Healing Fibromyalgia: Treatments and Remedies to Heal and Recover from Fibromyalgia
HI Hipsters, welcome to the Health Is PowHer Podcast Episode #19, I’m your host Dr. Anna and I’m super uber excited to talk about fibromyalgia as I have had the most crazy experience dealing with this crazy achey burning muscle and joint pain. In our previous pain episodes, we figured out I developed this immediately after a flu shot likely due to a neuroimmune challenge from my past history with polyglandular autoimmune syndrome. But I had no idea it could be that freaking PAINFUL!
I mean I have had peritonitis folks for almost 3 months with multiple drains and tubes and surgeries/adhesions from abscess and whatever - nothing can compare to that myalgia pain.
And the chronic fatigue, the brainfog, and sleep issues that go with it are just very frustrating, and when I first got this, of course I was catastrophizing - which as a pain physician is a HUGE trigger to create more pain in our bodies. So I had to learn real quick to stop that catastrophizing and anticipatory anxiety in its tracks.
Today we’ll get into some of the treatments of fibromyalgia but before we do that I wanted to tell you a little about what’s going on in the background of fibromyalgia in our bodies. This isn't all inclusive, but it's what I could get through today so if you're interested in learning more, please don't hesitate to reach out to us on Instagram and comment on our posts this week! We would love to hear from you!
Diagnosis:
Multisite pain with moderate to severe fatigue, or even just sleep problems (even not getting restful sleep), trouble concentrating, forgetfulness, disorganised, or slow thinking, muscle stiffness and sensitivity to lights, noises, smells, or even cold sensitivity or maybe heat intolerance. Depression, anxiety, or other mood or mental health issues can co-exist.
There’s an increased risk of stress, adverse events, trauma, previous medical problems that can trigger fibromyalgia
First off, fibromyalgia is part of many of the chronic pain disorders that is called central sensitivity or central sensitization syndrome. A fancy name for something that describes our pain pathways being overactive and the pathways that block or stop the pain are underactive.
So when something shouldn’t cause us pain normally like touching the skin for example, causes us extreme pain. So for example, when weather changes occur or barometric pressure drops, our tissues can swell and thus causes the “fibro flares”.
Also, our brains are more active in the pain-processing regions (but this can be mitigated by some of the Incredible fabulous mind-body therapies - like meditation as we discussed in last HIP episode #18)
There may also be a problem with the nerve fibers themselves where they are damaged.
There may not be enough feel good neurotransmitters, like serotonin, norepinephrine (which are known to activate the pathways that block the pain!!!). Or there may be problems with our brain receptors that work with the neurotransmitters.
There is a neuroimmune problem
Meaning the nervous system and the immune system can go haywire - likely what happened to me after a flu shot developing fibromyalgia. There is low grade inflammation not usually detected on regular blood tests. There also is concern that fibromyalgia may be its own “autoimmune disorder” that is not detected through many of the standard blood tests - a hidden autoimmune disorder.
Neuro-Endocrine dysfunction can also occur - especially within the Pineal- Hypothalamus-pituitary-adrenal axis.
Viral illness:
Chronic viral infections have been linked to fibromyalgia - while more robust data is needed though One study did find association between herpes (HHV6) nerve damage and fibromyalgia. EBV had been previously studied as well as retroviruses - though not confirmed yet.
Treatment Options:
PHARMACEUTICALS:
Low-Dose Naltrexone - pilot study data that shows benefits and if you listened to episode 9 where Dr. Andi Roths, PharmD discusses LDN
LDN not only may benefit the pain symptoms, but may also help regulate some of that neuroimmune dysfunction - balancing it out to healthier state as we discussed can be disrupted in fibromyalgia
Gabapentin or pregabalin - this helps the nerve pain, but also ver effective in improving sleep. It can cause changes in vision, extremity swelling, cognitive slowing, sleepiness/daytime drowsiness, lightheadedness, dry mouth and some people it makes them hungrier and gain weight
Tricyclic antidepressants (maybe your doctor or healthcare professional discussed amitriptyline or nortriptyline) - which are considered muscle relaxants and increases those awesome neurotransmitters (serotonin and norepinephrine) in the spinal cord that block pain. However, these can cause significant sedation, and because it has properties like benadryl, it can make you extremely sedated, worsen the fibrofog, and cause concentration issues, cause urinary retention, dry mouth, and constipation). Also there is a warning that it can cause suidical ideation or worsen mood (especially for adolescents). However, this can also be effective for sleep!!!
