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Table of Contents
Addendum
Abstract
Fibromyalgia is characterized
as a specific disease entity, and although the etiology remains controversial,
significant progress
has recently been made in alleviating the major symptoms of this malady.
Similarities to a related disease, Chronic Fatigue Syndrome (CFS),
are described. Psychological causes leading to endocrine imbalances
in brain regulatory mechanisms have been implicated. Genetic defects
have also been indicated, related to serotonin biochemical pathways.
In addition, autoimmune responses may be involved, including antibodies
to serotonin, a neurotransmitter, and its receptor. The mechanism of
pain at the biochemical level is described as related to fibromyalgia.
An important component of the pain pathway, substance P, is defined
and described in relation to pain as a major symptom. A variety of
related infectious organisms are described, including virus, bacteria,
fungi, and mycoplasma. Representatives of these organisms have been
detected in the blood of fibromyalgia patients with the Bradford High
Resolution Microscopy and polymerase chain reaction (PCR), which relates
to the severity of the disease. Mycotoxins isolated from a variety
of fungi are shown to increase cytosolic calcium, thereby leading to
mitochondrial damage, inhibition of adenosine triphosphate (ATP) production
and muscle fatigue. Therapies developed by the Bradford Research Institute
and currently employed in the Ingles Integrative Hospital and elsewhere
are detailed along with the rationale for its high success rate. The
formulations Proprietary Stabilized Alkanylated Sulfur Compound and
Stabilized Active Oxygen Carrier and their mechanisms of action are
related to therapy. Other forms of therapy include live cell injection
(transplantation), antioxidants, probiotics, acupuncture, aerobics,
amino acids, and other forms of dietary supplementation. A variety
of conventional drugs have also been implemented as therapy.
Introduction
Fibromyalgia (FM) syndrome is a more
common condition than had been previously estimated. Known to Hippocrates,
the Father of Medicine,
FM was described in the seventeenth century as "muscular rheumatism," but
it was not until the mid-1970s that the term fibromyalgia was introduced.
Fibromyalgia was originally thought to involve inflammation in the
muscles, but research has since proven that the muscles are not inflamed,
just stiff and painful.125
The very existence of fibromyalgia as a distinct clinical entity has been questioned,
partly because the most distressing symptom, pain, cannot be accurately measured
or quantitated. A second cause for doubt is the absence of a clearly defined
mechanism by which to define the disease. Fibromyalgia is believed to affect
from to seven to ten million Americans (three to six percent of the population).125
The median age at onset is from 29-37 years.126 Nine out of ten people who
have fibromyalgia are women.127
Practicing physicians are realizing that one risk factor for fibromyalgia is
a persistent fungal infection, including Candida albicans.128 From a recent
study, it appears that the effects of fibromyalgia decrease over time.129 Various
support groups for fibromyalgia patients have formed, including the American
Fibromyalgia Syndrome Association, Inc. and others. (See Chart 1.)
We hope that, within these pages, readers will find not only a clarification
of some
fibromyalgia mysteries but a greater prospect for relief from the suffering
this disease presents.
Chart 1: Basic Statistics of
Fibromyalgia
- Known by
Hippocrates, the Father of Medicine
- Affects 7-10 Million Americans,
3-6% of the Population
- Median Age at Onset, 29-37 Years
- 9 of 10
Patients are Women
- Fungal Infection a Common Cofactor, Including
Candida albicans
- Symptoms Decrease with Time
- Risk Factors
Include Exercise, Psychological Shock, Trauma, Lack of Sleep
- Symptoms
Include Muscle Pain and Stiffness, Sleep Disturbances, Tension,
Tingling, Numbness, Irritable Bowl Syndrome
Characterization
The symptoms of fibromyalgia bear some
similarity to those of a better-known disease, Chronic Fatigue Syndrome
(CFS). Some of the similarities
are abnormalities in neuroendocrine performance as well as abnormalities
in central neuropeptide levels and functional brain activity. Only
fibromyalgia patients exhibit abnormal pain responses to mild levels
of stimulation at locations known as "tender points" or
trigger points.1 The most common symptoms of fibromyalgia are muscle
pain, typically in the shoulder and upper arm, often accompanied
by sleep disturbances.2
Sleep Disturbances
Fibromyalgia patients report early morning awakenings, awakening feeling
tired or unrefreshed, and insomnia, as well as mood and cognitive
disturbances.3 Another aspect of these sleep irregularities are dysregulated,
biologic circadian rhythm disorders, such as stress hormone secretion.4
Gender Difference
Fibromyalgia is uncommon in men, and data on its characteristics and
severity are limited. In a Fibromyalgia Impact Questionnaire, men
with the disease reported more severe symptoms than women, decreased
physical function, and lower quality of life. Women had lower tender
thresholds with increased pain than that found in men.5 The male
is often a carrier of infectious organisms with minor symptoms, infecting
their spouse. Clinically, the male spouse is evaluated and treated
to prevent re-infection of the female partner.
