Polymyalgia and Fibromyalgia Syndrome

The medical definition of fibrositis is “an inflammation of the white fibrous tissue of the body, especially of the muscle sheaths, ligaments, tendons, periosteum and facial layers of the locomotor system and marked by pain and stiffness”.

Recent evidence suggests that inflammation is not a common observation in fibrositis.

Lately, fibrositis has been divided into two distinct categories: Myofascial Pain Syndrome and Fibromyalgia Syndrome. Fibromyalgia is not simply just a muscle pain syndrome as most presentations involve an array of other symptoms.

The important issue here are, that this condition is not deforming, degenerative, life-threatening or imaginary; and, there will be flare-ups.

Fibromyalgia Syndrome can be recognized by the following:

• Chronic and generalized aches, pains and stiffness involving more than three anatomical sites for more than three months.
• Disordered sleep patterns especially stage 4 non-rapid eye movement sleep, which is the deep sleep we need.
  • Absences of other systemic conditions to account for these conditions.
  • Multiple tender joints at characteristic locations.
  • Severe fatigue.
  • Affects more women (up to 5%) than men (about 0.5%) and is influenced by the hormone cycle. 20% of fibromyalgia sufferers are over 60 years of age.
  • Myofascial Pain Syndrome is more localized, associated with tender spots (neck and shoulder) and sleep disturbance without chronic fatigue.

Sufferers of this condition often attribute a precipitating event to the initial onset of symptoms. These events include flu-like illness, human immunodeficiency virus, Lyme’s disease, particular parovirus, persistent stress, chronic sleep disturbance and physical trauma.

It appears that the basic pathological mechanism is micro or macro muscle trauma resulting in mitochondrial dysfunction in the muscle cells. This gives rise to decreased ATP energy production, loss of intracellular magnesium and potassium and accumulation of calcium. The calcium leak within the muscle cells would cause small fibres of muscle to contract in otherwise relaxed muscles. This will give rise to the palpable fibrous bands or nodules found in these patients. The reduced production of energy phosphates and dependence on anaerobic metabolism may give rise to local increase in lactic acid and other waste products within the tissue, giving rise to local muscle pain.

The treatment of this condition is centered around determining what factors are causing the deterioration in mitochondrial function i.e., viral, chemical, toxic waste products, physical trauma, tissue oxygenation problems or oxidant damage or stress, and treating the secondary effects of this dysfunction.

Nutrients that may play a part in improving mitochondrial function and ATP production are:

• Coenzyme Q10
• Pyridoxine
• Thiamine
• Niacin
• Magnesium, Vitamin C
• Manganese
• Pantothenic acid

Nutritional treatment includes:

• Ruling out the presence of rheumatoid arthritis, osteoarthritis and hypothyroidism.
• Checking for food allergens. Most common ones are dairy, soy, citrus, peanuts, wheat, fish, eggs, corn and tomato.
• Improving bowel waste elimination by supplementing with glutamine, fibre (e.g., Normafibe) and a probiotic (e.g., NutraLife Probiotica P3).
• Ensuring proper digestion is occurring by supplementing with digestive enzymes.
• Supporting liver detoxification by supplementing appropriately. Consider Legalon milk thistle capsules ONE three times a day.
• Reducing oxidant stress by supplementing with antioxidant nutrients such as vitamin C, E, selenium, manganese, copper, zinc and coenzyme Q10. 
• Reducing muscle pain and depression by supplementing with dl-phenylalanine, vitamin B1 and B6, and cayenne.
• Improving sleep and anxiety by supplementing with magnesium and vitamin B3. Consider Blooms Tri-Magnesium capsules and use TWO capsules, at night before bed.
• Supporting mitochondrial metabolism with coenzyme Q10, magnesium, vitamin B2, B3 and B5. Consider coenzyme Q10 150mg at breakfast and dinner.
• Increasing energy output with creatine phosphate.
• If myalgia is post-viral, supplementing with quercetin and omega oil (evening primrose oil and fish oils). Bioflavenoid vitamin C combinations are best.
• Avoiding aggravating factors.
• Using stretching and flexibility exercises like yoga and muscle massage.
• Using aspirin and non-steroidal anti-inflammatories like Voltaren, whilst being aware that these drugs can cause leaky gut syndrome in some individuals. Non-steroidal anti-inflammatory drugs are generally associated with potential rises in blood pressure, and bearing in mind the average age of a fibromyalgia patient generally, they should be avoided. Alternatives include Nageze Osteo Plus, which is a turmeric-based anti-inflammatory, of similar potency to Voltaren, but without accompanying risk.

A multidisciplinary approach is essential because management of fibromyalgia is very demanding. Self help must be encouraged to maintain treatment. Symptoms are worsened by emotional stress, medical illness, trauma, cold damp weather, overexertion and surgery. Tai Chi and exercise in warm water, preferably first thing in the mornings, have both been shown to offer remedial therapy without aggravating muscle systems.

Sound wave therapy has also been shown to reduce inflammation. Details of that treatment can be found at www.botanicamedicines.com.au