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Botanical and Nutritional Approach to Treating Fibromyalgia; Stephen W. Parcell, N.D.

FMS (fibromyalgia syndrome) is a widespread musculoskeletal pain and fatigue disorder for which the cause is still unknown. Fibromyalgia means pain in the muscles, ligaments and tendons—the fibrous tissues in the body. FMS used to be called fibrositis, implying that there was inflammation in the muscles, but research later proved that inflammation did not exist. The signs and symptoms are similar to Chronic Fatigue Syndrome (CFS), many feel they are one and the same. 
The predominant symptom is severe muscle pain, although other symptoms, such as fatigue, chest pain, low-grade fever, swollen lymph nodes, poor sleep or insomnia, frequent abdominal pain, irritable bowel syndrome, and depression, may be involved [1]. Of the estimated three to six million people afflicted with this disorder, the majority are women between twenty-five and forty-five years old.
Many fibromyalgia patients have an associated sleep disorder called the alpha-EEG anomaly. Most patients diagnosed with chronic fatigue syndrome have the same alpha-EEG sleep pattern and some fibromyalgia-diagnosed patients have been found to have other sleep disorders. For more information contact the Fibromyalgia Network, P.O. Box 31750, Tucson, AZ 85751 (800) 853-2929.
After a detailed history, the Naturopathic treatment of a patient with FMS might include stress reduction, exercises, counseling, dietary intervention, nutrient therapy, and specific botanical medicines. A reasonable therapeutic goal would be to strengthen, detoxify, and improve sleep.
Botanical Medicine:
There have been no clinical trials involving herbal treatment of Fibromyalgia. Many of the symptoms can be addressed, however, under an overall treatment plan. One could prescribe botanical drugs for many conditions here (adrenal exhaustion, stress, depression, fatigue, pain, etc). However, it might be prudent to focus the treatment on improving sleep first so that the efficacy of the other treatments can be more clearly assessed.
Cayenne (capsaicin cream). Use topically taking care not to involve sensitive skin areas. Initial burning usually subsides after a few treatments. Cayenne contains a resinous and pungent substance known as capsaicin. This chemical relieves pain and itching by acting on sensory nerves. Capsaicin temporarily stimulates release of various neurotransmitters from these nerves, leading to their depletion. Without the neurotransmitters, pain signals can no longer be sent [2].
For help with sleep , Passiflora incarnata (Passion Flower), Valeriana officionalis (Valerian), Eschscholzia califirnica (Californian Poppy) and Piscidia erythina (Jamaican Dogwood) could be used as a tea before bed. .
If a more comprehensive formula is preferred this one can be dispensed dry for use as an infusion. I like this formula because it addresses the nervous system, adrenal glands, and circulatory system. It could be used in conjunction with supplements.
·         2 parts Panax quinquefolium (American Ginseng)
·         2 parts Astragalus mongolicus
·         2 parts Angelica sinensis (Dong quai)
·         1 part Ginko biloba
·         1 part Cimicifuga racemosa (Black cohosh)
·         1/2 part Passiflora incarnata (Passion flower)
·         1/2 part Betonica officinalis (Wood betony)
·         1/2 part Matricaria chamomila (Chamomile)
·         1/2 part Zizyphus sativa (Jujube red dates)
This formulation is a tonic which will support people with chronic weakness, anxiety, headaches, sleep disturbances and general fatigue as well as diminished blood flow to the extremities. The person who needs this will probably have a weak pulse, weak digestive system, have headaches and will be fatigued. A dose of between half and one teaspoon (infusion) two or three times daily taken between meals is suggested.
 
