Fibromyalgia Management Plan

As an information service Nutri-Pharm has developed a management plan specific for fibromyalgia.  We hope you find it useful.  The management plan is available free to download in PDF format if printed in its entirety via our Downloads page.

1. Diagnosis
Make sure a tender point examination is done because this is a key clinical feature, along with pain in all four quadrants of the body, and poor sleep.  Check with your local fibromyalgia support group for a doctor in the area who is experienced in fibromyalgia diagnosis if you are having difficulties finding medical answers.  Sometimes keeping a pain diary (rating your pain on a scale from 1 to 10, also recording sleep, medication taken, etc.) can help both yourself and your doctor.  Fibromyalgia appears to overlap with such conditions as irritable bowel syndrome, chronic fatigue syndrome and lupus erythematosus so it’s not diagnostically easy.

2. Sleep
Sleep is the vital piece of the fibromyalgia puzzle.  Deep (delta phase) sleep is required so that your body releases growth hormone to repair daily microscopic muscle damage.  If you suspect sleep apnoea (blocked airway related to snoring) or bruxism (teeth grinding which can cause TMJ, a type of severe joint pain) then consider visiting a sleep clinic to clarify the sleeping problem.  Most fibromyalgics are very light sleepers so make your bedroom quiet, dark and comfortable.  Establish a relaxing pre-sleep routine and aim to get to bed at a similar time each night.  Light aerobic exercise within four to five hours prior to bedtime can assist sleep by stimulating the release of the relaxant compound serotonin.

Many people benefit by using meditation or relaxing mental imagery as part of their sleep routine.  Avoid caffeine, alcohol and sugars before bed as these can disrupt sleep.  If you suffer from restless leg syndrome a quick short leg exercise routine before going to bed may be helpful.  A light massage with Myopax can help relax the muscles and assist with sleep.  Both over the counter and prescription sleeping tables have a role if sleep remains difficult.

3. Serotonin
Many of the problems of fibromyalgia, including poor sleep, increased pain sensitisation and migraine can be explained (at least in part) by reduced amounts of the neurotransmitter serotonin.

Serotonin is a “relaxant” chemical messenger in the brain which is required for healthy sleeping patterns, digestion and many other functions.  Serotonin is also involved in pain processing in the brain.  In a study of a drug known as fenclonene (which blocks the production of serotonin) normal patients who took the drug experienced severe fibromyalgia symptoms.

An emerging treatment for fibromyalgia is 5-HTP (5-hydroxytryptophan).  5-HTP is a natural compound (produced from the African plant Griffonia simplicifolia) which is converted in the body to serotonin.  A clinical study (by Caruso) comparing 5-HTP and placebo in treating fibromyalgia showed significant improvement in symptoms in the 5-HTP group.  5-HTP also has good anti-depressant properties and is well tolerated.

A combination used by many therapists for fibromyalgia is 5-HTP, St. John’s Wort (hypericium perforatum) and magnesium (low magnesium levels are found in many fibromyalgia patients).  See your health practitioner for treatment specific to your needs.

A very good food source of tryptophan (the amino acid the body uses to make serotonin) is turkey.  Taking thiamin (vitamin B1) and niacinamide (a form of vitamin B3) maximises tryptophan’s conversion to serotonin.  An excellent “serotonin sandwich” is therefore turkey on wholemeal bread with some sliced mushroom followed by a glass of ovaltine!

4. Dealing with the many aspects of Fibromyalgia
Fibromyalgia is a complex syndrome of different, seemingly unrelated symptoms (although research is starting to find the links between them).  The diversity of fibromyalgia symptoms can easily add confusion and stress to an already difficult illness.  A helpful approach in managing the syndrome can be to balance specific measures for specific symptoms along with a generalised view of the syndrome.  For example, massaging crampy leg muscles before going to bed is a specific treatment, but in allowing you to have better quality sleep, your entire fibromyalgia syndrome is being assisted.

Note also that many health workers specialise in quite narrow fields of interest, so that it can be easy to fragment a syndrome into a series of symptoms.

