Fibromyalgia Introduction

:fibromyalgia.jpg Fibromyalgia is a condition marked by achy pain, tenderness, and stiffness in muscles, areas of tendon insertion, and soft tissue structures. Any muscle or fibrous tissue may be involved. The most common areas are the neck, shoulders, low back, thighs, and hands. This condition does not affect joints.

Fibromyalgia is not an inflammatory disorder. The condition may be either generalized (primary) or localized (secondary), and is classified as idiopathic (having no known cause). Fibromyalgia may be precipitated by stress, poor sleep, trauma, exposure to cold, a systemic disease, or viral infection. Primary fibromyalgia is more common in women than men. Secondary fibromyalgia is often the result of trauma, or an overuse or overworking of the body. Men are far more likely to get this class of fibromyalgia. [1]

Fibromyalgia Symptoms

Pain is the primary symptom of fibromyalgia. Onset is usually gradual and diffuse. Secondary fibromyalgia can have an acute or sudden onset if it is trauma related. Stiffness is the second most common complaint. This too is diffuse, and is usually worse in the morning and after periods of exertion. Tenderness is present and localized to specific points (tender points). There may be muscle spasm and tightness.

Non-muscular symptoms include; poor sleep, insomnia, anxiety, depression, fatigue, and irritable bowel syndrome. Many of the non-muscular symptoms can exacerbate the muscular symptoms, resulting in a “feed forward” cycle. [2]

Fibromyalgia Statistics

  • It is estimated that 3 to 6 million Americans have fibromyalgia.
  • As many as 1 in 50 persons are affected.
  • 80-90% of the cases are women, usually in the childbearing age.
  • Men, children, and elderly account for the remaining 10-20% of cases. [3]

Fibromyalgia Treatment

Treatment of fibromyalgia is difficult because the cause is not known; therefore there is no target for treatment. Relaxation techniques, stress reduction, exercise, sleep therapy, stretching, massage, and hot and cold applications are all recommended to treat the pain and stiffness associated with fibromyalgia. Prescription medications can be useful to treat insomnia (anti-depressant medications), pain (corticosteroid injections), and depression (SSRIs).

Alternative therapies focus on underlying factors that can contribute to the development of fibromyalgia, such as nutrient deficiencies, oxidative stress, and neurotransmitter disregulation.

Supplements helpful for Fibromyalgia

Melatonin Melatonin is a substance secreted by the pineal gland in the brain in response to light and dark cycles. Melatonin is responsible for sleep/awake cycle patterns in individuals. Because the secretion of melatonin is greatest in the dark cycle of ones day, it improves sleep. Melatonin has been extensively studied as a treatment for various sleep disorders, including the associated sleep difficulties often seen in individuals suffering from fibromyalgia.

A study found that melatonin levels in individuals with fibromyalgia are lower during dark hours compared to normal controls. This decrease in melatonin is believed to contribute to a loss of sleep, daytime fatigue, and the increased pain perception in those with fibromyalgia. [4] Supplementation with melatonin for 30 days significantly improved patients’ global assessment and sleep quality. It also decreased the number of tender points and the severity of pain. [5]

5-HTP 5-HTP is a precursor to the neurotransmitter serotonin. Supplementation causes serotonin levels to increase within the brain, which is beneficial in treating fibromyalgia. Serotonin levels are often low, and brain metabolism is disrupted in the brains of individuals with fibromyalgia. Supplementation causes an improvement in mood disorders such as depression and anxiety. It also positively affects insomnia and the many body aches and pains of fibromyalgia. [6] In a short 30-day study, supplementation resulted in clinical improvement in all symptoms of fibromyalgia. [7]

SAM-e SAM-e is a cofactor in many biochemical processes in the body. It is anti-inflammatory, analgesic, and has slight anti-depressant properties, and has been studied as a treatment for fibromyalgia for such properties. In one study, SAM-e supplementation resulted in improvement in mood and a decrease in painful trigger points. [8] Another study found that SAM-e resulted in improvement in disease activity, decreased pain, decreased fatigue, decreased morning stiffness, and improved mood. [9]

Vitamin B12 Vitamin B12 is indicated for the treatment of fibromyalgia. Patients with fibromyalgia have increased levels of homocysteine in their blood. Homocysteine builds up in the blood as a response to deficient Vitamin B12, Vitamin B6, and folic acid. Studies have shown that the increased homocysteine, and more specifically, the decrease in Vitamin B12 correlates with the levels of fatigue in fibromyalgia patients. [10] Because homocysteine can also be elevated due to deficiencies in both Vitamin B6 and folic acid, these nutrients should also be supplemented.

Malic Acid and Magnesium Malic acid and magnesium have been recommended as a effective treatment for the reduction of pain in fibromyalgia sufferers. Supplementation reduces lactic acid, which is elevated in the muscles of individuals with fibromyalgia. Lactic acid is the by-product of anaerobic or oxygen deprived metabolism. It is the substance that causes muscle cramps after a heavy workout. Malic acid and magnesium also improve oxygen delivery to the muscles, which will decrease any new production of lactic acid. One study found that supplementation resulted in improvements in the variables of pain and tenderness, in patients suffering from fibromyalgia. [11]


[1] Beers M and Berkow R. Fibromyalgia. The Merck Manual 17th Ed. 1999: 481-482.

[2] Beers M and Berkow R. Fibromyalgia. The Merck Manual 17th Ed. 1999: 481-482.

[3] National Institute of Arthritis and Musculoskeletal and Skin Diseases. November 2004.

[4] Wikner J, Hirsch U, Wetterberg L, Rojdmark S. Fibromyalgia- a syndrome associated with decreased nocturnal melatonin secretion. Clin Endocrinol (Oxf). 1998 Aug; 49(2): 179-183.

[5] Citera G et al. The effect of melatonin in patients with fibromyalgia: a pilot study. Clin Rheumatol. 2000; 19(1): 9-13.

[6] Julh JH et al. Fibromyalgia and serotonin pathway. Altern Med Rev. 1998 Oct; 3(5): 367-375.

[7] Caruso I et al. Double blind study of 5-HTP versus placebo in the treatment of primary fibromyalgia. J Int Med Res. 1990 May; 18(3): 201-209.

[8] Tavoni A, Vitali C, Bombardieri S, Pasero G. Evaluation of s-adenosylmethionine in primary fibromyalgia: a double blind crossover study. Am J Med. 1987 Nov 20; 3(5A): 107-110.

[9] Jacobsen S, Danneskiold-Samsue B, Andersen RB. Oral s-adenosylmethionine in primary fibromyalgia: a double blind clinical evaluation. Scan J Rheumatol. 1991; 20(4): 294-302.

[10] Regland B et al. Increased concentration of homocysteine in cerebral spinal fluid in patients with fibromyalgia and chronic fatigue syndrome. Scan J Rheumatol. 1997; 26(4): 301-307.

[11] Russell IJ, Michalek JE, Flechas JD, Abraham GE. Treatment of fibromyalgia syndrome with SuperMalic: a randomized double blind placebo controlled crossover pilot study. J Rheumatol. 1995 May; 22(5): 953-958.


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