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Fibromyalgia - Background Information

•   10-12% of US population report chronic, widespread pain
•   At least 30% report chronic regional pain
• Some individuals have arthritis, bursitis, tendonitis, or other anatomically well-defined causes of pain – millions more have chronic pain syndromes
• Fibromalygia is the most common chronic, widespread pain syndrome

         American Pain Society. 2005. Guideline for the management of fibromyalgia syndrome pain in adults and children. www.ampainsoc.org [847-375-4715]

Onset of FMS

• 50% with insidious onset of pain and fatigue
• 50% associate onset with a traumatic events

Staud R. Fibromyalgia pain: do we know the source? Curr Opin Rheumatol 2004; 16:157-63

FMS – Genetic Disposition

• Relatives of FMS patients have higher than expected rate of FMS.
• Family members of patients with FMS also display a high frequency of a number of conditions related to FMS:
  •  irritable bowel syndrome
  •  migraine headaches
  •  mood disorders

Staud R. Fibromyalgia pain: do we know the source? Curr Opin Rheumatol 2004; 16:157-63

Triggers of FMS

Like many illnesses, FMS symptoms may occur when genetically predisposed individuals are exposed to certain environmental triggers that can initiate development symptoms. Stressors include:

•  physical trauma
• infections
• emotional distress
• endocrine disorders
• immune activation

Staud R. Fibromyalgia pain: do we know the source? Curr Opin Rheumatol 2004; 16:157-63

25(OH)D Deficiency & Fibromyalgia

• It is estimated that 40-60% of patients with fibromyalgia may have some component of vitamin D deficiency and osteomalacia.
• Patients often complain of aching bones and muscle discomfort. Such patients are often misdiagnosed with fibromyalgia, chronic fatigue syndrome, myositis, or other nonspecific collagen vascular diseases.

Holick, MF. Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am J Clin Nutr. 2004; 80(suppl): 1678S-88S.

Interleukin 10 Deficiency and Fibro

Objective: The term chronic widespread pain refers to a group of painful diseases of poorly understood pathophysiology. One major subgroup is fibromyalgia (FM), as defined by the criteria of the American College of Rheumatology. Among other hypotheses, a potential pathophysiologic role of cytokines in chronic widespread pain has been proposed. We undertook this study to investigate whether cytokine profiles differ in patients with chronic widespread pain and controls.

Conclusion: Chronic widespread pain is associated with a lack of anti-inflammatory and analgesic Th2 cytokine activity (IL-10), which may contribute to pathogenesis.

Uceyler N et al. Reduced levels of anti-inflammatory cytokines in patients with chronic widespread pain. Arth Rheum 2006; 54:2656-64

•  Specifically, a diet high in minimally processed, high-fiber, plant-based foods such as vegetables and fruits, whole grains, legumes, and nuts will markedly blunt the post-mean increase in glucose, triglycerides, and inflammation.
• Additionally, lean protein, vinegar, fish oil, tea, cinnamon, calorie restriction, weight loss, exercise, and low-dose to moderate-dose alcohol each day positively impact post-prandial dysmetabolism.
• Experimental and epidemiological studies indicate that eating patterns, such as the traditional Mediterranean or Okinawan diets, that incorporate these types of foods and beverages reduce inflammation and cardiovascular risk.
• This anti-inflammatory diet should be considered for the primary and secondary prevention of coronary artery disease and diabetes.

            O’Keefe JH, Gheewala NM, O’Keefe JO. Dietary strategies for improving post-prandial glucose, lipids, inflammation, and cardiovascular health. J Am Coll Cardiol. 2008; 51(3): 249-55

Ant-Inflammatory Supplements:

1. Multi (2/day)
2. Magnesium (400-1000 mg/day)
3. EPH/DHA (1-3 g/day)
4. Vitamin D (1,000-10,000 IU/day)
5. L. acidophilus & bifidus

Additional antiox & anti-inflammatory spices:

• co-enzyme Q10 (100 mg/day)
• a-lipoic acid & acetyl-L-carnitine
• Ginger/turmeric/boswellia (2 caps/day)

 Information quoted from Dr. Seaman's 2008 Dayton, OH Seminar Series