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Depression Under the Fibromyalgic Cloud, Research Paper Example

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Research Paper

Abstract

Fibromyalgia is a condition that baffles both health care providers and the patients who suffer from the disease. There are a number of overlapping symptoms that are prevalent in most cases of fibromyalgia, as well as an array of secondary symptoms that vary from one patient to the next. This “fibromyalgic cloud” of symptoms can prove daunting for those who suffer under it; even getting a diagnosis can prove difficult, and finding effective treatment can sometimes seem impossible. The fibromyalgic cloud is comprised of different symptoms that are difficult to manage, and that may be derived from many different sources and are not easily understood, making treatment very difficult. With so few answers available for patients, many who suffer from fibromyalgia turn to alternative treatments and remedies to manage this chronic condition. Despite the skepticism often seen in the sphere of traditional medicine, there is statistically significant evidence demonstrating the efficacy of several alternative lines of treatment, including the administration of herbal remedies. This paper discusses the various overlapping conditions that form the fibromyalgic cloud, and explores a number of alternative treatments that have proven effective in treating these conditions.

BioMed Section

Fibromyalgia is a baffling disorder, one that frustrates both health care providers and the patients who suffer from it. Among the most frustrating aspects of this condition is the mystery surrounding its cause; physicians and health care providers disagree about what causes it, as various studies demonstrate evidence that it is caused by everything from environmental toxins to genetic predisposition (with some believing that environmental toxins can trigger the activity of a genetic predisposition). Along with no clear consensus as to the cause of fibromyalgia is a lack of consensus regarding how to treat it. Some health care providers take a purely pharmacological approach to treating fibromyalgia, while others believe a holistic approach can be more effective. What is most baffling of all, though, is that many of those afflicted with fibromyalgia simply cannot get their health care providers to take them seriously, and they suffer the symptoms for months or years as they seek help in treating their condition. With so little understanding of what causes fibromyalgia, and how to treat it, sufferers are turning to alternative approaches to manage their condition.

Questions about the efficacy of alternative treatments are sometimes difficult to answer; with information about conventional treatments as scarce as it is, information about alternative remedies is even scarcer. This paper will attempt to explore what kinds of alternative treatments are being used to manage fibromyalgia, as as well as determine the efficacy of such treatments.

What Is Fibromyalgia?

Just as health care providers have difficulty understanding what causes fibromyalgia, and have difficulty agreeing on how to best treat the condition, so too is there no definitive consensus on how to describe or assess the symptoms of the disorder. This lack of consensus stems largely from the fact that sufferers of fibromyalgia exhibit a fairly broad spectrum of symptoms, with no two sufferers displaying the exact same set of symptoms (Velkuru, 2009). Because patients with fibromyalgia often display a wide range of overlapping symptoms and clinical features, the diagnosis and treatment of the disorder can be quite frustrating (Velkuru, 2009).

The following description of fibromyalgia will be used as the premise for further exploration in this paper:

Fibromyalgia is an idiopathic, chronic, nonarticular pain syndrome with generalized tender points. It is a multisystem disease characterized by sleep disturbance, fatigue, headache, morning stiffness, paresthesias, and anxiety. Nearly 2 percent of the general population in the United States suffer from fibromyalgia, with females of middle age being at increased risk. The diagnosis is primarily based on the presence of widespread pain for a period of at least three months and the presence of 11 tender points among 18 specific anatomic sites… Although there are no guidelines for treatment, there is evidence that a multidimensional approach (may be effective). American Academy of Family Physicians, 2007 (Chakrabarty, 2007)

