Youthful Aging By Norm Shealy
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Fibromyalgia is one of the most incapacitating and misunderstood of all reasonably common ailments. The prevalence of fibromyalgia in the United States and in Europe IS between 2 and 3% of the population. Although rheumatologists classify fibromyalgia as a distinct entity, the vast majority of physicians are frustrated by it and consider patients with fibromyalgia to be psychiatrically disturbed. Most fibromyalgia patients are treated with antidepressants, which have a mediocre benefit in the long run. Fibromyalgia patients have high annual and lifetime utilization of all medical services. Fibromyalgia patients report more symptoms and other disorders than patients with other rheumatic conditions and the total symptom complex of fibromyalgia patients leads to greater global disability.
The most common comorbid findings in patients with fibromyalgia are myofascial pain syndrome, depression, anxiety. Irritable bowel syndrome and chronic fatigue syndrome. Primary fibromyalgia patients are more commonly females aged 25 to 40 and complain of diffuse musculoskeletal pains, stiffness, fatigue, anxiety, poor sleep, headaches, subjective swelling of joints, irritable bowel syndrome and numbness. Despite complaints of joint swelling and the presence of multiple tender points at specific sites, there is no physical evidence of joint swelling. Symptoms are characteristically much worse during damp, cold weather. Most patients with fibromyalgia have been seen by numerous physicians before a diagnosis is made and the diagnosis is most often confirmed by referral to a rheumatologist. Standard treatment is nonsteroidal anti-inflammatory drugs, medications to ensure adequate sleep, local tender point injections and various physical therapy modalities. Antidepressant drugs are commonly used by family physicians and internists. They are not recommended as primary treatment defined in 1990 by the American College of Rheumatology. The Fibromyalgia Impact Questionnaire (FIQ), a 10 item, self-administered test measures physical function, work status, depression, anxiety, stiffness, fatigue and well-being. Some physicians consider fibromyalgia part of a ''affective spectrum disorder'' which shares common pathophysiological features with other mood disorders.
Emotional trauma is highly statistically associated with the onset of fibromyalgia. Physical trauma, especially when disability compensation is involved, is also common. Sexual abuse has been reported in 65% of fibromyalgia subjects but also in 52% of controls and thus seems not to be significantly more common in those with fibromyalgia.
Many biochemical abnormalities have been reported in patients with fibromyalgia: growth hormone-insulin-like growth factor-1 axis disorder (present in both fibromyalgia and chronic fatigue syndrome); low levels of serum serotonin; and increased 24 hour urinary cortisol excretion present in patients with post traumatic stress disorder and major depression.
Low Levels of IGF-I
Patients with fibromyalgia who have low IGF-I levels fail to secrete growth hormone after stimulation with Clonodine and L-dopa. Substance P, which is elevated in many patients with pain, has been implicated as has nerve growth factor and dynorphin A. Overall, hypothalamic-pituitary-adrenal axis dysregulation is present in both fibromyalgia and chronic fatigue syndrome. But interestingly, 24 hour urinary cortisol excretion, which is significantly increased in patients with post-traumatic stress disorder and major depression, is not present in patients with fibromyalgia. On the other hand, individuals with fibromyalgia have diminished 24 hour heart rate variability due to increased nocturnal predominance of low frequency band oscillations consistent with exaggerated sympathetic modulation of the sinus node. This latter observation is undoubtedly related to the sleep disturbances and fatigue common in this syndrome.
At the Shealy Institute hundreds of fibromyalgia patients have depression, as well as:
- Low or deficient levels of DHEA
- Deficient levels of taurine (86% of patients) and up to 7 essential amino acids
- Inability of the electroencephalo-gram to demonstrate appropriate response to photostimulation
- Significant increase in EEG asymmetry between the two hemispheres when an electric clock is placed within six inches of the head
- Deficiency of intracellular magnesium
The treatment program that works most effectively is:
- Transcranial electrical stimulation with the Liss cranial stimulator, SheLi series, one hour each morning for 4 to 12 weeks.
- Photostimulation for one hour daily
- Transdermal magnesium (2 teaspoons twice daily)
- B complex 100 mg. daily
- Physical conditioning
- Daily hot soaks or saunas
The success rate is far greater than more complex treatments including multiple injections at trigger points, extensive physical therapy, and antidepressant drugs.
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