Fibromyalgia (FM) is a mysteriously debilitating syndrome that afflicts between 6 and 12 million people in the United States. The condition bears a striking resemblance to chronic fatigue syndrome and affects mostly women (female to male ratio is about 10:1) between the ages of twenty-five and fifty. It is estimated that 15 to 20 percent of patients seen by rheumatologists have FM. Health care costs for people afflicted with this condition average about $10,000 per year, and FM patients are almost six times more likely than the general public to apply for disability payments. More than 25 percent of FM patients who remain employed report missing more than 120 days of work per year due to their disease.
The primary symptoms of fibromyalgia are generalized muscle pain, muscle tenderness, stiffness, and aching, along with significant fatigue. Other symptoms include sleep disorders, depression, poor memory and concentration, headache (tension or migraine), dizziness, tingling of the extremities, irritable bowel syndrome, irritable bladder (urgency and frequency of urination), temporomandibular joint syndrome (TMJ), cold intolerance, and allergic reactions to drugs, chemicals, and environmental toxins. Blood tests and X-rays normally do not reveal any specific abnormality. Ruling out rheumatoid arthritis, lupus, and other conditions with similar symptoms (especially pain and fatigue) to FM is an important part of the diagnostic evaluation. Some physicians believe FM to be a variant of chronic fatigue syndrome, since 90 percent of patients with FM report significant fatigue.
After many years of research, there is still no effective conventional medical treatment for fibromyalgia. Lyrica, an anticonvulsant, is often prescribed for FM pain. However, it can cause drowsiness, dizziness, dry mouth, constipation, and blurred vision. Antidepressants, such as Cymbalta, have been used to provide short-term relief for sleep disorders and depression, while anti-inflammatory medications have been used for treating the pain, with poor to fair results.
Since fatigue is such a prominent symptom with FM, I recommend avoiding strong indica strains and high-CBD products, both of which might increase fatigue. The MMJ products and delivery methods that seem to work best for FM are:
• Topicals—generalized transdermal patches (1:1/CBD:THC—daytime; CBN—evening); and transdermal gel pens (CBD, THC, and CBN).
• Vaporizing hybrids—both 50:50 strains and sativa-dominant hybrids (60:40 and 70:30—if you can tolerate the psychoactive effect). I’ve also had some patients with FM who do well with a 60:40 indica-dominant strain.
• Edibles—hybrid and sativa.
• Topicals—localized (Apothecanna Extra Strength and Mary’s Medicinals CBC seem to be most effective).
• Tinctures—1:1, 2:1, 3:1, or 6:1/CBD:THC.
• Tablets—both swallowed and sublingual; hybrids are best. Stratos tablets are available in both sativa (Energy) and hybrid (Relax), as well as 1:1 and 15:1/CBD:THC. Med-a-mints are also available in both sativa and hybrid sublingual tablets.
Although the cause of FM is unknown, most of the risk factors associated with chronic fatigue syndrome—especially food allergy (dairy products, wheat and gluten grains [barley, rye, and spelt], fermented foods, and nightshades [potatoes and eggplant] are most common), emotional stress, intestinal candida overgrowth, Lyme disease, nutritional deficiencies, and adrenal exhaustion—are also present with fibromyalgia. Research suggests that damage to the cells’ energy production in the mitochondria (the energy production center of the cells), as a result of an excess of free radicals, is the primary cause of FM. Reduced circulation to muscle cells and low levels of the neurotransmitter serotonin may also contribute to FM. The metabolic shutdown in the muscle cells might possibly be due to the accumulation of phosphate and uric acid. Some of the standard medications (Zyloprim) used to treat gout (elevated uric acid) and other drugs that reduce uric acid and phosphate (Probenecid, Sulfinpyrazone, and Robinul) have significantly improved the well-being of some FM patients. It is now known that in people who have FM, the body breaks down muscle protein at an unusually high rate and converts it to glucose for energy. It has been theorized that this increased level of muscle tissue breakdown is one of the primary causes of the pain, aching, and fatigue. Aluminum and heavy metal toxicity may also play a role in causing FM.
The majority of fibromyalgia patients report that their symptoms came on following some type of trauma or severe infection. Many women with FM have a history of abuse. This can alter neurologic and hormonal response and create abnormal responses to stress—generally a heightened nervous system response that may create painful trigger points in the muscles.
Most people with fibromyalgia need some Functional Medicine testing to determine underlying imbalances.
The most important tests are for the following:
• Adrenal function.
• Stool and leaky gut.
• Food sensitivity.
• Nighttime neurotransmitters.
• Genetic detoxification and methylation, if you are chemically sensitive.
A holistic doctor can do these tests to determine the underlying causes of your syndrome.
The holistic treatment for FM is nearly identical to that of chronic fatigue syndrome.
The anti-inflammatory, candida-control diet described in Chapter 5 is recommended for FM. Avoiding gluten is critical if you have FM. Many patients feel significantly better after making just this one dietary change.
