Unmasking Unending Pain: Fibromyalgia

Healthy & Natural Journal, Oct, 2000 by Billie J. Sahley

Fibromyalgia is an intense, crippling, nagging, constant chronic pain syndrome that continues to take a toll on the population. Fibromyalgia is now thought to be one of the most pervasive rheumatic disorders. Approximately 16 million people are estimated to have fibromyalgia. Fibromyalgia mainly affects women aged 25 to 55 years (female to male ratio is 5:1). It bears a remarkable resemblance to chronic fatigue syndrome (CFS). Often there is a familial pattern to fibromyalgia, and the predisposition to develop this syndrome may be inherited. A broad spectrum of physical and emotional symptoms is characteristic of both syndromes, and both are receiving increased attention in the medical community, especially pain practitioners.

Fibromyalgia (FM) is usually classified as a soft tissue musculoskeletal condition. It resembles CFS in some ways. Symptoms of stiffness, chronic musculoskeletal pain, aching, disturbed sleep, depression, anxiety and fatigue plague patients with both syndromes. Patients do not experience all of the symptoms, but patients with FM have many specific tender points in the body.

Specific diagnostic points have become the primary diagnostic factor for FM. A patient must have at least 11 of 18 tender points at specific locations to assist physicians to differentiate FM from CFS. Tender points are located over muscles and end insertions and can extend from mildly irritating to completely disabling. The increased level of muscle tissue breakdown has been suggested as one of the main reasons for aching, pain and fatigue.

The onset of FM can be gradual or very sudden. Symptoms may suddenly appear or present after an illness or a traumatic or stressful episode. Patients are more sensitive to environmental factors such as temperature and weather changes, activity levels and stress. FM has been called irritable everything and hypersensitivity syndrome. But once established, FM syndrome seems to continue although symptoms may become better or worse. FM patients never remain static. Complete remissions are rare.

FM can occur within your muscles or where your muscles join their tendons, but not in joints. The pain is chronic and widespread. Muscles ache when they should not and remain tired and stiff after work or exercise. They continue to cause pain long after an injury has healed.

Many people with FM constantly hunch their shoulders and neck. Emotional tension, stress and anxiety can exacerbate FM. You may think you are relaxed, but you must be reminded to loosen your shoulders and take slow deep breaths. Only then are you able to relax.

The ATP connection

Recent research indicates that FM patients may be deficient in certain compounds required for the synthesis of adenosine triphosphate (ATP). ATP synthesis requires the presence of magnesium, oxygen, substrate, ADP and phosphate. Deficiencies of any of these substances can clearly lead to the symptoms of depression, fatigue, muscle pain and anxiety. Those who suffer chronic anxiety have high lactic acid levels.

One of the most crucial elements for ATP synthesis is magnesium. Recent research suggests FM patients have below normal levels of magnesium.

More malic acid

At the Pain & Stress Center, over the past 10 years we have been evaluating different combinations of nutritional supplements in an effort to find an effective treatment for fibromyalgia. In the past two years, after a review of clinical data in the Journal of Nutritional Medicine, we began using a combination of malic acid, magnesium and B-6. The malic acid formula contains 800 mg. of malic acid, which is a naturally occurring nontoxic organic acid generally recognized as safe and classified under food acids by the FDA. