Fibromyalgia is a challenging diagnosis to get. First of all, most conventional treatments for it are barely effective. Secondly, it often gets misdiagnosed as other conditions, which makes getting proper care even more difficult. And thirdly, there is still some stigma involved with having it when it comes to mainstream medicine. Thankfully, some pioneers have shown how holistic fibromyalgia relief can be both validating and effective, paving the way for better care.
Fibromyalgia is confusing for both patients and doctors. Up until two decades ago, healthcare professionals believed it was just in the patient’s mind, that there was no actual underlying physiological issue. And, because it affects mainly women, they thought it was some kind of gender-related exaggeration. This is similar to what Chronic Fatigue Syndrome patients had to deal with and also what we’re dealing with now with regards to Adrenal Fatigue Syndrome (AFS).
It was only after a study that came out in 2002 that doctors and researchers saw that, indeed, there are actual physiological differences in those with fibromyalgia. In that study, they exposed participants to gradually painful stimuli and asked them to report when they felt pain. The fibromyalgia group reported experiencing pain when the stimuli was at half the intensity as it was with the control group. This means that these participants were twice as sensitive to pain as those without the condition.
They also had these same participants go through brain scans and found that those with fibromyalgia had hyperactivity in certain brain areas that those without the condition did not.
Indeed, nowadays, the research agrees that fibromyalgia involves the central nervous system (CNS). If you have fibromyalgia, your CNS is more sensitive to pain and lacks the ability to control its pain signals.
This is sometimes referred to as Central Sensitization, and it has two main components. The first is that your brain is unable to turn down, or suppress, the pain signals traveling to the rest of the body. The second is that your spinal cord, which is part of your CNS, amplifies the pain signals coming up from your body to your brain. The result is a generalized feeling of pain and tenderness in your muscles, but with certain hotspots.
From the brain, you have the descending fibers that go down to the spinal cord. From the body, you have what are called peripheral nociceptors. Those are pain receptors in your peripheral nervous system (PNS), the part of your nervous system that branches out from the spinal cord to the rest of your body, into the muscles and soft tissues. These nociceptor fibers converge into the peripheral nerve, which goes into what’s called the dorsal root ganglia. They then travel up the dorsal horn of the spinal cord towards the brain through what are called the ascending fibers.
The reason it’s good to understand the pain pathway is because, with holistic fibromyalgia relief, you combine different approaches that intervene at each of the different points in that pathway. For example, you may intervene at the peripheral nociceptors but also at the ascending fibers. We’ll get into each in more detail in this article.
More recently, researchers discovered that it’s not just neurons involved in Central Sensitization, but also glial cells, which are the other type of cell in your CNS along with neurons. While neurons’ main role is to transmit electrical and chemical signals throughout your nervous system, glial cells are their support cells. And they outnumber neurons by many fold. And just like there are different types of neurons, there are also different types of glia.
Astrocytes are like the nurturers of neurons. They supply neurons with the nutrients they get from the vascular system in your brain and nervous system. Oligodendrocytes are the glia that put myelin sheaths on neuronal axons, which then help to protect them and also help propagate the electrical signals through them faster. Microglia are the immune cells of your nervous system, and they behave like macrophages.
When it comes to pain, glial cells don’t have a big part to play in normal circumstances. When things are calm and quiet, microglia are just patrolling and scanning the environment. But when there is a threat or damage to neurons, they become activated. They secrete inflammatory cytokines as part of their immune response and stay on high alert. In that state, your neurons are also on high alert and there is what we call increased neuronal excitability.
If you have fibromyalgia, microglial activation and the excitatory and inflammatory chemicals they secrete will amplify your pain signals, which is what happens with Central Sensitization. This has been shown in PET scans of fibromyalgia patients. They have markers of glial activation throughout their cortex, and this activation is more intense in the walls of their frontal and parietal lobes. We don’t see this kind of glial activation in healthy patients.
The standard method for helping fibromyalgia patients focuses purely on symptom relief. And, although that is a very important part of patient care, it does have its limitations.
