Conditions:
Fibromyalgia
Related Terms
•
Fibrositis
Principal Proposed Treatments
•
SAMe (S-Adenosylmethionine), 5-HTP (5-Hydroxytryptophan), Capsaicin, Blue-Green Algae
Other Proposed Treatments
•
Acupuncture, Mind-Body Therapies, Malic Acid plus Magnesium, Vitamin B1, Vitamin E, Selenium
Fibromyalgia is a common chronic condition whose main symptoms are specific tender points on various parts of the body, widespread musculoskeletal discomfort, morning stiffness, fatigue, and disturbed sleep. The cause of the condition is unknown, but it occurs most often in women aged 30–50. Other symptoms commonly believed to be associated with fibromyalgia are irritable bowel syndrome, urinary frequency, anxiety, headache, and numbness or tingling.
Apart from tender points on the body, physical exams and lab tests for people with fibromyalgia are usually normal. Because of this, some physicians are inclined to believe that the condition is "all in the patient's head." One researcher has noted that many of the symptoms of fibromyalgia, including certain tender points, are common in the general population, and goes so far as to question whether it is a real condition.1
However, the general consensus is that fibromyalgia is real, and the American College of Rheumatologists has given it an official medical definition. It involves the presence of widespread chronic pain and the existence of pain in at least 11 of 18 specific points on the body when pressure is applied. Although the cause of fibromyalgia is not known, it may be related to poor sleeping with incomplete muscular relaxation.
Conventional treatment for fibromyalgia may include antidepressants (particularly those that help induce sleep), anti-inflammatory drugs, muscle relaxants, sleeping pills, and antianxiety medications.
Low-dose antidepressants have been shown to help chronic pain from many causes,2 and have been found to be effective in reducing fibromyalgia symptoms, even when given in doses too low to treat depression.3 It may be that antidepressants work for fibromyalgia by improving sleep.
Aerobic exercise may also be helpful for individuals with fibromyalgia,4 although not all studies agree.5
Principal Proposed Treatments for Fibromyalgia
There are three natural treatments that might be helpful for fibromyalgia, although the evidence is not yet strong: SAMe (pronounced "sam-ee"), 5-HTP, and capsaicin.
SAMe
SAMe, short for S-adenosylmethionine, is a chemical derived from a combination of the amino acid methionine and the main molecule for energy in the body, adenosine triphosphate (ATP). More well known as a treatment for depression and also osteoarthritis, preliminary research suggests that it may be helpful for fibromyalgia as well.
What Is the Scientific Evidence for SAMe?
Four double-blind trials have studied the use of SAMe for fibromyalgia,6–9 three of them finding it to be helpful. Unfortunately, most of these studies gave SAMe either intravenously or as an injection into the muscles, sometimes in combination with oral doses. When you inject a medication, the effects can be quite different than when you take it orally. For that reason, these studies are of questionable relevance.
However, the one double-blind study that used only oral SAMe did find positive results.10 In this trial, 44 people with fibromyalgia took 800 mg of SAMe or placebo for 6 weeks. Compared to the group taking placebo, those taking SAMe had improvements in disease activity, pain at rest, fatigue, and morning stiffness, and in one measurement of mood. In other respects, such as the amount of tenderness in their tender points, the group taking SAMe did no better than those taking the placebo.
It isn't clear whether SAMe is helping fibromyalgia through antidepressant effects or some other mechanism.
For more information, including dosage and safety issues, see the full SAMe article.
5-HTP
5-HTP, short for 5-hydroxytryptophan, is most commonly used as a treatment for depression. It is thought to work by increasing the amount of serotonin in the brain. However, evidence that it helps fibromyalgia is still preliminary.
What Is the Scientific Evidence for 5-HTP?
One double-blind study of 50 people with fibromyalgia found that those taking 300 mg of 5-HTP for 30 days reported significant decreases in the number of tender points and the amount of pain they experienced, compared to those taking placebo.11 They also noted improvements in sleep patterns, morning stiffness, anxiety, and fatigue. Interestingly, the people taking placebo also noted significant improvements in pain and sleep, although less marked than those experienced with 5-HTP. More studies are needed to determine how much 5-HTP really helps.
For more information, including dosage and safety issues, see the full 5-HTP article.
Capsaicin
Capsaicin, the "hot" in hot chili peppers, is widely used as a treatment for various painful conditions, such as shingles and arthritis. One double-blind study of 45 people found that it may be beneficial for fibromyalgia as well.15 In this study, participants used either the capsaicin cream or a placebo four times a day for four weeks, rubbing it into the tender points on one side of their body. Those who used the real treatment reported less tenderness in their tender points than those using the placebo. Interestingly, the points on their untreated sides were also less tender. There was no difference between those using capsaicin or placebo in the amount of overall pain or sleep quality. It must be noted, however, that it's hard to believe the study was really double blind, since it's impossible to hide the burning sensation caused by capsaicin!
Dosage
Capsaicin-containing creams are widely available in pharmacies. The cream used in this study contained 0.025% capsaicin, but the researchers suggested that better results might occur with 0.075% capsaicin.
When you start out, use only a little cream, as it will produce a burning sensation. After several applications, the burning will begin to diminish. You can then increase the amount of cream you use. When you no longer feel the burning, you know that you have reached the right dose.
Safety Issues
Capsaicin creams appear to be safe. The only reported side effect is the initial uncomfortable burning sensation, which stops after a few moments. Of course, you will want to avoid getting capsaicin into your eyes or onto other sensitive tissues. The pain can be quite excruciating, although no real harm should result. Take care to wear a glove when applying it, and to wash your hands afterwards.
Blue-Green Algae
The blue-green algae Chlorella pyrenoidosa might be helpful for fibromyalgia. In a double-blind placebo-controlled trial, 37 individuals with fibromyalgia were given either placebo or chlorella supplements at a dose of 10 g daily.16 At the end of 3 months, individuals were switched to the opposite group, and then treated for an additional 3 months. The results showed significant improvements in symptoms when participants used chlorella as compared to placebo.
Note: There are serious safety concerns about blue-green algae.
Safety
There are concerns that blue-green algae may at times secrete toxic substances17,18 or harbor cholera bacteria.19
Maximum safe doses of chlorella in pregnant and nursing women, young children, and individuals with kidney or liver disease have not been determined.
Other Proposed Treatments for Fibromyalgia
Acupuncture has been tried as a treatment for fibromyalgia in three controlled studies.20 The best of these enrolled 70 individuals and followed them for 3 weeks.21 Some evidence of benefit was seen, but further research is necessary.
Preliminary evidence suggests that mind-body therapies (such as stress reduction and guided visualizations) may be helpful for fibromyalgia.22
A natural substance present in apple juice and other plant foods, malic acid is widely marketed as a treatment for fibromyalgia, often in combination with magnesium. However, it has not been proven effective.
A mixture of malic acid and magnesium has been the subject of preliminary studies. In one double-blind study of 24 people, 1,200 mg of malic acid and 300 mg of magnesium taken daily for 4 weeks were no more effective than placebo.23 Good results have been seen in open trials,24,25 but such studies cannot eliminate the placebo effect and for that reason are not reliable.
Other proposed natural treatments include vitamin B1, vitamin E, and selenium, but there is no real evidence that they work.
View References
Last reviewed March 2002 by Medical Review Board
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