Epidemiology

Fibromyalgia was first identified in 1904 by Sir William Gowers, who gave it the name Fibrositis (Velkuru, 2009). It was not until 1976 that researchers determined that inflammation was not present in the tissues associated with fibromyalgia, and this determination prompted the decision to change the name of the disorder to fibromyalgia (Velkuru, 2009). In recent decades, fibromyalgia has come to be seen as the most common cause of musculoskeletal pain (Chakrabarty, 2007).  Fibromyalgia is believed to be present in approximately 3-5 percent of the general population, and occurs much more frequently in women than in men; roughly 90 percent of fibromyalgia sufferers are women (Velkuru, 2009)  Fibromyalgia occurs more frequently in patients with family members who also have the disease; this is seen as evidence of a genetic component in the causality of fibromyalgia.  Along with possible genetic components, the cause of fibromyalgia may also involve environmental factors. Along with the typical symptoms of pain in fibromyalgia, other symptoms such as mood disorders, sleep disorders and anxiety are commonly seen in those with the disorder (Chakrabarty, 2007).

As previously noted, the etiology of fibromyalgia remains indeterminate in most cases. In some cases, there are disagreements about whether presenting symptoms are the cause of, or the result of, fibromyalgia. Sleep disorders and insomnia are present in nearly all cases of fibromyalgia; the slow onset of some cases of fibromyalgia leaves some researchers wondering if long-term insomnia can trigger the onset of fibromyalgia, or if all cases of comorbid insomnia are a result of fibromyalgia. There are other overlapping conditions that are often seen in patients with fibromyalgia, and as with sleep disorders, there are questions about whether these various conditions are at the root of the disorder or are a result of it (Chakrabarty, 2007).

Additional hormone production and hormone functions that take place in the spinal column are maladjusted; these imbalances serve to amplify pain signals disproportionately to the expected stimuli (Velkuru, 2009). Pain perception in patients with fibromyalgia is distorted, with pain-from-pressure levels seen as the most obvious of the pain perception factors (Velkuru, 2009). This pain-from-pressure factor (as opposed to pain from injury) leads to a sensation of constant, chronic pain in those with fibromyalgia (Velkuru, 2009).

Clinical Features and Symptoms

The most common complaint from patients with fibromyalgia is the existence of pain at multiple sites; there are, in fact, 18 sites on the human body that are routinely checked through palpation to make diagnostic determinations in a clinical setting              (Chakrabarty, 2007). Along with the pain associated with fibromyalgia, nearly all patients complain of poor sleep or insomnia. As noted previously, there is some question about these sleep disturbances, and whether they are caused by fibromyalgia or whether they do, in fact, contribute to it. The aforementioned production of certain hormones that takes place during stage four sleep is compromised in patients with fibromyalgia; this compromised hormone production is believed by some to be a possible cause of fibromyalgia, though the general consensus is that this compromised function is a result of the disease, rather than the cause (Chakrabarty, 2007).

There are a range of secondary complaints that are associated with fibromyalgic sleep disorders; many patients complain that sleep is routinely interrupted, and that they do not feel rested after sleep. Other symptoms that may be associated with these sleep disorders are cognitive difficulties, memory loss, and problems in recalling words. Patients also complain of frequent headaches, both of the tension type and the migraine type. In addition to these symptoms, patients note feelings of lightheadedness, dizziness, anxiety, and depression (Velkuru, 2009).

As noted, the most common symptom of fibromyalgia is pain. This pain is typically chronic, and often manifests in the same ways. Fibromyalgic pain typically begins in the lower back and radiates down into the buttocks and legs. Along with this most common complaint of pain in the back, patients sometimes complain of pain in the neck and shoulders.  Finally, pain-from-pressure is seen in most patients; palpating various points on the body triggers a disproportionate pain response. There are other symptoms associated with fibromyalgia that are less obvious, such as the previously-noted hormonal dysfunctions. Other “hidden” symptoms often include hypertension and a higher-than-normal baseline heart rate (Velkuru, 2009). The amplification of pain associated with fibromyalgia typically begins in the spinal column. Glial cells that surround the spinal pain neurons are dysfunctional (though the reason for this dysfunction is unclear); this dysfunction has the effect of amplifying pain signals as they enter the spinal nervous system. Along with the pain associated with fibromyalgia, less-severe symptoms such as numbness and tingling are seen in some patients (Velkuru, 2009).