Psychological Impact
In a study involving 40 female fibromyalgia patients and 38 healthy
age-matched women, 51% of the patients had experienced very negative
life events during childhood or adolescence compared to only 28%
among the controls. Before onset, 65% of the patients experienced
some negative life event. Furthermore, the life events experienced
by the patients were more negative than those of the healthy controls.6
It is hypothesized that a significant transient depression of immunological
parameters initiated the fibromyalgia syndrome.
Skin Hypoxia
Skin temperature and skin blood flow were studied above tender points
in 20 patients with fibromyalgia and 20 healthy controls. In the
skin above the five tender points examined in each subject, an increased
concentration of erythrocytes, decreased erythrocyte velocity, and
a consequent decrease in the flux of erythrocytes was found. A decrease
in temperature was recorded above four of the five tender points.
Vasoconstriction occurs in the skin above tender points in these
patients, supporting the hypothesis that fibromyalgia is related
to impaired capillary flow inducing localized hypoxia above these
tender points.7 Trigger point injections of two-percent Lidocaine
and 50% glucose (60% glucose, 40% Lidocaine) often significantly
reduces local pain.
Environmental Chemical Sensitivity
Fibromyalgia patients chosen by the American College of Rheumatology
criteria were studied for cell-mediated sensitivity to environmental
chemicals employing lymphocytes. Controls were 25 healthy adults.
The patient group showed significantly higher sensitivities for aluminum,
lead, and platinum than the controls. There was also shown some suppression
of T-cell functionality in the patient group.8
Muscle Abnormalities
The most common morphological finding in muscle biopsies in longstanding
fibromyalgia is type II fiber atrophy. This can also be found in
many other conditions such as disuse atrophy, affections of the corticospinal
tracts, steroid atrophy, and other different neuromuscular disorders.
A slight proliferation of mitochondria in type I muscle fibers are
correlated with the duration of the disease. Some fibromyalgia patients
showed a deletion of the mitochondrial genome.9
Altered Cerebral Blood Flow
Compared with control subjects, the regional cerebral blood flow in
fibromyalgia patients was significantly reduced in the right thalamus
(p=0.006) but not in the left thalamus. Other specific parts of the
brain also showed a reduction in blood flow.10 Fibromyalgia patients
differ from healthy persons in regional cerebral blood flow distribution
in several brain structures involved in pain processing and pain
modulation, both at rest and during experimental pain induction.11
Hormone Imbalance
Almost all the hormonal feedback mechanisms controlled by the hypothalamus
are altered. Typical for fibromyalgia patients are elevated basal
values of ACTH, follicle-stimulating hormone (FSH), and cortisol
as well as lowered basal values of insulin-like growth factor 1 (IGF-1),
free triiodothyronine (precursor of the thyroid hormone thyroxine)
and estrogen. Typical alterations in set points of hormonal regulation
for these patients can be explained as a primary stress activation
of hypothalamic corticotropin-releasing hormone (CRH) neurons caused
by chronic pain. In addition to the stimulation of pituitary ACTH
secretion, CRH activates somatostatin on the hypothalamic level,
inhibiting, in turn, the release of growth hormone and thyroid-stimulating
hormone (TSH) on the hypophyseal level. The net result of these alterations
in hormonal imbalance is an elevation of the neurotransmitter serotonin
in the central nervous system (CNS).12
Genetic Alterations
Depression and fibromyalgia share several common symptoms, indicating
a close relationship between both disorders. Genetic epidemiological
studies show that genetic transmission is involved. The gene for
the serotonin transporter promoter seems to be associated with neurotic
anxiety and fibromyalgia. Biochemical studies related to the serotonin
and norepinephrine neurotransmission are disturbed in both diseases.13
It is also noted that heavy fungal infection in the blood of FMS
patients affects the limbic system, causing both anxiety and depression.
It is suspected that there is a dysfunction in the serotonin pathways
in fibromyalgia. A study was conducted related to the gene for the
protein receptor into which serotonin binds. The study included 168
fibromyalgia patients and 115 healthy controls. Two strands of DNA
are held together in the double helix by hydrogen bonds between complimentary
base-pairs (base-pairing). One of these base pairs is between thymidine
(T) and cytidine (C). The number of T/C base pairs was increased in
fibromyalgia patients compared to the controls. These results imply
a genetic involvement in fibromyalgia.14
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