Fibromyalgia (FM) is a common cause of widespread pain, occurring in 2%–8% of the general population worldwide. Central nervous system (brain and spinal cord) pain sensitization is now considered the primary pathology in FM. Areas of the brain involved in pain processing and interpretation (areas called dorsolateral prefrontal cortex, anterior cingulate, amygdala, hippocampus, insula, and others) differ in FM patients compared to healthy controls, possibly mediated by altered neurotransmitter levels [e.g. glutamate and gamma-amino butyric acid (GABA)], which will, in turn, affect other neurotransmitter levels.1

Careful history taking often reveals a significant stressful trigger event or period, such as an accident, a flulike illness, emotional stress, or overwork, preceding the onset of symptoms.2 A sensitive temperament, characterized by high levels of empathy, and a higher than normal sensitivity to environmental factors and emotional cues from others, appears to be a premorbid condition for many patients.3 In addition, FM patients have been shown to demonstrate a state of being called alexithymia more than healthy controls — this is when individuals have difficulties both in identifying and describing feelings. The tension of experiencing stressful triggers and the consequence of living in a society that expects high productivity at the expense of self-care, superimposed on a natural sensitivity and inability to express feelings, may predispose the central nervous system of FM patients to abnormal sensory processing.

No specific diet has been shown to be effective for FM. However, obesity and being overweight contribute to lower quality of life scores. An increase in dietary antioxidant intake may be beneficial based on evidence of increased oxidative stress and reduced antioxidant enzyme activities in FM patients, although no specific supplements are currently supported by research.4

An anti-inflammatory diet, with increased consumption of whole plant based foods and avoidance of processed foods, may be helpful and likely benefits patients’ health in a more general way. Removal of excitotoxins such as MSG and aspartame from the diet may be rational in light of the central nervous system abnormalities in glutamate and GABA distribution and function observed in FM patients, though research support is mixed.4 Strict avoidance of trans fats (partially hydrogenated oils, margarine, and shortening) and increased consumption of foods rich in omega-3 fatty acids, calcium, and antioxidants are strongly encouraged and address some of the common deficiencies in the standard U.S. diet.

Poor physical fitness is associated with increased symptom severity in FM patients.5 Though the quality and quantity of evidence is still low, massage and body work interventions are low risk and accessible. Patients can be encouraged to try various modalities if they are so inclined.

Should these interventions fail to relieve your symptoms, at RMRM, we have an extensive menu of other options including ketamine, lidocaine, and nicotinamide adenine dinucleotide (NAD+) that we’d be happy to discuss further with you.

  1. V. Napadow, R.E. Harris: What has functional connectivity and chemical neuroimaging in fibromyalgia taught us about the mechanisms and management of ‘centralized’ pain?. Arthritis Res Ther. 16:425-432 2014
  2. D. Clauw: Fibromyalgia: a clinical review. JAMA. 311:1547-1555 2014
  3. E.N. Aron, A. Aron: Sensory-processing sensitivity and its relation to introversion and emotionality. J Pers Soc Psychol. 73:345-368 1997
  4. A. Rossi, A.C. DiLollo, M.P. Guzzo, et al.: Fibromyalgia and nutrition: what news?.Clin Exp Rheumatol. 33:S117-S125 2015
  5. F. Estevez-Lopez, C.M. Gray, V. Sigura-Jiminez, et al.: Independent and combined association of overall physical fitness and subjective well-being with fibromyalgia severity: the al-Andalus project. Qual Life Res. 2015
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