Overview

Fibromyalgia is a functional diagnosis, for which conventional medicine has identified no causative mechanism; its cause may be multifactorial, with multiple contributing factors. It may have an auto-immune component [Lelu2011  🕮 ].

Although Fibromyalgia and chronic fatigue syndrome appear to share many of the same symptoms and causative factors, they appear to be distinct disorders with different treatments. Hence, careful differential diagnosis based on history, signs, and symptoms is necessary for effective treatment [Liptan2016].

It is also possible that a patient may present with diagnoses of both Fibromyalgia and chronic fatigue syndrome.

Please see conventional, complementary, and alternative medical treatments for important background information regarding the different types of medical treatments discussed on this page. Naturopathic, Complementary, and Alternative treatments that may be considered include:

Etiology

The cause of Fibromyalgia is unknown, but among the theories that have been advanced, post traumatic-stress reaction [Liptan2016] appears most credible. In a nutshell, psychological or physical trauma induces a self-perpetuating cycle of sympathetic nervous system arousal ('fight-or-flight') that triggers and sustains prolonged abnormal muscle contraction. This prolonged elevated muscle tone in turn depletes muscle-mitochondrial energy stores, resulting in increased levels of lactic acid being produced. Lactic acid is responsible for the characteristic "burn" an athlete normally feels after a set of strength-training exercises. But whereas in normal athletic training, the lactic acid dissipates after the workout, in the case of Fibromyalgia, the muscle tension never relaxes, and the lactic acid can never dissipate. Unfortunately, the pain causes a reflex feedback cycle in which the neurological system is driven further into sympathetic arousal, and muscle tension is further increased.

In addition to driving painful muscle contractions, the elevated sympathetic nervous system arousal also disrupts the Fibromyalgia-sufferer's sleep, resulting in a hypervigilance that has been characterized as "sleeping with one eye open." This state prevents the patient from achieving the deep sleep state necessary for physical and mental repair. The end result of this unrestful sleep is daytime fatigue and mental fog.

Other contributing factors may include mitochondrial dysfunction. Note that Dr. Weyrich has argued that mitochondrial dysfunction may be secondary to overgrowth with yeasts and fungi, and [Shaw2008] has pointed out that elevated urinary levels of tartaric acid and other markers of overgrowth with yeasts and fungi are associated with Fibromyalgia [Dr. Weyrich: however, it is not clear that these findings are not better associated with a diagnosis of chronic fatigue syndrome].

Diagnosis

Symptom picture:
  • Widespread muscle pain.
  • Fatigue.
  • Brain-fog.

Differential Diagnosis

Treatment

Conventional Treatments

  • Effective Treatment of Chronic Fatigue Syndrome and Fibromyalgia - A Randomized, Double-Blind, Placebo-Controlled, Intent-To-Treat Study [Teitelbaum2000]

    • Naturopathic, Complementary, and Alternative Treatments

    Low Dose Naltrexone (LDN)

    Clinical studies have shown that Low Dose Naltrexone benefits Fibromyalgia. For example, a crossover study of 10 women diagnosed with fibromyalgia obtained a 30% reduction in symptoms, and also noted that "baseline erythrocyte sedimentation rate predicted over 80% of the variance in drug response. Individuals with higher sedimentation rates (indicating general inflammatory processes) had the greatest reduction of symptoms in response to low-dose naltrexone" [Younger2009  🕮 ]

    A follow-up randomized double-blind placebo-controlled crossover study of 31 women found that 32% of the participants had a significant reduction in pain and a significant reduction in either fatigue or sleep problems [Younger2013  🕮 ].

    In another study of 8 women with an average age of 46 years and symptom duration of 14 years, an average reduction of pain by 15% and overall symptoms of 18% was obtained after a treatment duration of 8 weeks. A reduction of inflammatory cytokines was also noted [Parkitny2017  🕮 ]

    The mechanism of action of LDN in treating Fibromyalgia appears to be via Toll-like receptor 4 antagonism and/or opioid growth factor antagonism [Toljan2018  🕮 ].