Diagnosing fibromyalgia

There are no laboratory tests for fibromyalgia. Diagnosing the condition can be difficult; there is disagreement among health care providers as to how to determine if a patient is suffering from fibromyalgia. Some health care providers focus on a process of elimination; when other conditions with similar symptoms and features are ruled out, a diagnosis of fibromyalgia can be determined (Velkuru, 2009).  Other health care providers have agreed on a set of criteria that involves palpating a specified set of points on the body to determine the existence of chronic pain primarily on the upper half of the body (Chakrabarty, 2007).

Considering that there is no clear consensus among the members of the medical community about what causes fibromyalgia or how to diagnose the disorder, there is little wonder that many patients complain that they are not taken seriously by their health care providers. However, since pain management via NSAIDS and hormone dysfunction is common, it is difficult for physicians to specifically point out the causes of this condition within their patients, thereby leading to diagnostic challenges that are difficult to overcome.

Management and Treatment

The most frustrating aspect of fibromyalgia for patients is the fact that it is very difficult to treat. There are no specific treatments for fibromyalgia that are effective in all cases, and the majority of patients with the disorder complain that they are dissatisfied with their treatment (Velkuru, 2009).  Fibromyalgia is a chronic condition, and there is no cure for it. In the absence of any specific effective treatments for fibromyalgia, health care providers typically focus on managing symptoms of pain, sleeplessness, anxiety, and the range of other symptoms seen in sufferers (Chakrabarty, 2007).

It is known that glutamate (Glu) is a key neurotransmitter which may be prevalent in large amounts in patients who suffer from fibromyalgia, which is represented as a means of promoting experiences of pain (Harris, 2010). Therefore, it is important to recognize that Glu may be a responsible contributor to pain in patients who face different levels of pain in response to fibromyalgia (Harris, 2010). Although the exact connection is unknown, it is nonetheless essential to consider how fibromyalgia patients may test with high levels of Glu that coincide with pain at various levels (Harris, 2010).

Most physicians who treat patients with fibromyalgia will attempt to find treatments that are specific to individual patients. Managing pain in patients can be the greatest challenge, as fibromyalgia does not typically respond well to conventional analgesics. Non-steroidal anti-inflammatory drugs (NSAIDS) may be of some help, but the lack of inflammatory conditions in the tissues associated with fibromyalgia means that NSAIDS do not always provide any relief to patients. NSAIDs are not always the most optimal choice for patients who seek relief from this condition, as side effects and interactions with other medications may occur. The hormonal dysfunctions renders opiate drugs largely useless for treating Fibromyalgic pain (Chakrabarty, 2007).

Research has shown that some of the most effective treatments for fibromyalgia involve treating the peripheral syndromes seen in the disease. Medications that help patients sleep, or that serve to regulate mood disorders and depression, often provide the added benefit of ameliorating the patient’s pain disorders. The most effective conventional medications are the tricyclic family of anti-depressants; as these medications reach levels of peak efficacy in the body, patients sometimes see improvements in their pain levels (Velkuru, 2009). Even when the improvements in mood do not equate directly to improvements in pain levels, they may at least equate to improvements in the patient’s quality of life.

Treating the sleep disorders associated with fibromyalgia may also have an overall beneficial effect on the patient’s pain levels. Some studies have shown that treatment with Trazodone, a sleep medication, has improved the outcome for a significant number of patients. Trazodone does not eliminate the symptoms of fibromyalgia entirely; rather, the improvement in the quality of sleep –most notably, the prevalence of longer period of stage four sleep in treated patients- would seem to allow for an improvement in the hormone functions associated with sleep. This improvement in hormone functions seems to offer at least some relief to patients with fibromyalgia (Velkuru, 2009).