Nutrient Therapy:
Magnesium:. Hypoxia and decreased tissue ATP is often seen in FMS. Through magnesium’s role in ATP synthesis tissue hypoxia and pain due to ATP deficiency can be reduced. Magnesium also inhibits platelet aggregation and dilates blood vessels. Levels of this mineral are often found to be low in patients with fibromyalgia [3-5]. 600 mg/day in divided doses. Some people may develop loose stools with this amount
5-HTP : Individuals with fibromyalgia often have low serotonin levels in their blood. Supplements of 5-HTP may increase serotonin synthesis in these cases. In one study patients took 200-400 5 -HTP or L-Tryptophan for one year. Both groups had significant reduction in pain and sleep disturbance. [6-10]. Taking B6 and Niacin concurrently might be a good idea. These factors are substrates for the synthesis of serotonin from tryptophan. 400 mg/day between meals.
Malic Acid: Malate is a substrate for the citric acid cycle. Given with magnesium, it may raise ATP levels in the tissue. It has been postulated that tissue hypoxia and ATP deficiency lead to gluconeogenesis with breakdown of muscle proteins [5]. 2400 mg malate and 600 mg Mag. /day.
SAM: Oral SAM was tested in one controlled study and had some significant beneficial actions, such as reduced pain, fatigue, and stiffness, and improved mood. 800 mg/day [11].
Thiamin: Fibromyalgic patients often have low thiamin status and reduced activity of some thiamin-dependent enzymes [12]. Thiamin has been successfully used with neuralgia. High doses of B1 can cause B6 or magnesium deficiency. 100mg/day.
Vitamin E: Vitamin E was shown to be effective for fibrositis in a 1942 study [13]. 400 - 800 IU/day.
 
References:
1.         Wolfe, F., et al., Aspects of fibromyalgia in the general population: sex, pain threshold, and fibromyalgia symptoms. J Rheumatol, 1995. 22(1): p. 151-6.
2.         Lynn, B., Capsaicin: actions on nociceptive C-fibres and therapeutic potential. Pain, 1990. 41(1): p. 61-9.
3.         Eisinger, J., et al., Selenium and magnesium status in fibromyalgia. Magnes Res, 1994. 7(3-4): p. 285-8.
4.         Eisinger, J., et al., Protein peroxidation, magnesium deficiency and fibromyalgia. Magnes Res, 1996. 9(4): p. 313-6.
5.         Russell, I.J., et al., Treatment of fibromyalgia syndrome with Super Malic: a randomized, double blind, placebo controlled, crossover pilot study. J Rheumatol, 1995. 22(5): p. 953-8.
6.         Chambliss, M.L., Are serotonin uptake inhibitors useful in chronic pain syndromes such as fibromyalgia or diabetic neuropathy? Arch Fam Med, 1998. 7(5): p. 470-1.
7.         Nicolodi, M. and F. Sicuteri, Fibromyalgia and migraine, two faces of the same mechanism. Serotonin as the common clue for pathogenesis and therapy. Adv Exp Med Biol, 1996. 398: p. 373-9.
8.         Stratz, T., et al., [Serotonin concentration in serum of patients with generalized tendomyopathy (fibromyalgia) and chronic polyarthritis]. Med Klin, 1993. 88(8): p. 458-62.
9.         Wolfe, F., et al., Serotonin levels, pain threshold, and fibromyalgia symptoms in the general population. J Rheumatol, 1997. 24(3): p. 555-9.
10.        Juhl, J.H., Fibromyalgia and the serotonin pathway. Altern Med Rev, 1998. 3(5): p. 367-75.
11.        Jacobsen, S., B. Danneskiold-Samsoe, and R.B. Andersen, Oral S-adenosylmethionine in primary fibromyalgia. Double-blind clinical evaluation. Scand J Rheumatol, 1991. 20(4): p. 294-302.
12.        Eisinger, J., et al., Effects of magnesium, high energy phosphates, piracetam and thiamin on erythrocyte transketolase. Magnes Res, 1994. 7(1): p. 59-61.
13.        Steinberg, C.L., The tocopherols (vitamin E) in the treatment of primary fibrositis. J Bone Joint Surg, 1942. 24: p. 411-23.