti-seizure medication, pain relief
•    Milnacipran (Savella)-antidepressant
•    Tricyclic antidepressants-doxepin, trazodone
•    Pain medication-oxycodone, OxyContin
•    Neurontin-anti seizure, pain management