Fibromyalgia – Pain By Another Name
I know a lot of people who suffer from some form of chronic pain and alongside that there are often many symptoms which get treated as if they are separate and unrelated.
“Fibromyalgia…is a chronic pain syndrome accompanied by other symptoms such as depression, anxiety, fatigue or sleep disturbances...it has…a greater presence in women than in men…Despite its high prevalence, its etiology is still unknown and there are no effective treatments.“
Chronic pain has a number of possible causes but I believe that an underlying hypometabolic state can usually be found. People with ongoing pain issues are sometimes told they have fibromyalgia and then given very little useful help or advice. Sadly, they often end up believing there really is ‘no effective treatment’.
““Fibromyalgia syndrome” (FMS) is the diagnosis clinicians most often give patients who have chronic widespread pain and abnormal tenderness. Most FMS researchers state that the etiology of the disorder is unknown. In doing so, they fail to account for a substantial line of evidence showing that the main mechanism of FMS is inadequate thyroid hormone regulation.”
Women suffer from FMS (as well as thyroid issues) more commonly than men and this is most likely due to lower body temperature, slower liver function and higher estrogen levels.
“Many features of fibromyalgia and hypothyroidism are virtually the same, and thyroid hormone treatment trials have reduced or eliminated fibromyalgia symptoms. These findings led the authors to test the hypothesis that fibromyalgia patients are hypometabolic compared to matched controls.”
People diagnosed with hypothyroidism are almost always treated with T4 (thyroxine) for hormone replacement. Tests sometimes show a buildup of T4 in the blood of hypothyroid women. This can be because estrogen (as well as low thyroid and body temperature) interferes with the ability of the liver to convert T4 into active thyroid hormone, T3.
Over time this can suppress – rather than improve – metabolic function, eventually worsening the chronic nature and progression of FMS type symptoms.
Recognizing the relationship between thyroid function and chronic pain is very helpful, however many are led to believe that their thyroid has been examined and is now being treated effectively, when this is usually far from accurate.
Unfortunately a culture has also been promoted which erroneously assumes that thyroid issues have been properly ruled out as a factor in many cases of FMS. Widely used modern diagnostic methods lack genuine meaning and accuracy when it comes to assessing sub-optimal thyroid function.
“…a small percentage of hypothyroid FMS patients recover with T4 alone…For most patients to fully recover, however, they must use either combined T4/T3 therapy (with a 4:1 ratio of T4-to-T3) or T3 alone.”
Popular dietary advice given to those already suffering from symptoms of stress and hypometabolism can often exacerbate the progression of illness, and limit the effectiveness of what might otherwise be a reasonable approach to thyroid hormone replacement.
Polyunsaturated fats are included as a ‘healthy’ alternative to animal fats in many dietary protocols, regardless of the fact that they have been shown to be highly inflammatory and metabolically suppressive.
Short term symptom reduction is often seen as a sign of overall metabolic improvement, ignoring all of the long term metabolism damaging effects.
FMS is an inflammatory condition associated with increased oxidative stress and this is demonstrated in part by higher levels of breakdown products of the polyunsaturated fats (lipid peroxidation) throughout the body.
“…lipid peroxidation, one of the main consequences of oxidative stress, can interfere in the etiology of pain perception, either by induction of central or peripheral hyperalgesia…oxidative damage can cause a local reduction of nociceptors and thereby reduce the pain threshold.”
The consumption of hard to digest grains, seeds, nuts, beans and legumes as well as under cooked starchy and fibrous vegetables (and certain fruits) can promote an overgrowth of bacteria, particularly when digestion and liver function are already sluggish.
More bacteria generally means an increase in endotoxin and serotonin release in the intestines, which can then lead to greater stress on the liver and eventually cause estrogen levels circulating throughout the body to rise. This is likely to worsen inflammation and promote further interference with thyroid function and metabolism.
Tissue injury and inflammation cause more serotonin to be released and rising levels of serotonin have been directly implicated in the progression of chronic pain and many of the other issues which often go along with it.
“Peripheral tissue and nerve injury can lead to hyperalgesia, a state in which painful stimuli are perceived as more painful than normal. One major contributor to hyperalgesia is augmented sensitivity of primary nociceptive neurons, a phenomenon called peripheral sensitization…our results reveal a novel pain mechanism in which…5-HT [serotonin]…maintains central terminal sensitization by activation of presynaptic 5-HT3A receptors…”
Many different things which help to lower serotonin or limit its impact have successfully reduced pain and a variety of related symptoms in fibromyalgia.
“…a novel antidepressant…mirtazapine was used…characterized by selective blockade of 5-HT2 and 5-HT3 [serotonin] receptors…for fibromyalgia…Intensity of pain, sleep disturbances, fatigue and other symptoms were measured…the majority…experienced…improvement…of > or = 40% reduced intensity of fibromyalgia symptoms as well as reduced severity of depression….suggests a common pathophysiology of depression and symptoms of fibromyalgia.”
