BDO: What causes the pain associated with fibromyalgia?
Dr. Dunston: There are myriad causes for the pain associated with fibromyalgia and includes hormonal imbalance, toxicity and nutritional deficiency. Toxicity includes infections. All of these issues trigger the pain cascade that includes production of inflammatory cytokines like interleukin 10 and NF kappa B. Nerve endings are stimulated and transmit or conduct information regarding pain using neurotransmitters to the brain, which recognizes the stimulants as pain. Nociceptors are the nerve endings that transmit a sensation of pain to the brain. They can be stimulated by nutritional deficiencies, toxicities and hormonal disruptions and transmit a pain signal.
BDO: How is fibromyalgia diagnosed? I heard that it is very difficult to diagnose.
Dr. Dunston: Yes, the diagnostic criteria as above can be very confusing because there are so many different criteria. Basically, if someone has widespread chronic intractable pain present fairly often and has any of the other associated symptoms, then the diagnosis is fibromyalgia. This really just means pain in the body and describes symptomatology ad not a disease process. As you can see the causes are myriad and in reality comprehensive Functional Medicine diagnostic tests must be completed to a certain the true diagnosis and underlying causative factor. As this is not the standard of care currently, it requires patients to seek out qualified practitioners who can correctly assess the cause of the fibromyalgia and treat it.
BDO: What is the best form of treatment for fibromyalgia?
Dr. Dunston: The standard of care for treating fibromyalgia includes medications. However, they typically just control symptoms and must be used long term. They do not address the underlying cause of the symptoms. There are better options.
BDO: If medication is the best treatment, what kind and how long must you take it? I’ve heard that medications that treat other illnesses, such as depression, fatigue, sleep disorders, and Lyme disease are effective in treating fibromyalgia. How effective are they? What are the side effects of these types of medications, since they do not directly treat fibromyalgia itself?
Dr. Dunston: Standard of care treatment for fibromyalgia includes pharmaceutical agents designed to decrease pain and inflammation in the body or to decrease the perception of pain in the brain. The only drug approved by the FDA for use in fibromyalgia patients is Lyrica.
Typical treatments include NSAIDS (non-steroidal anti-inflammatory agents), such as Aleve, Ibuprofen, Tylenol and narcotic medications, such as codeine or even morphine.
Antidepressants help to decrease the sensation of pain in the brain by increasing serotonin levels. Citalopram (Celexa), Escitalopram (Lexapro), Fluoxetine (Prozac), Paroxetine (Paxil, Pexeva), and Sertraline (Zoloft) are often used at low doses to decrease fatigue and pain in fibromyalgia patients. Benzodiazapines like Xanax and Valium can be useful for relaxing tense and painful muscles and improve sleep in fibromyalgia patients.
There are concerns, however, for chemical dependence with Benzodiazipines and narcotics and none of these listed treatments actually addresses the underlying cause of fibromyalgia. They just address the symptoms and can have serious side effects, which include addiction and less serious but difficult symptoms, such as gastrointestinal distress (nausea, vomiting and diarrhea), sexual disturbance (decreased libido and difficulty achieving orgasm or erection), nervousness, agitation or restlessness, dizziness, sleep and energy disturbance, weight gain, and headaches.
Physical therapy and treatment can also help patients emotionally cope with pain. Most patients who do not have a proper and comprehensive evaluation need continued medication support to alleviate their symptoms.