Fibromyalgia
According to the American Chronic Pain Association, fibromyalgia affects an estimated two to four percent of the population, or about 6-12 million people. Although fibromyalgia can affect men and women, approximately ninety percent of people suffering from fibromyalgia are female. Fibromyalgia is a chronic condition characterized by muscle and joint pain, but often accompanied by a variety of other symptoms such as anxiety, sleeping problems, fatigue and morning stiffness.
What is Fibromyalgia?
Fibromyalgia is a disorder characterized by widespread musculoskeletal pain
accompanied by fatigue, sleep, memory and mood issues. Researchers believe that fibromyalgia amplifies painful sensations by affecting the way your brain and spinal cord process painful and non-painful signals.
Symptoms often begin after an event, such as physical trauma, surgery, infection or significant psychological stress. In other cases, symptoms gradually accumulate over time with no single triggering event.
Women are more likely to develop fibromyalgia than are men. Many people who have fibromyalgia also have tension headaches, temporomandibular
joint (TMJ) disorders, irritable bowel syndrome, anxiety and depression.
While there is no cure for fibromyalgia, a variety of medications can help control symptoms. Exercise, relaxation and stress-reduction measures also may help.
What are the symptoms of fibromyalgia?
The primary symptoms of fibromyalgia include:
• Widespread pain - The pain associated with fibromyalgia often is described as a constant dull ache that has lasted for at least three months. To be considered widespread, the pain must occur on both sides of your body and above and below your waist.
• Fatigue - People with fibromyalgia often awaken tired, even though they report sleeping for long periods of time. Sleep is often disrupted by pain, and many patients with fibromyalgia have other sleep disorders, such as restless legs syndrome and sleep apnea.
• Cognitive difficulties - A symptom commonly referred to as "fibro fog" impairs the ability to focus, pay attention and concentrate on mental tasks.
Fibromyalgia often co-exists with other conditions, such as:
• Irritable bowel syndrome
• Chronic fatigue syndrome
• Migraine and other types of headaches
• Interstitial cystitis or painful bladder syndrome
• Temporomandibular joint disorders
• Anxiety
• Depression
• Postural tachycardia syndrome
What causes fibromyalgia?
Many researchers believe that repeated nerve stimulation causes the brain and spinal cord of people with fibromyalgia to change. This change involves an abnormal increase in levels of certain chemicals in the brain that signal pain. In addition, the brain's pain receptors seem to develop a sort of memory of the pain and become sensitized, meaning they can overreact to painful and nonpainful signals. There are likely many factors that lead to these changes, including:
• Genetics – Because fibromyalgia tends to run in families, there may be certain genetic mutations that may make you more susceptible to developing the disorder.
• Infections – Some illnesses appear to trigger or aggravate fibromyalgia.
• Physical or emotional events – Fibromyalgia can sometimes be triggered by a physical event, such as a car accident. Prolonged psychological stress may also trigger the condition.
What are the complications of fibromyalgia?
Fibromyalgia can cause pain, disability, and a lower quality of life. US adults with fibromyalgia may have complications such as:
• More hospitalizations – If you have fibromyalgia you are twice as likely to be hospitalized as someone without fibromyalgia.
• Lower quality of life – Women with fibromyalgia may experience a lower quality of life.
• Higher rates of major depression – Adults with fibromyalgia are more than 3 times more likely to have major depression than adults without fibromyalgia. Screening and treatment for depression are extremely important.
• Higher death rates from suicide and injuries – Death rates from suicide and injuries are higher among fibromyalgia patients, but overall mortality among adults with fibromyalgia is similar to the general population.
• Higher rates of other rheumatic conditions – Fibromyalgia often co-occurs with other types of arthritis such as osteoarthritis, rheumatoid arthritis,
systemic lupus erythematosus, and ankylosing spondylitis.
How is fibromyalgia treated?