A hypometabolic state and digestive distress go hand in hand for a number of reasons, and they can probably all fall under the general blanket of metabolic stress. It’s unlikely to be a coincidence that inflammatory bowel issues such as IBS and SIBO have been shown to be involved in the progression of thyroid dysfunction and FMS.
“Up to 32% of patients with fibromyalgia are labelled as having IBS, and 81% report irregular bowel habits…a common finding in both fibromyalgia and IBS is…the presence of bacterial overgrowth…it is likely that endotoxin produces hyperalgesia…”
The substances which rise under stress and which are promoted by excess bacteria and endotoxin release – including serotonin, estrogen and nitric oxide – have been directly implicated in all of these conditions.
“Serotonin (5-HT) precursors such as tryptophan (5-HTP), drugs that release 5-HT…stimulate the HPA axis, indicating a stimulatory effect of serotonergic input on HPA axis function. Hyperfunction of the HPA axis could also reflect an elevated serotonergic tonus in…FMS patients.”
“…NO [nitric oxide] can actively participate in the hyper sensitization in FM…the use of [nitric oxide] inhibitors can be a very plausible alternative for the treatment of painful symptoms such as those presented in FM syndrome.”
Methylene Blue (MB) has been shown to provide protection from bacterial endotoxin, serotonin, estrogen and nitric oxide, as well as directly promoting mitochondrial energy system (metabolic) function. MB has also been shown to inhibit prolactin (which is known to rise alongside increasing estrogen levels) and which has been demonstrated to be high in another chronic pain related condition, polymyalgia rheumatica (PMR).
Under circumstances where sugar is being avoided, levels of stress hormones such as adrenalin and cortisol generally increase, helping to move things in a direction which is more likely to become increasingly hypometabolic.
Sugar restriction promotes the release of polyunsaturated fats out of storage as free fatty acids, aggravating inflammatory issues and causing oxidative stress. The polyunsaturated fats damage the liver, intensify problems associated with endotoxin, estrogen and serotonin and interfere with thyroid hormone conversion into the active form, T3.
This can eventually lead to a vicious circle in which the responsiveness of tissues to T3 is also significantly suppressed, metabolic function is being driven by stress rather than proper energy system performance, and pain is gradually increasing.
There are many different ways to approach the issue of chronic pain and yet they are all interrelated. Biology cannot ever be anything other than holistic. In this sense fibromyalgia is as much a brain issue as it is an hormonal or nervous system problem.
A great example of this is the way that pain dysfunction is now being shown to be able to be treated with the use of ‘brain based’ therapies such as those which look at vestibular and ocular function in relation to improving nervous system performance. Such methods can be said to tap directly into the brain and nervous system, but this is not separate from all else.
“Medical records of 124 patients (78 women, 46 men) were reviewed. Vestibular deficits were detected in 83 patients (66.9%)…Patients being treated with medications for chronic, noncancer pain or other underlying neurologic disorders may have a higher-than-average incidence of vestibular dysfunction.”
Exposure to chronic stress can lead to many different ‘disease’ outcomes with interrelated and overlapping physiological conditions and symptomology. Fibromyalgia and chronic fatigue are sometimes considered to be expressions of the same underlying problems. High levels of nitric oxide, endotoxin, serotonin and estrogen, as well as hypometabolism can all be implicated.
“…chronic fatigue syndrome (CFS), fibromyalgia (FM), multiple chemical sensitivity (MCS) and posttraumatic stress disorder (PTSD)…share common symptoms…Many patients meet the criteria for diagnosis for two or more of these disorders and each disorder appears to be often induced by…stress…followed by a chronic pathology…”
In combination with the treatments that have had success, a diet avoiding the polyunsaturated fats and limiting difficult to digest fibrous and starchy foods, including regular intake of milk, cheese and gelatin, sweet ripe fruits, fruit juice, white sugar and honey, has the potential to help deal with hypometabolism and its many symptoms including chronic pain issues.
Measuring and tracking temperature and pulse can shine a light on thyroid function and metabolism, enabling greater understanding of the impact of diet and other therapeutic approaches being used and providing information which can help improve chances of healing and recovery.
Some other safe things which have had success in treating pain related conditions include thiamine (B1), red light therapy (also in combination with MB), aspirin, activated charcoal, cyproheptadine, low dose naltrexone, progesterone, magnesium and certain antibiotics.
Popular anti-depressants such as the SSRI’s and many current and commonly prescribed pain medications have at the very least, been unsuccessful.
See more here
Evidence of direct estrogenic regulation of human corticotropin-releasing hormone gene expression. Potential implications for the sexual dimophism of the stress response and immune/inflammatory reaction.
Image: Jagran Junction: Aapki Awaaz, Aapka Blog: “Social Issues Blog”