It basically consists purely of turning down the pain volume by addressing the ascending and descending pain pathway fibers. And it does that via two main types of medications: SNRIs and anticonvulsants.
Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) address the descending pain pathway fibers. You may be more familiar with SSRIs, or selective serotonin reuptake inhibitors. They block the reuptake of serotonin by your neurons, allowing for more serotonin to be available in your system.
SNRIs work in a similar fashion, but they inhibit your neurons from the reuptake of both serotonin and norepinephrine. This allows for there to be more serotonin and norepinephrine in your system. They are antidepressants, like SSRIs, but also help with pain management.
Reuptake inhibitors all work by blocking your neurons from taking up neurotransmitters that were released into the synapses. Neurotransmitters are messenger chemicals that help signals travel from neuron to neuron. Some are excitatory and some are inhibitory. Excitatory neurotransmitters excite the neurons, making them more active, while inhibitory ones calm them down, downregulating their activity.
Some of the more commonly used SNRIs for fibromyalgia include Savella, a brand of milnacipran, and Cymbalta, a brand of duloxetine.
The second type of medication is anticonvulsants, which address the ascending pain pathway fibers. You typically use these medications for managing epileptic seizures, and nowadays more and more for bipolar disorder and other mood disorders.
With fibromyalgia, they are meant to downregulate the hyperexcited neurons in both your CNS and PNS. This then results in the reduction of the intensity of the pain. Some of the more commonly used anticonvulsants for fibromyalgia include Lyrica, a brand of pregabalin, which is the only anticonvulsant shown to have some pain-reducing effects so far.
Unfortunately, these two medications have quite limited efficacy, reducing pain by only a few percentage points. They also don’t really address the issue of microglia activation, neuroinflammation, and the role of peripheral nociceptors.
As we’ve seen, microglia can amplify the pain signals and are part of the Central Sensitization problem in fibromyalgia. This is why some newer approaches to holistic fibromyalgia relief attempt to deal with that issue. And one of the more promising ones is the use of low-dose naltrexone, or LDN.
Naltrexone is a type of medication healthcare professionals use mainly for alcohol and opioid use disorders. It works by reducing both the cravings for these substances as well as the high users get when they do use them. Some of the more well-known brand names of this medication are Vivitrol and ReVia.
Its mechanism of action is that it competes for the opioid receptors in your nervous system. This means that, when you take it, it binds to these receptors so that the substances you’ve ingested don’t find any receptors to bind to, leaving them pretty much with no effect. That’s why it’s an antagonist - it antagonizes the effect of the substance it is competing with. An agonist, on the other hand, is one that supports the effects of another chemical.
Used in low doses, naltrexone can help reduce pain and inflammation, and it’s used in the relief of different conditions, ranging from autoimmunity to cancer and chronic pain. It’s also sometimes used in the mental health field, as more and more research is pointing to the role of neuroinflammation as a causal, or at least contributing, factor in many mental health conditions.
More specifically, with inflammation, low-dose naltrexone acts as an antagonist at TLR4 receptors, which are found on both macrophages and microglia. This is how it can reduce their inflammatory responses. For holistic fibromyalgia relief, LDN quiets activated microglia, reducing their release of excitatory and inflammatory chemicals, and allowing them to return to patrolling the nervous system where they are in a dormant and anti-inflammatory state.
In a small pilot study of LDN’s effectiveness in fibromyalgia pain relief, six out of ten participants reported significant pain reduction with LDN use. In another double-blind study on 30 subjects, 57% of them reported a pain reduction of 30% or more.
When it comes to neuroinflammation, and chronic inflammation in general, there are also many other things you can do to address it. In fact, a holistic fibromyalgia relief program wouldn’t be complete without looking into the root causes of inflammation and how to resolve those causes.
The Inflammation Circuit is one of six circuits of organs and systems that work together to fight stress. The other five are the Hormone, the Bioenergetics, the Cardionomic, the Neuroaffect, and the Detoxification circuits. All of these form your body’s global response to stress, which we call the NeuroEndoMetabolic (NEM) Stress Response.
