Naturopathic Newsletter January 2010: Fibromyalgia

January 2010

As you may have already realized, my newsletters aren't always sent in a timely fashion. They tend to pop up in your inbox at some point during the course of the month. The main reason is that I need to be inspired by a particular topic before I decide to sit down and write about it. Well, after days and days of un-inspiration, the moment finally came this morning. Over Sunday morning brunch, I had a very interesting conversation with a friend of mine who just completed his rounds at a pain management hospital in Sherbrooke. We got onto the topic of Fibromyalgia (FMS), and I was intrigued to hear how the conventional medical focus continues to be on the development of different psychotropic drugs. I find this approach interesting and often helpful, yet limited and reductionistic. As a result, I decided to dedicate this newsletter to discussing the naturopathic understanding and approach to FMS.

Since FMS falls into what I call a "grey zone", it is a condition that I often encounter in my practice. By "grey zone", I mean that it is an atypical condition often diagnosed through exclusion.

FMS was first described in 1843 as a type of "rheumatism", referred to as fibrositis. Only recently has this definition been recongnized as incorrect. Any term that ends in "itis" refers to a degree of inflammation contributing to the development of the condition. However, it has been well established that inflammation is not present in FMS. As a result, the name has been changed to fibromyalgia, characterized by genealized fatigue and aching in a minimum of 11 of 18 possible tender points that fit a particular distribution, including in the areas of the shoulders, buttocks, occiput, upper chest, knees, and elbows. The fatigue and pain is often accompanied by a variety of other symptoms, which can include:

insomnia

headaches

muscle cramps

numbness and tingling

irritable bowel syndrome (IBS)

interstitial cystitis

anxiety

depression

brain fog

weight gain

The likely presence of other symptoms lends to the condition being referred to as a "syndrome".

It is my opinion, that although pertinent, applicable and interesting, the conventional medical approach to FMS can be limited and reductionistic. The principal approach is to manipulate brain chemistry to alter energy, sleep, mood and pain perception. Seeing as brain biochemical imbalance is part of FMS, this approach does make sense. However, it is my experience that this approach is incomplete and fails to look at the whole individual.

The established brain biochemical patterns of FMS include:

decreased serotonin levels

decreased norepinephrine levels

decreased dopamine levels

increased substance P levels

As a result, conventional medical treatment often consists of:

selective serotonin reuptake inhibitors (SSRIs), such as celexa, prozac, paxil

serotonin-norepinephrine reuptake inhibitors (SNRIs), such as cymbalta, effexor

tricyclic antidepressants, such as elavil

Although this medications can offer an improvement for some patients, they also come with varied side effects, including:

anxiety

fatigue

emotional blunting / apathy

drowsiness

nausea/vomiting

decrease in sexual function

weight gain

The majority of patients with FMS present to my office looking for an alternative for 3 main reasons:

1. the medications listed above do not provide symptom relief,

2. the medications listed above do provide symptom relief, but with undesirable side effects, or

3. the patient is looking for a more wholistic approach.

Similar to the conventional medical approach, the naturopathic approach to FMS includes examining possible imbalances in brain biochemistry. However, the naturopathic approach does also take into consideration the likelihood of an adrenal and/or thyroid imbalance in these patients.

Research has shown that very often, the symptoms of FMS coinside with infection, emotional stress, and physical trauma.What do these 3 events have in common? They each pose a significant STRESS on the body. As I have explained to most of you in our consultations, and as I have described in past newsletters, the adrenal glands are the body's stress mediators. Whether that stress be from a virus, a divorce, or a car accident, the adrenal glands engage in a complicated hormonal and biochemical dance altering "normal" body function to allow for stress adaptation. If the adrenal glands are in a state of fatigue and struggle from years of our modern lifestyle, then a stressful event can be enough to tip the balance scale. Once that scale gets tipped, the body (including the mind) will start to manifest signs and symptoms of an imbalance, including the presentation of FMS.

The conventional assessment of adrenal function via a one-time cortisol measurement in the blood is often ineffective in identifying what is called adrenal fatigue or adrenal exhaustion. To assess adrenal function, it is best to assess cortisol levels through the saliva measured at 4 different times throughout the day. Should this saliva test assess that your adrenal glands are in an unhealthy state, then your ND will discuss therapeutic options ranging from vitamin and mineral therapy, to herbs, to the use of glandulars. Speak to your local ND of the potential role your adrenal glands may be playing in your health issues.

Similar to the role that adrenal function plays in one's health, i have spoken with many of you of the importance of OPTIMAL thyroid hormone function. It is estimated that almost 5 million, mainly female, Americans are walking around with an undiagnosed thyroid condition. This is because both the "typical" presentation of a hypothyroid patient, and the lab values for "normal" thyroid function are outdated. The symptom list of hypothyroidism is extensive, including fatigue, aches and pains, insomnia, weight gain, depression, anxiety, constipation/IBS, etc ... Notice how these symptoms also match the symptoms of FMS! An underlying cause of FMS is often suboptimal thyroid function. When the gland or the hormone levels are suboptimal, but not to the extent of reaching a diseased state, the lab values for TSH (as well as T4 and T3) are often within "normal" range. However, this range is too wide, excluding the patients with suboptimal function. In my practice, I see this commonly. Subsequently, when suboptimal thyroid gland/hormone function is addressed, the symptoms listed above tend to resolve, including FMS. Again, speak to your local ND of the potential role your adrenal glands may be playing in your health issues.

With regards to the possible brain biochemical imbalance, a body of research has shown the application of several non-pharmaceutical options that too can address and affect serotonin, norepinephrine, dopamine, and substance P. These non-pharmaceutical options, also called nutraceutical, have the benefit of carrying a shorter list of potential side effects. Some of these options include: 5 hydroxy tryptophan (5HTP), l-tryptophan, melatonin, malic acid, magnesium, etc ... These options, as individualized to the needs of each patient, can be discussed with your local ND.

As with all health issues, a principal tenant of both conventional and naturopathic medicine is to do no harm. Our job is to attempt to understand the underlying imbalances that are at play in a given individual, causing their signs and symptoms that bring them into your office. From that assessment, we are to chose the least invasive interventions to stimulate the body and bring about restoration of balance and health. That being said, FMS is an excellent example of the importance of that individual assessment. From brain biochemistry to adrenal health to thyroid function, it is important to gather a whole picture of the individual, allowing for a more complete therapeutic approach. And if that therapeutic approach can use agents that do less harm by carrying fewer side effects, then why not give these a try first.