In recent years, there has been increasing evidence, both anecdotal and from controlled testing, that seems to indicate that fibromyalgia can be managed, at least in part, through the application of treatments that fall under the heading of Complementary and Alternative Medicine, or CAM for short. Because patients with fibromyalgia often face difficulties in receiving diagnosis and treatment, many have turned to CAM treatments to alleviate their suffering. The following section provides a review of some of the available literature in such treatments.

Clinical Skills Section

Because Fibromyalgia is so poorly understood, it is exceedingly difficult to create an effective framework for treatment that can easily be applied across a range of patients. Every patient with Fibromyalgia displays a different set of symptoms, or a different level of severity for each primary and secondary symptom. Some patients experience pain as the primary –or only-symptom, while other patients demonstrate a range of symptoms, from pain to sleep disorders to emotional and behavioral disorders. With these considerations in mind, a hypothetical patient will be presented as a means of demonstrating the creation of specific plans tailored to meet the needs of specific patients.

Patient: “Mary”

Age: 44

Height: 5’ 4”

Weight: 145 lbs.

Lifestyle:   Lt. Smoker, Lt. Drinker, Limited Exercise

Medications:  None Currently.  Not sexually active.  No birth control pills.

Varied Diet  (includes meat, vegetables, fruit, processed grains, legumes)

Mary has been displaying symptoms of fibromyalgia for approximately 18 months. Mary’s symptoms first appeared shortly after she was involved in an automobile collision in which she suffered a whiplash injury and a broken wrist. Within days of receiving these injuries Mary began to experience sleeplessness; a few days later, the pain that she was feeling in her neck was joined by pain in her lower back and along her spinal column. With each passing day, the symptoms grew worse, and the pain originating in her lower back eventually manifested up the entirety of her spinal column. Mary’s primary symptoms of pain and insomnia, along with a secondary symptom of moderate depression, have come to dominate her life. Mary has sought out numerous conventional treatments, including, but not limited to, the use of NSAIDs and opiate-based analgesics for pain and sedative-hypnotic medications for sleeplessness. Within weeks of beginning a new medication regimen, the drug’s efficacy would diminish, leaving only the negative side-effects, ranging from next-day grogginess to dependency issues. Concerned about these side-effects, Mary has chosen to abandon the use of most pharmacological treatments and to instead seek alternatives to them.

Clinical Goals

As a clinician, my goal in treating Mary is to first alleviate the symptoms of pain and sleeplessness, with an eye towards lessening or eliminating the prevalence of the overall fibromyalgic condition.

The clinical approach to treating Mary is not straightforward eventhough she has no known allergies, and is not currently taking medications of any kind.  This treatment is based on peer-reviewed assessments of herbal and alternative medicine that has demonstrated efficacy in treating fibromyalgia and its underlying symptoms.

The first course of action is to address lifestyle changes and adjunct therapies such as acupuncture. The use of acupuncture in treating fibromyalgic pain has demonstrated measurable success; in some cases, pain relief is on a par with some short-term analgesic approaches.

The prescription of a daily routine of a healthy diet and moderate exercise will have a two-pronged effect; these changes will help lessen Mary’s secondary symptom of moderate depression, and will also serve to aid her in achieving greater periods of restful sleep.

`Mary’s adjunct acupuncture therapy will begin with a once-weekly session for four weeks to establish a baseline of efficacy; subsequent to this period, her sessions may be expanded as needed.

The most significant treatments for Mary’s condition will involve the application of treatments for pain, sleeplessness, and depression. The following section contains detailed information about specific herbs and supplements that have demonstrated proven efficacy in these areas.

As is the case with anyone who suffers from fibromyalgia, it is impossible to predict –even in a hypothetical scenario- which, if any, treatments will be effective. In many cases where conventional pharmacology is applied to the symptoms of fibromyalgia, the treatments show great promise at the time of initiation, yet diminish in efficacy fairly rapidly. With this in mind, conservative strategies will be used to develop herbal treatment plans.

