Fibromyalgia (FM) is a common and potentially debilitating condition that can negatively impact every area of a person’s life. This chronic painful condition, formerly called fibrositis, affects mainly women, with an onset at ages 25-50 years. FM is characterized by muscle aches, stiffness and localized tender points. Related symptoms include chronic insomnia, anxiety, depression, headaches, numbness, extreme fatigue and digestive problems. Patients commonly complain of widespread pain and tenderness, and exhaustion after minimal effort. Often they feel unrested after sleep, although sleep laboratory tests are usually normal. Pain can be so severe that it is often incapacitating; yet pathophysiologic or laboratory reports may not show any abnormalities. FM resembles Chronic Fatigue Immuno-Deficiency Syndrome (CFIDS), and FM occurs more frequently in women with Polycystic Ovary Syndrome (PCOS). Anxiety levels are also increased, particularly in women with concomitant FM and PCOS.
Fortunately, lifestyle and environmental changes, sometimes coupled with appropriate medications, can relieve symptoms or even make them disappear. Medications such as antidepressants and muscle relaxants, are often used to treat FM. Pregabalin (Lyrica) and Milnacipran (Savella) are FDA-approved for the management of fibromyalgia, but are not effective in all patients, so there is continuous research to find other therapies. Gabapentin is a medication that is similar to pregabalin and has been shown to relieve FM pain.
Physicians and researchers at the Stanford Systems Neuroscience and Pain Lab are currently investigating whether the thyroid hormone T3 is one such treatment that may alleviate the symptoms of fibromyalgia. There is significant overlap between the symptoms of hypothyroidism (low thyroid hormone production), depression, chronic fatigue, and FM. Patients with low thyroid hormone production who have been treated with T3 for depression have had some improvement in symptoms. This is the first study to examine whether T3 may help with the symptoms of FM.
Also, at Stanford University, a single-blind, crossover trial showed that Low Dose Naltrexone (LDN) produced a significant reduction in fibromyalgia symptoms. In addition, pain thresholds were improved by LDN. Side effects (including insomnia and vivid dreams) were rare, and described as minor and transient. At higher doses (50mg – 100mg), naltrexone is a drug used to block the effects of opioids. However, at low doses (less than 5mg), naltrexone may have the reverse effect and actually strengthen analgesia. While the exact mechanism of this action is unknown, it is possible that low doses of naltrexone block the receptors on glial cells that are responsible for fibromyalgia symptoms. The drug has been used for many years off-label for the treatment of fibromyalgia, although this is the first clinical study.
Vitamin B-12 levels are often low in patients with fibromyalgia or Chronic Fatigue Syndrome. A malfunctioning thyroid or adrenal gland can decrease the ability of the body to absorb and utilize vitamin B-12. Vitamin B-12 is necessary for a healthy nervous system; it has been known for many years that depression and fatigue can be caused by low B-12 levels. SAMe is a supplement with anti-inflammatory, analgesic, and antidepressant effects. Malic acid and magnesium may help to relieve pain and tenderness of fibromyalgia. Ask our compounding pharmacist about the most appropriate supplements.
Evidence continues to emerge about the importance of hormone balance. For optimal benefit, therapy should be individualized with multiple problems treated simultaneously. Studies have reported that there is an altered hypothalamic-pituitary-adrenal axis (HPA axis) in CFIDS/FM, which means that the various glands that produce the body’s essential hormones may not respond to stimuli or feedback from another gland in a normal manner. This leads to altered function that is often overlooked when interpreting standard blood tests. Patients with CFIDS/FM typically have a number of hormonal deficiencies that must be addressed concurrently to assure successful treatment.
Low Dose Naltrexone (LDN) is available by prescription only from compounding pharmacies. We can also customize hormone therapy, including T3, to treat problems that have not responded to conventional therapy.