• Malic acid: 1,200 to 2,400 mg daily, in combination with magnesium (300 to 600 mg daily), vitamin B6, and other synergistic factors. This product is available as Fibroplex from Metagenics. The recommended dosage is 2 tablets two to three times daily with food. These supplements help restore normal energy production in the muscle cells as well as aid in aluminum detoxification.
• MitoVive (Metagenics): Especially important to take for FM are vitamins and supplements that help to stimulate mitochondrial function. Recommended dosage is 1 scoop in water, one to two times daily between meals, especially before light exercise.
• SeroSyn (Metagenics): This product contains 5-HTP for increasing serotonin, which is deficient in most people with FM, along with skullcap, which helps ease pain, and ginseng for mental clarity. It can also help with sleep as well as overcome brain fog. Recommended dosage is 1 tablet three times daily at least ten to twenty minutes before meals.
• NutraGems CoQ10 (Metagenics): 300 mg of super absorbable CoQ10 in a chewable gummy form. Recommended dosage is 1 serving daily at breakfast.
• Intravenous vitamin and mineral injections: These often produce significant improvement, and should be administered three or four times in a two-week period.
• UltraClear RENEW (Metagenics): Periodic seven- to twenty-one-day detox programs using this product have been shown in two clinical trials to greatly benefit FM patients as a result of its effect on leaky gut, enhancement of liver function, reduction of heavy metal toxicity, and reduction of free radical activity. Participants in studies had fewer tender points, more energy, less stiffness, and more flexibility. UltraClear RENEW comes in the Clear Change detox kits that contain an instructional booklet and free online support.
• PhytoMulti (Metagenics): This product contains methylated B vitamins, antioxidants, minerals, and DNA-protecting plant extracts. Recommended dosage is 1 tablet two times daily with food.
Exercise is an essential part of the treatment program for FM, but high-impact exercises such as jogging, basketball, or any other activity that involves jumping should be avoided. Ideal exercises include walking, a stationary bike or treadmill, swimming, qigong, t’ai chi, and yogic breathing. Another excellent type of exercise is the use of an AquaJogger. This is a buoyancy belt that fits around the chest and allows the person wearing it to stand up in a swimming pool and either walk or run against the resistance of the water.
Try to gradually work up to forty minutes of exercise, three times a week. You may have to begin with only five to ten minutes per exercise session. Learn to listen to your body, and do not push yourself to meet unrealistic goals. This is especially hard to do if you have been used to leading a very active, busy life. You must slow down and give your immune system a chance to heal.
Trigger point injections, IV nutrition (Myers’ Cocktail), massage therapy, biofeedback, acupuncture, hydrotherapy, and electrostimulation have all been reported to be effective for some people with FM.
Almost all FM patients have a history of chronic overdoing. Not knowing their boundaries and limits is the hallmark of people suffering with FM. They often lack the ability to balance activity and rest.
If you are suffering from FM, you need to learn to say NO! You must create boundaries and strictly adhere to them. Stop trying to please and caretake others at your own expense. You cannot afford to ignore your needs and desires, and care for yourself as if you are “leftovers,” as one patient described herself. You must make yourself the top priority in your life.
Counseling is strongly advised with FM patients. They need to learn to strike a healthier balance between work and relaxation along with establishing a slower pace, a healthier rhythm, in all of their activities. Learning to say no is vital to this process of healing.
FM support groups can be found locally through the Fibromyalgia Network, an organization based in Tucson, Arizona. Their phone number is (800-853-2929). The Arthritis Foundation in Atlanta, Georgia, also helps organize support groups and educational classes (844-571-HELP).
Leona H. is an unemployed twenty-nine-year-old diagnosed five years ago with fibromyalgia. She had been having symptoms for three years prior to her diagnosis. They began shortly after the unexpected death of her mother, leaving Leona as the oldest of three, to care for her teenage brothers. Her father was always busy working and spent very little time at home with his children.
Following her FM diagnosis, she was prescribed gabapentin, which was minimally effective for reducing her pain, but it made her too sleepy to function. Her primary symptoms are joint pain along with pain in her shoulders, neck, and upper back. Without MMJ, her pain level is a 7–8 and she’s barely able to function. But after smoking or ingesting an indica, it is reduced to a 3–4. She often uses the topical cream Apothecanna Extra Strength, which has worked well for relieving the pain.
Leona has also had migraine headaches since the age of twelve. These too have responded well to MMJ. She had been having intense, incapacitating migraines approximately once a week, but now they’ve been reduced to one or two per month, with minimal pain, if she smokes a sativa within twenty to thirty minutes of the aura beginning.
She’s currently seeing a therapist one to two times a month and is finding that to be quite helpful. The one time I saw Leona for the renewal of her MMJ license, in November 2016, she was shocked at how strongly she fit the personality profile of both the typical FM and the typical migraine patient. Her comment after hearing these descriptions of the “issues in the tissues” was “This is very helpful. It makes me feel like I have a lot more power to heal myself than I thought I had.”