Fibromyalgia (FM) is characterized by a whole body, widespread pain that affects millions of people and continues to be a challenge for both doctors and patients to manage. This is probably because there is no one cause that can be clearly identified with the onset of FM. The “best” approach to managing FM requires a “team” of healthcare providers and a multi-modal treatment approach including (but not limited to): medications, chiropractic adjustments, exercise training, relaxation techniques, proper nutrition/diet, and structured sleep habits. The focus of this month’s article is on various oral treatment options, both prescription and non-prescription varieties that focus on deep muscle pain, sleep problems, anxiety, and depression.

DRUGS: The following is a partial list of medications commonly prescribed for FM, according to WebMD. Please consult with your medical doctor as to which medication(s) may be best for you, if any: Cymbalta, Lyrica, and Savella.

HERBS/SUPPLEMENTS: Last month, we discussed getting enough vitamin D, avoiding food additives such as MSG and aspartame, consuming omega 3 fatty acids, avoiding caffeine, eating veggies, taking anti-oxidants (such as vitamin A, C, and E, and coenzyme Q10), and avoiding gluten. Additional considerations include:

1. 5-HTP: This is a “building block” for a powerful brain neurotransmitter called serotonin, which is thought to play a significant role in reducing FM-related pain, reducing depression, and helping to facilitate sleep – especially deep sleep! One study reported improvement in depression, anxiety, and insomnia as well as FM-related pain. This is usually well-tolerated by FM patients.
2. Melatonin: This is a natural hormone used to induce drowsiness and improve sleep patterns. It may also be effective in reducing pain associated with FM. This is regarded as being safe with few-to-no side effects, though it may cause daytime sleepiness for some so don’t drive or operate heavy machinery until you see how it affects you.
3. St. John’s Wart: Though NOT specific or unique in FM treatment, it is often used to treat depression, which is a common FM symptom and therefore, may be helpful. Several studies found this to be more effective than placebo and equally effective as some antidepressants called “tricyclics” in those with mild-to-moderate depression. Other studies found similar results when compared to selective SSRI antidepressants such as Prozac or Zoloft. It is usually well-tolerated with the most common side effects including stomach upset, skin reactions, and fatigue. This reportedly should NOT be mixed with other antidepressants or other supplements.
4. SAM-e: How this exactly works in the body remains unknown, but some feel this natural supplement increases serotonin and dopamine levels (two brain neurotransmitters). Studies support mood improvement and increased restful sleep but it is not significantly beneficial for FM pain reduction or FM-related depression. Additional studies are needed.
5. L-Carnitine: L-Carnitine intake has been linked to FM-related pain relief and general mental health benefits.
6. Probiotics: These “good guy” bacteria or yeast supplements may assist in digestive disorders such as IBS (irritable bowel syndrome), which is commonly associated with FM. Other uses include diarrhea management and urinary tract and female genital tract infections.
7. Other herbs/supplements that may help FM include: Echinacea, black cohosh, cayenne, lavender, milk thistle, and B vitamins. Caution is recommended with using herbs during pregnancy, with children, the elderly, those with immune system deficiency, and those taking a blood thinner.