A phytotherapeutic protocol for fibromyalgia.(Phytotherapy Review & Commentary)

Fibromyalgia is a disorder of unknown cause characterized by chronic widespread musculoskeletal pain and symptoms such as fatigue, sleep disturbances, gastrointestinal complaints and psychological problems. (1) A key diagnostic condition is the presence of multiple tender points on the body (11 of 18 tender points should be present, as defined by the American College of Rheumatology). However, not all patients meet this diagnostic hurdle.

[ILLUSTRATION OMITTED]

Disease onset appears to follow physiological and/or psychological stressors. (2) Prognosis for sufferers of fibromyalgia is poor. One study found no improvement in pain over two years, despite various treatments. (3) There is considerable comorbidity with chronic fatigue syndrome (CFS) and multiple chemical sensitivities (MCS). For example, a study of a cohort of CFS sufferers found 40.6% met the criteria for MCS and 15.6% met the criteria for fibromyalgia. (4) Another study found that 70% of tested CFS patients met the criteria for fibromyalgia. (5) The reverse association is also strong: 58% of a female group with fibromyalgia met the full criteria for CFS compared to 26.1% of a control group; for males the rates were even higher, 80.0% versus 22.2% for controls. (6) There is also a strong association with depression and to a lesser extent, other psychiatric disorders. (7)

Conventional treatments include painkillers, (8) ketamine, (9), (10) interferon-alpha (11) and more commonly antidepressant drugs (especially tricyclics). A role for non-pharmacological therapy including exercise (12) and chiropractic management (13) has been established in objective studies.

What Causes Fibromyalgia?

As stated above, a definitive cause is not known. However a number of abnormalities of immune and neuroendocrine response have been identified over the last 10 years. (2) The reduced hormonal and autonomic responses appear to reflect an impairment in the hypothalamic or central nervous system response to stimuli, rather than a primary defect at the level of the pituitary or peripheral glands. (1) Since good phytotherapeutic management for any chronic disease is based on the identification and treatment of both precipitating and sustaining causes, it is worthwhile to review the relevant findings in the conventional literature which can provide some insights for the treatment of this debilitating disease.

Abnormalities in Neuroendocrine Response

A recent review of pathogenic mechanisms in fibromyalgia concluded (14): "The symptomatology characterizing fibromyalgia comprises three systems: the musculoskeletal system with widespread muscular pain, neuroendocrine disorders, and psychological distress including anxiety and depression. Fibromyalgia is predominantly found in middle-aged women. Though the most prominent symptom of fibromyalgia is pain in defined regions of the locomotor system, the numerous other somatoform and psychological disorders suppose a common primary disturbance which is considered to originate within higher levels of the central nervous system. Studies of the entire endocrine profile of fibromyalgia patients support the hypothesis that an elevated activity of corticotropin releasing hormone (CRH) neurons determines not only many symptoms of fibromyalgia but may also cause alterations observed in the hormonal axes. Hypothalamic CRH neurons thus may play a key role not only in resetting the various endocrine loops but possibly also nociceptive and psychological mechanisms as well."

Another review on hormonal perturbations in fibromyalgia by the same research group asserted: (15) "Recent studies of the entire endocrine profile of FM patients following a simultaneous challenge of the hypophysis with corticotropin-releasing hormone (CRH), thyrotropin-releasing hormone, growth hormone-releasing hormone, and luteinizing hormone-releasing hormone, support the hypothesis that an elevated activity of CRH neurons determines not only many symptoms of FM but may also cause the deviations observed in the other hormonal axes."

Furthering this, a Dutch research team has proposed that fibromyalgia is associated with an altered functioning of the stress response system. (16) Based on a comparative study with healthy controls they conclude that: "The present data validate and substantiate our preliminary evidence for a dysregulation of the HPA axis in…