Your online resource for objective Fibromyalgia information
Fibromyalgia is a common ‘rheumatic’ disorder associated with extreme pain arising from muscles, tendons and ligaments. It is estimated that 2-4% of the general population are affected by fibromyalgia, and that women are more susceptible than men. Alongside the presence of chronic widespread symptoms it is not unusual to experience a sensation of poor circulation or an apparent feeling of swollen hands and feet, often accompanied by tingling and numbness in the fingers and toes. Individuals may also suffer from headaches, have poor concentration or lack of memory and they may even feel irritable or depressed.
The cause of Fibromyalgia is generally unknown but it is thought to arise from an abnormal response to stress. During a stressful experience there is a complex set of interactions between the hypothalamus (a part of the brain), the pituitary gland (also part of the brain) and the adrenal glands (at the top of each kidney). Several types of neurotransmitters are involved in this system, collectively known as the HPA-axis. It is thought that the HPA-axis is dysfunctional in individuals with Fibromyalgia.
Sufferers can have numerous abnormalities in their hormonal, metabolic and brain-chemical activity. These include levels of serotonin and melatonin (both involved in the sleep cycle and mood), cortisol and noradrenaline (stress hormones), growth hormone (involved in bone and muscle growth), and the chemical messengers substance P (associated with pain perception) and cytokines (involved in immune system response regulation and the inflammatory process). As with many conditions, genetic predisposition may increase an individual’s risk of developing Fibromyalgia.
Diagnosis is often difficult and the condition itself is far from simple in its definition. Whilst malfunctions in pain processing include the over sensitisation of nerves responsible for pain-transmitting and a dysfunction in the pathways involved in inhibiting pain, fibromyalgia also includes changes in the neuro-endocrine responses to stress. The neuro-endocrine system, or the ‘HPA-axis’, is a highly complex system that is triggered in stressful situations, and primes the body to cope with whatever situation is presented.
There are many influential variables within the HPA-axis (the interactions of stress response include neurotransmitters, hormones, the immune system and the nervous system) and multiple abnormalities can affect the normal functioning of both the immune and the nervous systems. In response, the body releases several types of chemical messengers that can then trigger both inflammation and pain. The detection of specific products called cytokines within the blood provides information on both the degree and severity of this process; increased levels of inflammatory cytokines are common to many chronic pain conditions, including fibromyalgia.
Pro-inflammatory cytokines have many physiological functions but, significantly, have been reported to modulate central nervous system functions including a process called neurogenesis, which is simply the method by which nerve cells are generated. Excessive inflammation and the production of cytokines, amongst other things, cause a series of processes that ultimately damage neurones, leading to their death. When cells within the brain die, this causes atrophy, or shrinking, by which there is loss of brain grey matter. Structural brain changes detected by a process called MRI scanning in fibromyalgia patients have been reported in specific areas of the brain that are known to regulate pain perception (Puri et al, 2010). Such changes arise in part through the loss of specific fatty acids from myelin, the fatty sheath that protects nerve cells, but it is possible to prevent and restore these changes through dietary improvement and specifically by modifying dietary fat intake.
Cytokine production falls into two categories: inflammatory and anti-inflammatory. There is increasing evidence that inflammatory cytokines register are high in fibromyalgia patients, which may explain many of the associated symptoms such as fatigue, fever, lack of sleep, pain, and aching. The most efficient way of decreasing inflammatory cytokines that can affect inflammation and pain processing is by the modulation of a group of hormones known as eicosanoids produced from the long-chain fatty acids AA (arachidonic acid) and EPA (eicosapentaenoic acid). Several studies have identified that fibromyalgia patients have imbalances in omega-3 and omega-6 fatty acids and therefore in AA and EPA. If AA predominates over EPA (as seen in fibromyalgia), this can result in the production of high levels of inflammatory eicosanoids which can trigger the production of inflammatory cytokines. Supplementing fibromyalgia sufferers with high doses of EPA can help balance the AA:EPA ratio and modulate cytokine production, with numerous benefits on brain function and in the regulation of inflammation and pain processing (Ozgocmen et al, 2000; Ko et al, 2010).
Individuals with fibromyalgia often rely on using selective serotonin reuptake inhibitors (SSRIs) to improve mood, help relieve pain, fatigue and sleep problems. Studies suggest that a combination of EPA and GLA have the same effects as SSRIs and can therefore provide relief from the symptoms of fibromyalgia but without the side effects associated with pharmaceutical products.
Diet also plays a major role in the symptoms of fibromyalgia, so identifying imbalances and modifying the intake of a variety of food types can produce major improvements in pain, cognition, sleep patterns and energy, to name but a few. For specific details of how diet can influence fibromyalgia and how to improve symptoms you can download our help pack below.
Adults and children aged twelve years and over should take 2 capsules of Pharmepa STEP 1: RESTORE daily for a period of three months. This initial ‘restore’ phase of the treatment programme should then be followed by a long-term ‘maintenance’ treatment of 4 capsules of Pharmepa STEP 2: MAINTAIN. For children we recommend Vegepa E-EPA 70 Orange Chewables. Adults and children aged eight years and over should take 4-6 capsules daily. For vegetarians, our Echiomega supplement provides a more effective solution than flaxseed oil, with higher conversion to the important long-chain fatty acid EPA.
Ko GD, Nowacki NB, Arseneau L, Eitel M & Hum A. Omega-3 fatty acids for neuropathic pain: case series. Clinical Journal of Pain 26:168-72.
Ozgocmen S, Catal SA, Ardicoglu O & Kamanli A. Effect of omega-3 fatty acids in the management of fibromyalgia syndrome. International Journal of Clinical Pharmacology and Therapeutics 38:362-3.
Puri BK, Agour M, Gunatilake KD, Fernando KA, Gurusinghe AI & Treasaden IH. (2010).
Reduction in left supplementary motor area grey matter in adult female fibromyalgia sufferers with marked fatigue and without affective disorder: a pilot controlled 3-T magnetic resonance imaging voxel-based morphometry study. Journal of International Medical Research 38:1468-72.
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