In general, most patients undergoing treatment for fibromyalgia will require a combination of medications and self-care strategies. The goal of treatment is to minimize symptoms while improving overall health. While there is no one size fits all treatment or cure, a combination of strategies can have a cumulative effect.
Medications
Medications can help reduce pain symptoms as well as improve sleep.
Here are a few examples:
• Pain relievers - Over-the-counter pain relievers such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others) may be helpful. Opioid medications are not recommended, because they can lead to significant side effects and dependence and will worsen the pain over time.
• Antidepressants - Duloxetine (Cymbalta) and milnacipran (Savella) may help ease the pain and fatigue associated with fibromyalgia. Your doctor may prescribe amitriptyline or the muscle relaxant cyclobenzaprine to help promote sleep.
• Anti-seizure drugs - Medications designed to treat epilepsy are often useful in reducing certain types of pain. Gabapentin (Neurontin) is sometimes helpful in reducing fibromyalgia symptoms, while pregabalin (Lyrica) was the first drug approved by the Food and Drug Administration to treat fibromyalgia.
Therapies
A variety of different therapies can help reduce the effect that fibromyalgia has on your body and your life. Examples include:
• Physical therapy - A physical therapist can teach you exercises that will improve your strength, flexibility and stamina. Water-based exercises might be particularly helpful.
• Occupational therapy - An occupational therapist can help you make adjustments to your work area or the way you perform certain tasks that will cause less stress on your body.
• Counseling - Talking with a counselor can help strengthen your belief in your abilities and teach you strategies for dealing with stressful situations.
Lifestyle Remedies
Additionally, various lifestyle remedies are available to help. Examples include:
• Stress management - Develop a plan to avoid or limit overexertion and emotional stress. Allow yourself time each day to relax. That may mean learning how to say no without guilt. But try not to change your routine completely. People who quit work or drop all activity tend to do worse than do those who remain active. Try stress management techniques, such as deep-breathing exercises or meditation.
• Sleep hygiene - Because fatigue is one of the main components of fibromyalgia, getting good quality sleep is essential. In addition to allotting enough time for sleep, practice good sleep habits, such as going to bed and getting up at the same time each day and limiting daytime napping.
• Exercise regularly - At first, exercise may increase your pain. But doing it gradually and regularly often decreases symptoms. Appropriate exercises may include walking, swimming, biking and water aerobics. A physical therapist can help you develop a home exercise program. Stretching, good posture and relaxation exercises also are helpful.
• Pace yourself - Keep your activity on an even level. If you do too much on your good days, you may have more bad days. Moderation means not overdoing it on your good days, but likewise it means not self-limiting or doing too little on the days when symptoms flare.
• Maintain a healthy lifestyle - Eat healthy foods. Do not use tobacco products. Limit your caffeine intake. Do something that you find enjoyable and fulfilling every day.
Alternative Therapies
The following alternative therapies for pain and stress are not new but still have a place as a treatment option today. These treatments have not been adequately studied but do appear to offer some pain and stress relief. Examples include:
• Acupuncture - Acupuncture is a Chinese medical system based on restoring normal balance of life forces by inserting very fine needles through the skin to various depths. According to Western theories of acupuncture, the needles cause changes in blood flow and levels of neurotransmitters in the brain and spinal cord. Some studies indicate that acupuncture helps relieve fibromyalgia symptoms, while others show no benefit.
• Massage therapy - This is one of the oldest methods of health care still in practice. It involves the use of different manipulative techniques to move your body's muscles and soft tissues. Massage can reduce your heart rate, relax your muscles, improve range of motion in your joints and increase production of your body's natural painkillers. It often helps relieve stress and anxiety.
• Yoga and tai chi - These practices combine meditation, slow movements, deep breathing and relaxation. Both have been found to be helpful in controlling fibromyalgia symptoms.
What is Low Dose Naltrexone?