Each circuit is composed of three main components, either organs or systems. And each circuit shares one component with another circuit. That’s how they’re all linked and why the NEM behaves as a global response. Its main aim is to return your body to a state of homeostasis after dealing with whatever stressor it was exposed to.
Inflammation is a natural and healthy immune response. It helps your body attack and get rid of pathogens, toxins, and dead and damaged cells. Your Inflammation Circuit is composed of your immune cells, gut, and microbiome. And this gives us the first clue as to some non-medication-related approaches to holistic fibromyalgia relief: ensuring your gut and microbiome are healthy.
More specifically, the reason your gut and microbiome are so involved in your Inflammation Circuit is because your gut actually holds two-thirds of your immune system cells in what’s called the gut-associated lymphoid tissue (GALT). The microbiome, which is the collection of bacteria and other microorganisms in your gut, is a kind of supportive and protective partner to your GALT. If it’s healthy, your GALT is functioning well and inflammation does its job in the immune response, then dissipates afterward. But if you have an imbalance in your microbiome – a state called dysbiosis – you are much more vulnerable to developing chronic inflammation.
More and more healthcare professionals agree that almost all forms of chronic inflammation begin in the gut and then spread elsewhere in the body. In the case of fibromyalgia, it could be inflammation that spreads to your brain and nervous system, activating the microglia and making the neurons hyperexcitable. It could also be compounded by inflammation that spreads to your musculoskeletal system, causing pain in your muscles and joints.
Other common symptoms of a dysregulated Inflammation Circuit include slower healing, autoimmunity, recurring infections, difficulty recovering from infections, irritable bowel syndrome (IBS), irritable bowel disease (IBD), small intestinal bacterial overgrowth (SIBO), food and drug sensitivities, candida, and pain of unknown origin.
Considering that your microbiome and GALT are located in the gut, it makes sense then to look into your diet as a factor in holistic fibromyalgia relief. You need to know what kind of diet worsens the symptoms and what kind of diet improves them.
We always like to give the gluten example when talking about diet and inflammation. It surprises many of our clients to learn that even if they’re not experiencing gastrointestinal problems, that doesn’t mean they don’t have gluten sensitivity. That’s why we either put our clients on an elimination diet or, when possible, do functional lab tests at our clinic to check for different food sensitivities.
So let’s say you have a gluten sensitivity you didn’t know about. You eat gluten often, maybe even on a daily basis. Each time you eat it, your GALT has to react because it perceives the gluten proteins as a kind of threat. That’s what a sensitivity or allergy is at its core. That immune response then creates inflammation in the gut. On top of that, the gluten is also causing more and more dysbiosis.
Dysbiosis and GALT dysfunction can lead the tight junctions in your gut’s lining to loosen and create leaks. And then you’re at risk of leaky gut syndrome. These leaks allow substances into your bloodstream that shouldn’t be there. Those could be pathogens, toxins, or food particles. These substances cause an immune reaction and inflammation.
This much inflammation is likely to travel to other areas of the body, especially if it's not stopped early enough. And when it travels, it causes symptoms that may not be so obviously linked to the gut. That’s why many of our clients with gluten sensitivity don’t know they have that sensitivity. They come to us complaining of brain fog, sleep problems, anxiety, and depression. Yet, those are the result of the neuroinflammation they’re experiencing thanks to gluten sensitivity and the gut-microbiome-brain connection.
You can see the gut-microbiome-brain connection even more clearly when we talk about the Neuroaffect Circuit of the NEM. This circuit is composed of your microbiome, brain, and autonomic nervous system (ANS). The ANS is the part of your nervous system that takes care of things without your conscious intervention, such as digestion, circulation, and breathing, etc.
