An Overview of CFS/Fibromyalgia

Published: July 11, 2012
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For years, many of us have dreamt of the day when we would see the headline "Effective Treatment for Chronic Fatigue Syndrome, Fibromyalgia (CFS/FMS), and Myofascial Pain Syndrome (MPS) Developed!" We are very excited to report that that day has arrived!

One of our studies published in the Journal of Chronic Fatigue Syndrome is titled "Effective Treatment of Chronic Fatigue Syndrome and Fibromyalgia — the Results of a Randomized, Double-Blind, Placebo-Controlled Study." After decades of hard work by hundreds of researchers in the field, we have progressed to the point where effective treatment is now available for these illnesses! In our study, 91% of patients improved with treatment.

In the average patient, after two years of treatment, the average improvement in quality of life was 90%. Pain decreased by over 50% on average. Many patients no longer even qualified for the diagnosis of CFS or fibromyalgia after treatment! Interestingly, many of the same principles for treating fibromyalgia also apply to muscle pain.

That the vast majority of patients improved significantly in the active group while there was minimal improvement in the placebo group proves two very important things. The first is that these are very treatable diseases. The second is that anyone who now says that these illnesses are not real or are all in your head are clearly both wrong and unscientific.

A new day is dawning in how CFS/fibromyalgia/MPS will be treated. In support of our work, an editorial published in the April, 2002 journal Practical Pain Management noted "the comprehensive and aggressive metabolic approach to treatment detailed in the Teitelbaum study are all highly successful approaches and make fibromyalgia a very treatment-responsive disorder. The study by Dr. Teitelbaum et al. and years of clinical experience make this approach an excellent and powerfully effective part of the standard of practice for treatment of people who suffer from fibromyalgia and myofascial pain syndrome."

It is important to recognize that these syndromes can be caused and aggravated by a large number of different triggers. When all these different contributing factors are looked for, and treated effectively, patients improved significantly and often get well!

What is Causing these Illnesses?

CFS/FMS acts as a "circuit breaker," with the hypothalamus decreasing its function to protect the individual in the face of what is perceived to be an overwhelming stress (just like blowing a fuse/circuit breaker in a house). This center controls sleep, hormones, temperature, and blood flow/blood pressure/sweating. When you don't sleep deeply, your immune system also stops working properly and you'll be in pain. In addition, if your muscles do not have enough energy, they will get stuck in the shortened position, also contributing to pain (think rigor mortis).

This "energy crisis" can be caused by any of a number of infections, stresses, or injuries.

Some of you had your illness caused by any of a number of infections. In this situation, you can often give the time that your illness began almost to the day. This is also the case in those of you who had an injury (sometimes very mild) that was enough to disrupt your sleep and trigger this process. In others, the illness had a more gradual onset. This may have been associated with hormonal deficiencies (e.g., low thyroid, estrogen, testosterone, cortisone, etc.) despite normal blood tests. In others, it may be associated with chronic stress, antibiotic use with secondary yeast overgrowth, and/or nutritional deficiencies. Indeed, we have found dozens of common causes and factors that contribute to these syndromes.

Understanding this helps us understand the symptom complex seen in CFS/fibromyalgia. Restoring energy production so that your hypothalamic circuit breaker turns back on, and eliminating what blew your fuse in the first place, also gives us many ways to effectively treat you!

To Turn Your Circuit Breaker Back On, Treat With S.H.I.N.E.!

A half-century of work by Dr. Janet Travell, the White House physician for Presidents Kennedy and Johnson and author of the Trigger Point Manual showed that the same problems caused by hypothalamic suppression resulted in muscles getting stuck in the shortened position. Chronic muscle shortening then causes myofascial and fibromyalgia pain. As she laid the groundwork for effective treatments these processes, our research team has dedicated our published study to her memory. Here are the 5 key areas, which we call the "S.H.I.N.E. Protocol," that need to be treated for Chronic Fatigue syndrome, fibromyalgia and muscle pain to resolve:

