Counseling Sheet

Agatha M. Thrash, M.D.
Preventive Medicine

Fibrositis, fibromyalgia, and myalgic encephalomyelitis/chronic fatigue syndrome are all names for the same syndrome according to some researchers, only with different manifestations in different people.

The family of rheumatic diseases affects the joints, muscles, ligaments, tendons, and fibrous tissue of the body. There are some differences between these diseases and some overlaps.

The joints are not directly involved except as they are associated with the other structures. Because people suffering from this condition do not always have laboratory evidence of disease, they sometimes get labeled as being psychoneurotic.

It is said that the cause of myalgia rheumatica is unknown. We believe that we have discovered some factors that are at least to be considered in the disease. Other known causes are sleeping disorders, wear and tear of aging, overuse and abuse, poor posture, and trauma.

The causes we have found include food sensitivities and environmental toxicities including things that are breathed, as well as things that are eaten or drunk. Reactions to drugs, emotional strain, frustrations, hostility, and guilt tend to present greater risks for nonarticular rheumatism.

Women are more frequently afflicted than men, and the typical ages are between 35 and 60. It can begin, however, in the teenage years, or in the elderly. It tends to get worse with age.

Apparently about 0.01% of the population are fibromyalgia syndrome carriers. It tends to run in families suggesting some sort of inherited predisposition. It does not appear contagious. PET scans of people with this illness show that the frontal lobes do not get enough oxygen which can cause cognitive and memory problems. The oxygen deficit appears to reflect metabolic demand, rather than poor oxygen availability.

Because of disuse, many people with this disorder get muscle atrophy, Numbness over various parts of the body or in some instances all of the body can be associated also with loss of taste or smell and inability to distinguish water temperature on the head and body while showering. Swelling of the hands and fingers has been reported in 60% of patients. Irritable bowel syndrome is present in 34% of patients. Sleep disturbance is a characteristic sign of this disorder. Heat, massage, and exercise programs often help. One woman's symptoms cleared up dramatically when she was treated for Giardia and other intestinal parasites. This indicates that allergies to parasites or increased intestinal permeability may be a large part of the fibromyalgic syndrome. Candida is another culprit which could be a part of the fibromyalgia syndrome.

Eighteen points at various locations on the body have been discovered which are tender to firm pressure in most patients with fibromyalgia, and some chronic fatigue syndrome patients. At least 11 of the 18 points must exhibit tenderness for the diagnosis of fibromyalgia to be confirmed by this test. Tenderness is determined if the patient says the spot is tender but adjacent areas are non-tender.

Controlled trials have demonstrated improvement in fibromyalgia patients who underwent cardiovascular fitness training. Low-impact exercises such as fast-walking, biking, swimming, or water aerobics with stretching techniques have been the most helpful.Ice seems to help some patients while heat may make things worse. Put a heating pad on high until it gets hot. Turn it off and lie down with your back on it, then put the ice packs on the hips and thighs. It can take several hours of ice on and off to bring the pain down. For joint pain it can be a toss-up between heat and ice. Use whichever feels best.

Regularize your sleep cycle. Go to bed and get up at the same time each day - weekends or weekdays.

Find out where your muscle knots (trigger points) are and do stretching, starting with these painful muscles first. Hot packs will help relax them, and then massage and stretching will make them go away (for a while). Getting rid of the knots eliminates a lot of pain. If you do not know how to put the maximum stretch on the muscle, visit a library carrying books on muscle stretches.

Try a three month course of oral magnesium chloride. The pharmacist can make it up in a 25% solution. The usual dose is 1 to 2 teaspoons a day. However, it should be diluted in water or another liquid so as to make it palatable. Fibromyalgia patients are nearly always deficient in magnesium. If calcium, magnesium, and potassium are available in one dose, buy it. Get another preparation, a magnesium peroxide formula called Superoxide-Plus, which has been used with success by some to reduce pain and increase energy. Obtain it from a health food store.

Some patients note improvements in pain and fatigue when they take vitamin supplements of B-1 (100 mg.) daily, B-6, B-12, folic acid, and vitamin C. Try a 3-month course. If improved, try leaving one after another off for a month at a time to determine if certain ones are not useful and can be permanently discontinued.

Try using 1 tablespoon of flaxseed twice a day; Boswellia Plus, 2 capsules, 4 times a day; St. John's wort, 1 cup 3 times a day of the tea or 2 capsules 3 times a day; and white willow bark tea, 2 to 4 capsules every 4 hours while awake.