As you already saw, the microbiome is the component that connects the Neuroaffect and Inflammation circuits. The way your physiological functions and responses are arranged makes it so that it’s impossible to isolate just one component from the rest. And this is why so much of the mainstream medical approaches to chronic conditions fail. Including those for chronic pain conditions.
Because your Neuroaffect Circuit is involved in the release of different neurotransmitters, and because many neurotransmitters are made in the gut, that is another link to the gut-microbiome-brain axis. It is the pathway to your neurotransmitter pool and why your gut has a lot more to do with your mood than what you’ve been told. A dysregulated Neuroaffect Circuit will lead to mood changes and other neuropsychiatric symptoms.
We cannot just throw a bunch of antidepressants and anticonvulsants at a fibromyalgia patient and wish them luck. They barely feel any better and end up with a gradually worsening quality of life. Some become bedridden and depressed. No, we must look for root causes and we must look at their body, mind, and environment as a whole.
Holistic fibromyalgia relief requires taking into consideration the food you eat and the possible sensitivities you have. If we can improve your microbiome, it will then help reduce the neuroinflammation constantly putting your microglia on high alert and over-exciting your neurons.
Indeed, we focus on diet with all of our clients, just because of how truly central it is to health. You can improve many chronic conditions with diet alone. We work with a lot of adrenal fatigue patients who come to us after exhausting all their other options. And many have tried different diets, from vegan, to keto, to paleo. But the trick to any dietary change is to ensure it suits each person individually.
Generally, there are some fundamental components to a healthy diet, including the adrenal fatigue diet. It has to be nutrient-dense, as organic as possible, free of processed foods and artificial chemicals, and anti-inflammatory. It should also include foods that support the balance of the microbiome, such as fermented foods and fiber. And it should help you stabilize your blood sugar levels.
The other important piece is to then use gentle supplements to fill in any nutritional gaps and give therapeutic doses to boost certain functions when needed. However, it's important to make these changes only after talking to your doctor. People with chronic medical conditions are more susceptible to developing other issues from taking the wrong supplements or the wrong doses.
Adrenal Fatigue Syndrome (AFS) is a condition you develop when your body is under chronic stress, whether that stress is physical or psychological in nature. For most of our clients, they have a mix of both. What happens with chronic stress is that it overworks your adrenal glands. They have to produce more and more cortisol, your body’s main anti-stress hormone, to meet the growing demand. At first, cortisol levels rise, which isn’t a good thing. But after a while, your adrenals get so exhausted that they can’t produce any more cortisol, and that’s also not a good thing. Cortisol levels outside the normal range will result in symptoms.
Symptoms of AFS include fatigue, weight gain, sleep disturbances, brain fog, anxiety, mild depression, hair loss, loss of libido, PMS, infertility, dry skin, brittle nails, lowered immunity, food and drug sensitivities, hypoglycemia, salt and sugar cravings, heart palpitations, and an inability to handle stress.
AFS and fibromyalgia can affect each other in the following ways.
If you have AFS, your body is more fragile and you are more likely to develop chronic inflammation. One of the roles of cortisol is to neutralize inflammation when it has done its job. So when cortisol is too high or too low, it cannot properly neutralize that inflammation. And, as you know by now, with more inflammation you get more microglial activation and more neuronal excitability.
On the other hand, the constant pain you feel with fibromyalgia, the underlying causes of the condition, and the strain it can put on your life socially, financially, and more, are huge stressors on the body. These stressors can then overwork the adrenals, triggering or worsening AFS.
This can be bad news, because you don’t want to develop all of these extra conditions when you are already struggling with one. But there is a good side to it, too. If you manage to improve one condition, the other will also start improving as well. And there are some things you can do, like changing your diet, that can help improve both conditions at the same time.
So far, we’ve looked at how you can turn down the pain volume in the CNS directly. We've also looked at addressing chronic inflammation as a way to reduce microglial activation and neuronal excitability. But what about the muscle fibers themselves?