  1. Sleep. Most patients with these illnesses find that they are unable to get 7-8 hours of deep sleep a night without taking medications. In part, this occurs because hypothalamic function is critical to falling and staying asleep. Unfortunately, many of the most common sleep medications actually aggravate the sleep problems by decreasing the amount of time spent in deep sleep. For patients to get well, it is critical that they take enough of the correct sleep medications to get 8 to 9 hours of deep sleep at night! These medications often work best at very low doses and  include Ambien, Desyrel, Neurontin, and Flexeril. In addition, natural remedies can help sleep. An excellent mix includes the herbs Theanine, Jamaican Dogwood, wild lettuce, valerian, passion flower, and hops. Other natural sleep aids include 5-HTP, and melatonin. Some patients find that over-the-counter antihistamines such as doxylamine (Unisom for sleep) or Benadryl can also help. In the first six months of treatment, it is not uncommon to sometimes need to take even six to eight different products simultaneously to get eight hours of sleep at night. After 6-18 months of feeling well, most people can come off of most sleep (and other) medications.
  2. Hormonal Deficiencies. The hypothalamus is the main control center for most of the glands in your body. Most of the normal ranges for our blood tests were not developed in the context of hypothalamic suppression or these syndromes. Because of this (and for a number of other reasons) it is usually necessary, albeit controversial, to treat with thyroid, adrenal (very low dose cortef; DHEA), and ovarian and testicular hormones—despite normal blood tests! These hormones have been found to be reasonably safe when used in low doses.
  3. Infections. Many studies have shown immune system dysfunction in FMS/CFS. Although there are many causes of this, I suspect that poor sleep and inadequate zinc levels are 2 (of many) major contributors. The immune dysfunction can result in many unusual infections. These include viral infections (e.g., HHV-6, CMV, and EBV), parasites and other bowel infections, infections sensitive to long-term treatment with the antibiotics Cipro and Doxycycline (e.g., mycoplasma, chlamydia, Lyme) and, most importantly, fungal/Candida infections. Avoiding sweets (stevia is OK) and taking probiotic pearls (healthy milk bacteria in a special "pearls" coating) can be very helpful. We often also add prescription antifungals.
  4. Nutritional Supplementation. Because the western diet has been highly processed, nutritional deficiencies are a common problem. In addition, bowel infections can cause poor absorption, and the illness itself can cause increased nutritional needs. The most important nutrients include (these can be found in combination in a good multivitamin powder):
    1. Vitamins — especially the B vitamins, vitamin B12 and antioxidants (e.g., vitamin C and E).
    2. Minerals — especially magnesium, zinc and selenium.
    3. Amino acids (proteins).
    4. Energy cofactors.
  5. Exercise as able. Decreased activity causes deconditioning. Pushing too hard, though, causes "postexertional fatigue," where you feel like you were hit by a truck the following day. So the proper balance is to do a level of walking that leaves you feeling "good" tired afterwards and better the next day. After 10 weeks on S.H.I.N.E., your energy levels will usually increase markedly, allowing you to condition instead of simply crashing after exercise.

D-Ribose — An Exciting New Discovery!

D-Ribose is an outstanding new nutrient (a special sugar — even OK for those who need to avoid sugar) for those of you who want a powerful energy boost. In addition to its role in making DNA and RNA, those of you familiar with biochemistry remember Ribose as the key building block for making energy. In fact, the main energy molecules (like "energy dollars") in your body (e.g., ATP, FADH) are made of ribose plus B vitamins/phosphate. That makes these energy molecules similar to the paper that money is printed on—kind of like being able to print your own energy currency!

D-Ribose has many uses, including treating heart muscle weakness (congestive heart failure). We were so impressed with this product that our research center has done 2 studies looking at ribose in CFS/FMS, with the most recent study being published in July 2012. In the study, 257  people with CFS/FMS were treated at 53 clinics. On average, they showed a 61% increase in energy at just 3 weeks! Pain, sleep and "brain fog" also improved.

There are many other treatments available as well. Although space does not allow for a full discussion of these in this article, I discuss them at length in my books Pain Free 1-2-3! (McGraw Hill 2006) and From Fatigued to Fantastic!, and also in our S.H.I.N.E. Protocol.

So Can I Make My Pain Go Away?

Fibromyalgia and myofascial pain and associated nerve entrapments are now very responsive to treatment! In many cases, they usually will improve dramatically and often even go away if you simply get the eight hours of sleep a night I discuss above, take a good vitamin powder plus ribose, take thyroid hormone, and treat the underlying yeast infections. Other patients require more thorough evaluation and treatment. Localized myofascial pain also requires an evaluation for structural causes.

Aspirin family medications (including ibuprofen) are not very effective for most fibromyalgia and myofascial pain patients. I avoid Tylenol because it can markedly deplete a critical antioxidant (glutathione). Helpful natural treatments include the herbal sleep formulas which can be used during the day for muscle pain and/or anxiety, and herbal supplements that provide relief for muscle pain (formulas containing, boswellia and white willow bark or Curcumin, boswellia, nattokinase and DLPA). Although some effect can be seen immediately, improvement continues to build over six weeks. The medications I find to be most helpful for myofascial pain include Skelaxin (which are not sedating), Ultram and Neurontin. Lidocaine patches (Lidoderm) and creams creating a mixture of medications can also be highly effective for local areas of pain without significant side effects. There are many other helpful natural therapies, medications and other effective ways to help manage pain as well. These can be used to help keep you comfortable while we go after the pain's underlying causes.

How Do I Go About Getting Well?

The American Board of Integrative Medicine (ABIHM) includes over 1,500 board-certified holistic practitioners who can help you. Their website can also help you locate a certified holistic physician near you. In addition, I treat patients worldwide. Consultations can be done in person or by phone.

My best-selling book From Fatigued to Fantastic! (Penguin/Avery 2007) and my book Pain Free 1-2-3 (McGraw Hill 2006) will supply you and your physician with all the information that you need to get treated effectively.

Other Tools

The free "Energy Analysis Program" can help you learn how to optimize your energy production. This online questionnare analyzes answers you provide to energy and lifestyle-related questions (even your pertinent lab tests if available) to create a specific set of recommendations for improving your energy level.

Our goal is simple — we want you to regain your vitality and feel better now!

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