In treating Mary’s condition, the oral administration of appropriate herbal treatments will commence at the time her lifestyle plan is implemented.  Although nutrition cannot cure symptoms it can cure the cause of the imbalance.  Eventhough Mary’s diet is varied, she would be encouraged to eat a diet comprised of lean meats, poultry and seafood, vegetables (especially the green leafy variety), legumes, grains, dairy, natural antioxidants and vitamins including vitamin D).

Sleep hygiene would be discussed with Mary and she would be placed on a trial of the following herbs:  (Valerian officinalis), valerian root for its anxiolytic, sedative, hypnotic and spasmolytic qualities aimed at improving skeletal muscle response, insomnia, depression and anxiety.  (Harpagophytum procumbens), Devil’s claw for its anti-inflammatory, anti-rheumatic, and analgesic success in alleviating inflammation at the level of the tissues.  (Hypericum perforatum), St. John’s Wort  with dual and overlapping anti-inflammatory, and analgesic properties, would be prescribed to assist in balancing the pain profile, particularly for episodes involving acute pain, in conjunction with providing anti-depressant properties as a nervine.  This should give her a little boost in her recreation/exercise input.  Social support would be discussed with Mary as part of her daily living, working and overall wellness routine.  Mary would be encouraged to include friends and family in her quest for improved wellness and health maintenance.  Mary would also be encouraged to schedule the approximate session at the close of the initial session.  Mary’s herbals would be refilled after further evaluation.

Each herb must be administered with rigorous attention to detail. Because it is not known which herb, if any, will be effective for any given imbalance, I would be prepared with the client’s consent  to maintain the use of a particular herb as long as needed to determine its relative efficacy, yet timely abandon the use of any herb in favor of trying the next treatment. In this manner, the client and I can determine which herbs are effective for individual imbalances and also determine which ones do and do not work concurrently.

Any herbalist willing to take on challenging cases such as those patients with fibromyalgia must display great patience. The treatment of fibromyalgia with herbal remedies is a newly-emerging field; the very act of offering such treatment places the herbalist squarely astride the fields of both “clinician” and “researcher.” I would be dedicated to carefully document every symptom, no matter how slight; every herb at every dosage; all other details about diet, exercise, and other lifestyle choices; and any other information that may be the least bit relevant. Those of us who set out to treat fibromyalgia with herbal remedies are blazing new trails; the treatments developed for Mary today may help hundreds or thousands of patients tomorrow.

Materia Medica Section

Authors Leslie J. Crofford, MD, and Brent E. Appleton, MD conducted so-called “meta-analyses” (a broad review of available studies) of various CAM treatments used in the treatment of fibromyalgia. Though they too made note of the lack of randomized testing of such treatments (with even fewer of these test done specifically on patients with fibromyalgia), they did manage to find several studies that examined various herbal treatments and other CAM approaches. Crofford and Appleton discussed several different herbal and botanical treatments that either were taken specifically for fibromyalgia, or were taken for some disorder that can be found as a typical peripheral condition in fibromyalgia patients:

Sleep Disorders

Insomnia and sleep disorders that include difficulty in falling asleep or maintaining sleep are not just common to sufferers of fibromyalgia; these conditions are, however, a nearly-universal concomitant symptom-cluster of fibromyalgia, along with the condition’s primary symptom of associated pain. The prevailing literature regarding the use of herbal treatments for sleep disorders show several supplements that have demonstrated remarkable efficacy, with some rivaling conventional pharmacological treatments while offering fewer significant side-effects (Currie and Wheat, 2008).

Perhaps the most effective herbal treatment for insomnia is Valerian Root (Currie and Wheat, 2008; Wirth, 2005).

Valerian Root

Pharmacology: The compounds in valerian root inhibit the activity of enzyme-induced GABA in routine brain function (Clarocet, 2007).