Some studies showed that fibromyalgia patients have actual modifications in their muscle fibers. Gauge needles found that the muscles have increased pressure. Other studies used surface electromyography (SEMG) and found that fibromyalgia patients have increased SEMG amplitude. These findings suggest that fibromyalgia muscles have difficulty reaching a state of relaxation.
It’s like your muscles are tight and tense and you can’t get them to relax. But very few healthcare professionals will suggest addressing the muscles directly, even though there are certain techniques that many patients report do reduce the pain. These can help in your holistic fibromyalgia relief, and they can be a combination of the following:
One study showed that fibromyalgia patients have an average of 12 myofascial trigger points, which are the knots you feel in your muscles. These are big pain generators and addressing them directly can lead to global pain relief. Trigger point injections, such as with lidocaine, which is a local anesthetic, can help.
Different types of physical therapy and massages can reduce the pain in your muscles. These include:
You can do a combination of the above or focus on just one. If you want to focus on just one, then the most effective for fibromyalgia is myofascial release. This form of therapy utilizes slow, assisted traction and stretching. The therapist will pull and push on different parts of your body. If you’re just starting out, you might want to do a full 20-weeks program of one session per week. Then, afterward, you can do this therapy once in a while or when needed.
Certain other types of massage, like Swedish massage, don’t seem to have an effect. So it’s best to stick to the above list. Also, if you want to do your own stretching or exercises at home, you can benefit from that too. But be aware that resistance training is not very effective for fibromyalgia. And any kind of intense physical activity can worsen adrenal fatigue. It may be best to stick with stretching for now.
Another often overlooked method is the use of topical analgesics. For example, topical NSAIDS can help reduce myofascial pain, especially if you apply them to the hotspots. Topical clonidine can block peripheral nerve signals coming from the muscles and going to the brain. And topical ketamine can reduce pain from peripheral neuropathy, which is something both those with diabetes and fibromyalgia are at risk of getting.
There also seems to be a link between autoimmunity and fibromyalgia. There's an interesting study that took IgG from fibromyalgia patients and injected it into mice. It showed that these mice developed hyperexcitability in their nociceptors. This happened at the level of the dorsal root ganglion and its satellite glial cells. The dorsal root ganglion is a kind of gateway between the CNS and PNS. It acts as a filter for pain between them.
The hypothesis is that these auto-reactive IgGs triggered the satellite glial cells into secreting inflammatory mediators that then excited the neurons. And this sensitization of the nociceptor neurons depends on the activation of the NMDA receptors of the satellite glial cells.
NMDA receptors are a type of receptor you find on nervous system cells, whether neurons or glia. And they bind to the neurotransmitter glutamate. Fibromyalgia patients have elevated glutamate, which is an excitatory neurotransmitter, in the cerebral spinal fluid as well as in specific areas of the brain. More glutamate means more excited neurons, which sensitizes the pain pathways in the brain and spinal cord.
This brings us to the final piece of a holistic fibromyalgia relief plan: using an antagonist for the NMDA receptors. For example, oral memantine or low-dose IV ketamine.
If you’re suffering from fibromyalgia and are feeling hopeless about your therapy options, it may be due to the limitations of conventional approaches. The two main medications used by mainstream medical practitioners only address the problem of Central Sensitization. They don’t do much for the peripheral nerves, microglial activation, muscle tightness, hotspots and triggers points, or underlying inflammation.
Those are all issues that you can and should address in your holistic fibromyalgia relief program. And you should also get help for any AFS or NEM dysregulation you may be experiencing as well. Improving one condition will help improve the rest, which is good news. Some potential options for relief include changing your diet, using local analgesics, trying LDN, trigger point injections, myofascial release, and using NMDA receptor antagonists along with the conventional medications.
If you’d like to talk to us about your specific condition, we’d be happy to see if one of our nutritional programs and functional lab tests can help. Just give us a call for a free initial consultation with one of our coaches.
To get holistic fibromyalgia relief, you need to look beyond the conventional approach. There are several pain pathways of the condition, and you can intervene at each point. You can also start addressing some possible root causes, such as inflammation, with these specific tips and techniques.