5. Exercise
A number of studies show that light exercise improves fibromyalgia, both in terms of pain management and lifestyle.  Stretching and aerobic exercises such as walking or swimming are quite beneficial.  Fibromyalgic muscles do not repair easily so exercise should not be high impact, or repetitive with high loads.  Many fibromyalgia sufferers find it painful to exercise, so try a light massage first and start slowly.  Exercise releases pain-killing endorphins so thing are often easier once you get started.  Note that typical “rehabilitation” type exercises involving repetitive exercises generally do not help fibromyalgia, and may make symptoms worse.

6. Massage
Many fibromyalgia patients benefit from massage.  Because fibromyalgic muscles often have microtrauma and decreased collagen content, the level of massage should be adapted to suit.  The end point should be more relaxed muscles without excessive pain.  Lymphatic drainage massage can be beneficial.  This is where the lymph vessels are gently massaged to mobilise lymphatic fluid, thus helping to clear the body of toxins.  It is worth finding a massage therapist who is experienced in fibromyalgia.

7. Pain relief
Research underlines the pain sensitisation mechanism whereby continual pain signals eventually lead to an increased pain response in the brain.  It is, therefore, very important to minimise your degree of pain wherever possible.  General measures include:

8. Diet
With the close association between fibromyalgia and irritable bowel syndrome the importance of diet is underlined.  Fresh fruit and vegetables are the favoured foods.  They contain many protective anti-oxidants, vitamins (which fibromyalgics often absorb poorly) and dietary fibre.  They also release sugars slowly, which helps fibromyalgia patients in a number of ways including improved sleep, better energy and reduced risk of migraine (see item 9).

Wholemeal bread is much preferred to white bread, and brown rice in preference to white rice.  Try wholemeal pasta instead of the more refined standard pasta.  These less processed products have many more vitamins and other nutrients and their sugars are more slowly released than the more processed equivalent.

Avoid refined sugars and other heavily processed foods.  These have very few nutrients and our digestive systems do not thrive on them.  Other “seemingly healthy” fast sugar release foods include fruit juices and potatoes.  Dilute fruit juice with water, and if you love your potatoes, try potato salad – this is the form of potato that releases sugar the slowest.

Some of these dietary adjustments take some will power, but many health benefits are possible as a reward for perseverance.

Most importantly, take time to eat, enjoy and properly digest your food.

9. Migraine
Many fibromyalgics suffer from migraine.  A common factor in the two conditions may be a shortage of the neurotransmitter serotonin.  Migraine sufferers have low levels of serotonin in their tissues and low serotonin is associated with increased pain response and poor sleep, the two classic symptoms of fibromyalgia.

5-hydroxytryptophan (5-HTP) is converted in the body to serotonin.  5-HTP has been shown to markedly improve migraine.  5-HTP is also well tolerated.  Another factor associated with migraine is fluctuations in blood glucose, with migraines often reported about 45 minutes after eating refined sugars (this corresponds to a high blood sugar level rapidly dropping). Avoiding refined sugars and foods which release sugar quickly can help control migraines.  Avoid alcohol and common allergy foods such as cow’s milk, chocolate, eggs, oranges and cheese.

Relaxation therapy can assist as well as magnesium and vitamin B6.

10. Thinking Problems
Many fibromyalgia patients find “mental fogginess” to be the worst aspect of the condition.  This may be due to an imbalance of serotonin in the brain or simply lack of sleep.  Making lists and being as methodical as possible can help as well as simplifying your daily tasks.

11. Myofascial Pain Syndrome (MPS)
The connective tissue of muscles is known as the fascia and myofascial pain refers to pain coming from both the muscle fibres and the related connective tissue.  Myofascial pain is generally a sharper more specific pain whereas fibromyalgia produces generalised aches.  The majority of fibromyalgia sufferers report myofascial pain.

MPS can cause migraine or tension headache, tennis elbow, sciatica, carpal tunnel syndrome and many other conditions.  MPS is characterised by trigger points which are very tight bundles of muscle and connective tissue that generate lots of pain when touched.

Treatment is with myofascial massage which is a specialised technique of long slow massage strokes that gradually “release” the trigger point.  Myopax may be used to assist during this massage.

12. Temporomandibular Joint Disorder (TMJ)
Many fibromyalgia patients suffer from this painful jaw condition.  This is where the hinge part of the jaw can become extremely painful and the associated muscle groups very tight.  Massaging the muscles with Myopax may help relax them.  Getting a mouth guard fitted may also help.