Key Constituents:  contains a variety of compounds, including valerenic acids, sesquiterpenes, and valepotriates (Office of Dietary Supplements, 2011)

Traditional Uses: Used to treat sleep disorders, gastrointestinal upset, and attention deficit hyperactivity disorder

Clinical Evidence-Base:  a study that administered various doses of Valerian root, as either 450 mg or 900 mg in an aqueous solution, found significant dose-dependent improvement in the onset of sleep in patients with fibromyalgia. In addition to the increased rate of sleep onset, most patients experienced longer periods of REM sleep and shorter periods of non-REM sleep. These improvements in sleep would seem to offer a significant benefit to patients with fibromyalgia, both in terms of mood improvement and in the hormonal functions that take place during stage four sleep.  This herb, like many, can be administered in several ways, such as tinctures, prepared capsules or infused as a tea. As is the case with many herbal treatments and supplements, there are several considerations regarding the use of Valerian Root; the two most common concerns are determining the potency of a given supplement and determining the appropriate effective dose for a given patient (Wirth, 2005). Neither of those concerns can be adequately addressed within the scope of this paper, as the variables are considerable. What is clear from the available literature is that Valerian Root has demonstrably proven to be as or more effective than several common pharmacological treatments for symptoms of insomnia (Sachs, 2000). Both flunitrazepam  and oxazepam, members of the commonly-prescribed family of benzodiazepams, were shown to provide rates of efficacy similar to Valerian Root, while also stimulating markedly greater side effects (post-sleep drowsiness and dependency being the most significant of these effects) (Sachs, 2000).

Valerian Root is not the only herbal treatment that is known anecdotally to promote sleep; it is, however, one of the few which has been studied in a controlled manner. While there are many other herbs that have earned reputations among users as being beneficial in the treatment of insomnia, it is their lack of verifiable support that leaves them outside the scope of my overview.

Depression

In recent years, St. John’s Wort has acquired a reputation as an effective alternative to prescription medications for the treatment of mild-to-moderate depression. A 2011 study demonstrated an efficacy rate of over 70 percent; this is roughly comparable to the effective rates of typical SSRI anti-depressants (Carpenter, 2011). As is the case with many other herbal treatments, St. John’s Wort demonstrates significantly lower rates of negative side-effects; specifically, the rate of negative side-effects associated with St. John’s Wort approaches nil (Carpenter, 2011).

St. Johns’s Wort has demonstrated efficacy in treating mild-to-moderate depression in both short- and long-term cases (Carpenter, 2011).

St. John’s Wort:

Pharmacology: St. John’s Wort inhibits the ability of brain tissue to reuptake dopamine, serotonin, and noradrenaline, and also activates glutamate and gamma-amino-butyrate receptors (Lawvere and Mahoney, 2005).

Key Constituents: Hypericin, pseudohypericin, hyperforin, flavonoids, procyanidins, essential oils.

Interacts with some medications and may interfere with their effectiveness (NCCAM, 2011)

Traditional Uses: Generally used to treat depression and mood disorders (NCCAM, 2011)

Clinical Evidence-Base: Referencing a meta-analysis of the available information on St. John’s Wort, Drs. Crofford and Appleton assert that the herb is “comparable to conventional antidepressants in treating mild depression.” The authors discuss the manner in which St. John’s Wort functions; it acts similarly to the tricyclic family of antidepressants. This function may offer the same improvement to sufferers of fibromyalgia, though they admit that no formal tests have been conducted specifically on patients with fibromyalgia. Like so many studies of CAM treatments, this article reports difficulties in finding relevant studies; despite the hurdles faced by the authors, there is no question that they found and reported on significant positive outcomes for patients with fibromyalgia who used the herbal treatments noted in this report.

While all of the herbs mentioned in this section (and throughout this paper) have few, if any, associated negative side-effects, it must be reiterated that any herbal treatments can potentially be harmful. Anyone considering the use of herbal treatments for fibromyalgia –or for any other condition- should discuss their use with his or her health care providers, as well as with pharmacists and anyone else who may provide information about proper use, potential drug interactions, and possible side-effects. It has been stated, but it bears repeating, that among the limitations associated with the use of herbal treatments and dietary supplements are the lack of consistency in purity, dosage, and the possibility of adulteration.  With so few controlled trials involving such approaches to treating fibromyalgia or its individual symptoms, the use of herbs and supplements places the burden of responsible use squarely on the user. Considerable care should be taken to understand the nature of each treatment, the appropriate dosages, the potential contraindications, and the veracity of the manufacturer’s claims regarding purity and dosage content.

With those considerations in mind, the evidence supporting the efficacy of many of these herbs and supplements is mounting every day; hopefully this growing body of evidence will serve to foster further studies of these treatments.

Pain

As noted in other sections of this paper, the process of nociception –the manner in which the human body processes noxious stimuli- is compromised in fibromyalgia patients (Chakrabarty, 2007). The mechanism by which nociception is affected is unclear; the resulting effect seems to amplify or exaggerate the communication of pain signals between the spinal sections of the CNS and the brain receptors (Chakrabarty, 2007). Because many traditional treatments for pain –notably NSAIDS and opiate-based analgesics- often fail to reliably treat fibromyalgic pain, it is this symptom that most frequently spurs sufferers to turn to complementary and alternative treatments (CAMs) (Velkuru, 2009). As is the case with most fibromyalgia treatments, the available literature is sparse; still, there are some solid studies that aggregate the prevailing literature.

The herb in particular that warrants mention in several studies that examine the efficacy of herbal treatments for pain is: Harpagophytum procumbens, commonly known as Devil’s Claw. Multiple studies have proclaimed the herb offers significant relief from various instances of inflammatory, muscle- and musculoskeletal pain (Wirth, 2005; Wilkinson, 2006), with some treatments noting the herb’s controlled-trial rates of efficacy rivaling those of prescription medications such as Rocoxefib for pain management (Wikinson, 2005).

Devil’s Claw

Pharmacology: Devil’s claw interacts with cholinergic receptors in the form of  harpagoside, methanolic extract, which reduce blood pressure and heart rate significantly (Drugs.com, 2011).

Key Constituents:  Iridoid glycosides, primarily harpagoside.

Used as a means of improving upset stomach and appetite, but is not recommended for those persons with ulcers (bidmc.org, 2011)

Traditional Uses: Used for a variety of types of joint pain and muscle pain in some patients (bidmc.org, 2011)

Clinical Evidence-Base: In a double-blind study used to compare devil’s claw to diacerhein, a “slow –acting drug for osteoarthritis (SADOA), devil’s claw was proven to be as effective as the latter, but it should be noted that diacerhein in its own right has not been proven to be largely effective (bidmc.org, 2011).

Authors Andrew Chevallier and David Keifer examine a wide variety of herbs and discuss the ways in which various herbs can be used to treat an array of symptoms and conditions. Their suggestions are well-supported with evidence from medical literature; as such, this book may prove to be quite helpful for sufferers of fibromyalgia. Among the hundreds of herbs they discuss are: Valeriana, Devils claw and St. John’s Wort.  They discuss the various ways in which these herbs affect temperament and bodily functions, and make a strong case for the use of such treatments for fibromyalgia.

The Use of Herbal Treatments for the Primary Symptoms of Fibromyalgia

The medical literature available on the subject of pharmacological treatments for fibromyalgia is quite limited; the available information about alternative treatments is even more limited. Though there are some peer-reviewed studies that examine the use of pharmacological treatments for fibromyalgia, the bulk of the published studies pertain to the treatments for the primary symptoms of fibromyalgia (pain; sleep disorders; emotional, behavioral, and depressive disorders), rather than for the overall condition itself. .It is my sincere desire that this information provide a starting point both for fibromyalgia patients who are seeking information about the treatment of their own symptoms and as a guide for future research on the subject.