LDN is a prescription drug that helps to regulate a dysfunctional immune
system. It reduces pain and fights inflammation. It is not a narcotic or a
controlled substance. It is an opioid receptor antagonist that is taken orally to block opioid receptors. An antagonist is a chemical that acts within the body to reduce the physiological activity of another chemical substance.
Naltrexone was approved by the FDA in 1984 for the treatment of opioid addiction, usually at a dose of 50-100mg a day. It blocks the receptors that opioids like oxycodone bind to negating the euphoric effect. However, at much lower doses, naltrexone has been used for autoimmune disorders like
Hashimoto’s disease as well as chronic pain.
For more information on how LDN works, please click here.
Image Credit: https://pubchem.ncbi.nlm.nih.gov/compound/Naltrexone
How does LDN provide relief?
Before we discuss how LDN works, we need to go over the role of endorphins in the body. Endorphins are opiate-like molecules in the body. They are produced in most cells in the body and are important regulators of cell growth and the immune system. The particular endorphin that has been found to influence cell growth is called Opioid Growth Factor (OGF). For an endorphin such as OGF to exert its beneficial effects, it must interact with the body’s cells. It does this by binding to a receptor on the surface of the cells.
Naltrexone is an orally administered drug that binds to opioid receptors. In doing so, it displaces the endorphins which were previously bound to the receptors. Specifically, by binding to the OGF receptors, it displaces the body’s naturally produced OGF. As a consequence of this displacement, the affected cells become deficient in OGF and three things happen:
1) Receptor production is increased, in order to try to capture more OGF.
2) Receptor sensitivity is increased, also to try to capture more OGF.
3) Production of OGF is increased, in order to compensate for the perceived shortage of OGF.
Since LDN blocks the OGF receptors only for a few hours before it is naturally excreted, what results is a rebound effect; in which both the production and utilization of OGF is greatly increased. Once the LDN has been metabolized, the elevated endorphins produced as a result of the rebound effect can now interact with the more-sensitive and more-plentiful receptors and assist in regulating cell growth and immunity. The elevated level of endorphins can result in an enhanced feeling of well-being as well as a reduction in pain and inflammation. The duration of the rebound effect varies from person to person but generally lasts about one day. This effect can only be utilized by taking a low dose of naltrexone and not a high dose or extended-release naltrexone.
What does the research show?
Research has been done over the years evaluating how LDN and its use in fibromyalgia patients. Some of the studies that have been published are smaller studies but show promise for the treatment of chronic pain using LDN. Studies include:
• Pain Medicine - showed a 30% reduction in symptoms compared to placebo with minimal side effects that were described as minor and transient.
• Current Rheumatology Reviews - found that LDN was an effective and inexpensive treatment option for fibromyalgia
• Biomedicines - found that not only were symptoms reduced but pro-inflammatory cytokines were lowered.
For a list of more studies, please click here.
What dosage forms are available?
LDN is available by prescription only from compounding pharmacies. It is available as an immediate-release oral capsule or a liquid. LDN is typically prescribed at doses from 0.001mg-16mg with the most common dose of 4.5 mg.
Ask your doctor or one of our compounding pharmacists if LDN is right for you.
Sources:
https://www.theacpa.org/conditions-treatments/conditions-a-z/fibromyalgia/two-takes-on-fibro/quick-facts-on-fibromyalgia/ https://www.nycpainspecialists.com/blog/2018/1/23/ldn-a-fibromyalgia-fix
https://kresserinstitute.com/low-dose-naltrexone-new-treatment-option-fibromyalgia/
https://www.cdc.gov/arthritis/basics/fibromyalgia.htm
https://www.mayoclinic.org/diseases-conditions/fibromyalgia/symptoms-causes/syc-20354780#:~:text=Fibromyalgia%20is%20a%20disorder%20characterized,process%20painful%20and%20nonpainful%20signals.
https://academic.oup.com/painmedicine/article/10/4/663/1829894?login=true
https://pubmed.ncbi.nlm.nih.gov/28325149/
https://pubmed.ncbi.nlm.nih.gov/28536359/