Serotonin and norepinephrine reuptake inhibitors (duloxetine, milnacipran, venlafaxine (not as beneficial in trials)) - this is similar to tricyclic antidepressants though generally better tolerated. Significantly helps muscle pain and also helpful for people with co-existing depression. These can cause insomnia, constipation (maybe even diarrhea), dry mouth, nausea, headaches, and may even make some people hungrier.
Topicals: Compounding pharmacies can make topical lotions with muscle relaxant, anti-inflammatory, and lidocaine that can help with the fibroflares.
Naproxen or other OTC analgesics can work for flares but no evidence of benefit. Naproxen is generally more beneficial as it it works for 12 hours and there is less risk of medication overuse headache or rebound pain with the longer acting analgesics instead of ibuprofen or acetaminophen that lasts 4-6 hrs if used more extensively.
NON-PHARMACOLOGIC THERAPIES
Nutrition
Anti-inflammatory diet may have some benefit in fibromyalgia as eating inflammatory foods actually worsen the pain. Highly processed foods or even foods with gluten have been found to be a trigger for some living with fibromyalgia. However, this doesn’t mean it’s a forever thing or that we should fear food, it’s more about eating healthier and less focused on demonizing food. Because once you get inflammation down and gut microbiome and nervous system to start working back to its normal self, then these foods probably won’t bother people at all - or maybe in moderate amounts.
In episode 8 of the Health Is PowHer podcast, Randy Evans, master’s level integrative and functional medicine dietitian/nutritionist discusses what real healthy anti-inflammatory eating is and how to start. So download that episode and check it out to get started - you can’t go wrong eating healthier with healthy fats, protein, and complex carbs at every single meal - maximize those micro and macronutrients! If you missed his nutrition healthy eating 5-page guide to get you started on the right path that was free is now only going to be available for HIP members to launch late September!
BODYWORK
Encompassing myofascial release, physical therapy, massage, trigger point deactivation or osteopathic manipulation may be beneficial though it has mostly affected the health related quality of life and not so much moved the pain needle.
But regardless, bodywork itself is a DESENSITIZATION technique that does have to be done more frequently - and if not by a practitioner, then providing it for yourself through foam rolling, peanut lacrosse balls, one of those theracanes or back buddies to apply pressure to any knots on the shoulder, neck, back, hip, there are vibrating divides or electrostimulation devices like jeane rub or massagers that also help with desensitization. This should be done at least 5 times throughout the day for several minutes, even if it’s a pat or rub or brushing of the skin/tissue while at work or at school where there are areas of pain in the body.
For example, if someone is having amplified pain on their head or muscle knots around the back of their head/neck then just rubbing/scalp massage, applying pressure at the tender spots for a few minutes is DESENSITIZATION. You know when you hit your elbow on the door and then rub it immediately - and it feels better??? Well there’s an actual pain mechanism for why it works! Also don’t forget to Check out episode #15 on the benefits and the how-to of myofascial release.
ACUPUNCTURE
Acupuncture has been found to be effective for pain relief, sleep quality and general quality of life in fibromyalgia (though fatigue was not found to be reduced in this 690 participant systematic review by Kim et al. in 2019.
I’m a board-certified medical acupuncturist and absolutely have embraced acupuncture as a modality that has significantly helped many of our patients with pain at the large academic medical centers I have worked at. We currently have a team of medical acupuncturists that have found significant relief for our children, adolescents and young adults with pain syndromes.
If you have a medical acupuncturist (a physician acupuncturist) or a Licensed Acupuncturist in your area, sometimes it costs money depending on your insurance and some insurances cover acupuncture depending on your provider. Usually it’s beneficial to go once to twice weekly for the first month and then to space it out every 1-2 weeks and then monthly for maintenance.
Acupuncture works through multiple different mechanisms with one of the largest mechanisms being that when you insert an acuneedle (a cat whisker size one) into the actual acupoint - it basically sends a signal (like real electrons people) all the way up to the spinal cord and brain - activating those pathways that stop the pain. It activates these pathways that block the pain through releasing endorphins (opioid like substances), and neurotransmitters like serotonin and norepinephrine that I mentioned also blocks active pain pathways.