    See also [Yang2023  🕮 ]

    Dr. Weyrich has been trained to use Low Dose Naltrexone (LDN) and offers these protocols as a complement to other therapies; however at this time Dr. Weyrich has only treated two confirmed cases of Fibromyalgia using LDN:

    1. In the first case the patient did not adequately taper completely from high doses of opiates and therefore did not tolerate the treatment. Dr. Weyrich remains optimistic that a more prolonged wash-out period would have resulted in successful treatment.
    2. In the second case, the patient reported significant improvement in symptoms and remained on the treatment (as of 08/19/2019) See testimonial

    Dr. Weyrich strongly believes that LDN is a very beneficial intervention for treating Fibromyalgia, and he is actively recruiting patients.

    Please see What is Low Dose Naltrexone? for more information.

    Immune System Balancing

    [McCulley2018, pp 180, 223-228] reports that Fibromyalgia is not a true autoimmune disorder because there are no antibodies, but since it has other features of immune dysregulation, proposes an approach to treating this disease, which should be supervised by a properly trained medical professional. Dr. Weyrich has considerable interest in this topic, but has not treated any cases of Fibromyalgia with Immune System Balancing.

    Please see What is Immune System Balancing? for more information.

    Neuro-Gen High-Performance Neuromodulation (HPN)

    HPN has been reported to be useful for treating Fibromyalgia [Snook]. Dr. Weyrich has been trained to use Neuro-Gen High-Performance Neuromodulation system by it's inventor, Corey Snook. However, Dr. Weyrich has not treated any cases of Fibromyalgia with this technique.

    Please see What is Neuro-Gen High-Performance Neuromodulation? for more information.

    Neurofeedback

    Neurofeedback may be useful for treating Fibromyalgia. Dr. Weyrich has been certified in neurofeedback since 2008, and more recently completed an additional residency training program at ADD Clinic of Scottsdale, AZ. However, Dr. Weyrich has not treated any cases of Fibromyalgia with this technique.

    Please see What is Neurofeedback? for more information.

    Neurotransmitter Balancing

    Neuro Research [Hinz2015] reports that Fibromyalgia can be benefited by balancing neurotransmitter levels in the body.

    Dr. Weyrich has been trained in neurotransmitter balancing protocols, but has not treated Fibromyalgia using this technique.

    Please see What is Neurotransmitter Balancing? for more information.

    Pathophysiology

    • Elevated levels of tartaric acid (3-hydroxymalic acid or 2,3-hydroxy-succinic acid) are associated with Fibromyalgia. Tartaric acid is an analog of the Krebs cycle intermediate malic acid that inhibits the Krebs cycle enzyme fumarase that converts fumaric acid to malic acid [Shaw2008], [Russell1995  🕮 ].
    • Pain Is Real; Fibromyalgia Isn't [Ehrlich2003  🕮 ]
    • Stop using the American College of Rheumatology criteria in the clinic [Wolfe2003]
    • Fibromyalgia Among Friends [Smythe2004]
    • Diagnosis and Treatment of Hypothalamic-Pituitary-Adrenal (HPA) Axis Dysfunction in Patients with Chronic Fatigue Syndrome (CFS) and Fibromyalgia (FM) [Holtorf2008]
    • Secretory pattern of GH, TSH, thyroid hormones, ACTH, cortisol, FSH, and LH in patients with Fibromyalgia syndrome following systemic injection of the relevant hypothalamic-releasing hormones [Riedel1998]
    • Thyroid Functions in Patients with Fibromyalgia Syndrome [Neeck1992  🕮 ]
    • Neuromediator and hormonal perturbations in Fibromyalgia syndrome: results of chronic stress? [Neeck1994  🕮 ]
    • Health status and disease severity in Fibromyalgia: results of a six-center longitudinal study [Wolfe1997  🕮 ]
    • Diagnosis and Treatment of Hypothalamic-Pituitary-Adrenal (HPA) Axis Dysfunction in Patients with Chronic Fatigue Syndrome (CFS) and Fibromyalgia (FM) [Holtorf2007]
    • Fibromyalgia: a clinical review [Clauw2014  🕮 ]
    • AAPT Diagnostic Criteria for Fibromyalgia [Arnold2019  🕮 ]
    • Low Dose Naltrexone in the Treatment of Fibromyalgia [Metyas2018  🕮 ]

    References