Research by Dr. James Penland revealed that those on low copper diets requested pain medications more often than those on diets containing normal levels of copper. The normal amount of copper required is 2 mg. per day. Good food sources are cauliflower, green peas, all beans and peas - especially soybeans and peanuts, kale, molasses, green beans, all nuts - especially pecans and walnuts, wheat germ, seeds, and yeast.

Symptoms are often relieved by warm and dry weather, a hot shower or bath, local heat, restful sleep, general relaxation, moderate activity, massage, stretching exercises, and swimming.

The patient may worsen the condition by anxiety, guilt, hostility, anger, stress, or consumption of coffee or tea.

Many who treat the fibromyalgia type of pain recommend taking fever baths for at least 20 minutes. See instructions in our book HOME REMEDIES pages 110 and 111. The only time some patients have been able to achieve a remission was after 3 to 4 series of 15 fever baths in a one year period. After each series take a break of 1 to 6 weeks. Once starting, continue until the series of 15 baths is finished: 1 bath daily for 5 days, skip 2, and repeat 3 times for a series.

Some have suggested a relationship between systemic candidiasis and fibromyalgia. If present, treat it.Garlic also helps. Use 1 to 5 fresh cloves sliced thinly at each meal for a 4 week trial, or use 3 Kyolic capsules, 3 to 4 times a day.

Do stretching exercises in a hot tub 4 to 10 times a week, with a water temperature about 103° F or whatever is comfortable, for 20 to 30 minutes. Remission for one patient on this routine for one year built up gradually, starting after the first month and continued at about 80% after the hot tub was discontinued. Stretching is highly beneficial even if a hot tub is not used.

Try to stay warm and flexible through warm clothing and whatever means needed. Try not to stand or sit too long, and wear support stockings and good shoes with arch supports.

You may wish to try lymphatic drainage massage if you have it available in your area. Alternating hot and cold packs can be most helpful, 3 to 5 minutes of hot, 30 to 60 seconds of cold.

Manual vibration (not mechanical) as well as ice massage, ice wrap, or ice pack, as tolerated may be helpful. "I have had very good results in dealing with my fibromyalgia symptoms by following a nonfat vegan diet," so goes the testimonial of one fibromyalgia patient.

Herb mix: 2 parts wild yam, 1 part licorice root. To one quart of gently boiling water add one heaping tablespoon of the herb mixture, 1 tablespoon of white willow bark, 1 tablespoon ground hawthorn berry, and simmer gently 20 minutes. Strain and drink the entire amount in one day. Make fresh daily.

A totally vegetarian diet should be used. This diet is the most favorable for nonarticular rheumatism. There are certain nutrients involved in making sugar metabolism in muscles more abundant, and in correcting biochemical abnormalities in sugar metabolism in fibromyalgia and chronic fatigue syndrome patients. These nutrients are vitamins B-1, B-6, C, and the mineral magnesium, and the substance called carnitine. There are foods high in each of these, but it is also possible to take them in pill form. B-1 should be taken at 50 to 300 milligrams a day, B-6 at 60 to 200, C at 50 to 500 milligrams per day, magnesium citrate or aspartate can be taken at 200 to 500 milligrams per day, and carnitine at 250 to 1,000 per day.

B-1: Oranges, tangerines, melons, figs, raisins, whole grains, nuts, spinach, dry beans, limas, peas, lentils, soybeans, smaller amounts widely distributed in natural foods.B-6: Whole grains, legumes, potatoes, bananas, and oatmeal. Small amounts are found in vegetables and fruits.

C: Raw fruits and vegetables, salads, cooked potatoes and cabbage, etc.

Magnesium: Nuts, well cooked whole grains, legumes, peanuts, carrots, spinach, and other greens.

Try working with an elimination and challenge diet to discover foods to which you are sensitive. Most patients with fibromyalgia have food sensitivities of which they are unaware. Discovering these and carefully avoiding the suspect food for one year can be of immeasurable benefit.

If your weight is normal or above, a day or two of fasting per week can do you a lot of good.

Some will be able to take a walk, a bicycle ride, a swim, or something comparable for 45 minutes on a daily basis as a minimum. There are times when more than 45 minutes can be spent, such as weekends. At that time one to three hours of exercise as strenuous as walking should be done. This may be yard work or other purposeful labor if desired. All who can do this much exercise will benefit from it.

About 60% of those with 11 or more tender points (the standard definition for fibromyalgia) did not have chronic widespread pain. Counts of tender points rose with age and were significantly higher in women. They were correlated with depression, fatigue and poor sleep patterns (Ref: AMERICAN JOURNAL OF EPIDEMIOLOGY, 138 (8):641 Oct 15, 1993).