Acupuncture is also beneficial for relaxation, trauma (being used for veterans who have experienced significant PTSD) and providing more robust healing responses for specific conditions.
Supplements:
I tried multiple supplements even though there is a paucity of evidence for any of them to help fibromyalgia pain but the ones that stood out for me are Omega-3’s at high doses 2-4 grams daily (Wiley’s finest is the brand I typically recommend - nad I don’t have any financial conflicts with them - currently but I hope to work with them in the future because they do take the care to ensure healthy omega-3 levels as well as minimal contaminants). But omega-3’s typically are so hard to digest, fishy burps, indigestion and it has to be stopped before any surgery or if causing excessive bruising/bleeding.
COQ10 or UBIQUINOL
CoQ10 may improve fatigue in women with fibromyalgia, when I tried it I took a specific form called ubiquinol which did improve my energy levels as I noticed when I went off of it for a couple weeks I could feel the difference.
Vitamin D
Low Vitamin D has been linked to widespread pain and diminished immune system with a study showing that vitamin D replacement improved MSK pain/symptoms, depression and quality of life in patients with chronic widespread pain.
SAMe - or S-adenosylmethionine
It is typically found at Costco/walmart or other supplement stores or natural food stores has been studied to help treat co-existing condition of depression for individuals who haven’t responded to other antidepressants. However, SAMe can sometimes rev up irritability or energy for the first couple weeks so should be taken in the morning or at lunch and then switched over to night.
St. John’s Wort (hypericum peforatum)
A natural herbal antidepressant recommended by Rakel’s integrative medicine group to take 300 mg up to three times daily of a 0.3% hypericin standardized extract - preferably organic. However, when taking with medications it can lower the levels of those drugs - so be cautious with certain medications and always talk to your healthcare provider
ESSENTIAL OILS
This is something I used for myself as a certified aromatherapist, I created my own topical ointment after multiple fails and finally found one of my concoctions actually worked for the pain and muscle spasms, cramps, and stiffness and even for the burning of the skin.
I made it for many of our nurses and colleagues and their families and they swear by it too. I use this most days well when i’m not using my other bug repellent ointment concoction that I made as well.
It contains a special proprietary blend of organic oils of sesame, arnica, st. john’s wort, peppermint, black pepper, marjoram, frankincense, ginger, rosemary, pine and sometimes thyme and lavender. For long term use of essential oils I have to rotate different ones for safety reasons.
Anyhow, if any of you are interested in aromatherapy products like the muscle rub one above as well as bug repellent or even hand sanitizer with essential oils, let us know as we are thinking about a product line! DM us at @Health_Is_PowHer or email us at hello@healthispowher.com
REISHI MUSHROOM
I take a combination of medicinal mushrooms like turkey tail, reishi, shitake, lion’s mane throughout the winter to boost my natural killer T-cell count and it seems to be protective for me at least of viral illnesses. I used to get run down with being a pediatrician b/c i’d catch a virus every two weeks. Well anyway, Reishi has been found in one study to improve the physical fitness of women living with fibromyalgia, which is a huge plus b/c we all know exercise is so incredibly tough for those living with muscle pain.
PROBIOTICS
Certain prebiotics and probiotics have been looked at in small research studies with some showing decreased impulsivity and improved decision making capacities as well as decreasing inflammation and anxiety
AWARENESS of EMOTIONAL PAIN
Also, healing the emotional pain can heal the physical pain. Listen to the previous episode on The Secret Health Manifest which touches on how to let go of emotional trauma, stress, and misalignment of your higher self to finally allow your body to heal. The reason why emotional pain can worsen physical pain is BECAUSE THEY ARE ON THE SAME PAIN PATHWAYS. They are intertwined together. so one cannot heal without the other.
Don't forget, HIP Members Club is opening late September/early October, so please DM us at Instagram @Health_Is_PowHer or email us at hello@healthispowher.com to be on the waitlist. Founding members get a discount for life!!
This members club is for women finally wanting to make the choice for ultimate self-care to achieve the whole health. This is for women who are determined to take the next steps on their health journey. And most of all this is for women supporting women in all walks of life!!
We will have a monthly health and wellness topic with a live webinar and Q&A session that will be recorded to view for members at any time. In addition, we'll have a workbook, and a private facebook for all of us to support one another on this wellness journey.
First month we are going to work on "removing objections, blocks, and plateaus on our path to wellness". So stay tuned!