Conclusion

Despite the various and often conflicting views on fibromyalgia, there is little doubt any longer of the serious nature of the disorder. There remain some in the medical community who are skeptical about fibromyalgia, and who do not accept it as a legitimate diagnosis. These skeptics, however, are increasingly disproven as more and more studies are conducted on the cause and treatment of fibromyalgia.

The preponderance of evidence on the subject of fibromyalgia has become overwhelmingly convincing; current prevailing wisdom among most health care providers reflects the fact that fibromyalgia sufferers display quantifiable dysfunctions related largely to processes in the Central Nervous System. Though fibromyalgia is a chronic condition that has no specific cure, there are many proven methodologies that have significant efficacy in treating the various overlapping disorders that make up the Fibromyalgic Cloud.

While it is not intended to offer a comprehensive look at all available herbal remedies for fibromyalgia, if it provides the encouragement and impetus for even one patient to cease suffering in silence and step out from under the Fibromyalgic Cloud in search of natural remedies, it will have been a success.

Bibliography

Arnold, L., M.D. Strategies for managing fibromyalgia.The American Journal of Medicine. V122. N.2. December 2009.

Barney, P., M.D. (1998). Doctor’s guide to natural medicine. Pleasant Grove, UT: woodland Publishing.

Carpenter, D.J. (2011). St. John’s Wort and S-adenosyl methionine as “natural” alternatives to conventional antidepressants in the era of the suicidality boxed warning: what is the evidence for clinically relevant benefit? Alternative Medicine Review, 16(1): 17-39.

Chakrabarty, S., M.D. (2007).fibromyalgia.American Family Physician.V76 N2. July 2007.

Chevallier,A., Keifer, D. (2007). Herbal remedies. New York, NY:DK Publishing.

Clarocet (2007). Ingredient reference library: valerian root. Retrieved from http://www.clarocet.com/referencelibrary/valerian/science.htm

Crofford, L., M.D., Appleton, B., M.D. (2001). Complementary and alternative therapies for fibromyalgia.Current Rheumatology Reports. V.3. Spring 2001.

Currie, G. and Wheat, J. (2008).Internet Journal of Alternative Medicine.V5 N2. 2008.

Drugs.com (2011). Devil’s claw. Retrieved from http://www.drugs.com/npp/devil-s-claw.html

Harris, R.E. (2010). Elevated excitatory neurotransmitter levels in the fibromyalgia brain. Arthritis Research & Therapy, 12: 141-142.

Hartman, D. (2010).Complementary medicine treatments for fibromyalgia.Journal of Heart-Centered Therapies.V13 N1.Spring 2010.

Lawvere, S., and Mahoney, M.C. (2005). St. John’s Wort. American Family Physician, 72(11): 2249-2254.

Mitchell, D. (2011). The complete guide to healing fibromyalgia. New York, NY: St. Martin’s Press.

Murray, M. The thyroid gland.Total Health V25 N4. Aug/Sep 2003.

National Center for Complementary and Alternative Medicine (NCCAM) (2011). St. John’s Wort. Retrieved from http://nccam.nih.gov/health/stjohnswort/ataglance.htm

Office of Dietary Supplements, National Institutes of Health (2011). Dietary supplement fact sheet: valerian. Retrieved from http://ods.od.nih.gov/factsheets/valerian

Sachs, J. (2000). Natural strategies to ease depression. Better Nutrition; Feb2000, V62 N2.

Velkuru, V., M.D. (2009).fibromyalgia.Primary Care Reports. 01 February 2009.

Wilkinson, E. (2006). Review advises herbal remedies for pain. Pulse. 20 April 2006.

Wilkinson, J. (2000). Health: Herbal wonders of the world . . . New evidence suggests that herbs will be the ‘new’ medicine of the future, fighting the effects of smoking abuse, cancers, depression, pain and stress. The Belfast News Letter. 04 Oct 2000

Wirth, J.H. (2005). Use of Herbal Therapies to Relieve Pain: A Review of Efficacy and Adverse Effects. Pain Management Nursing.V6 N4. December 2005.

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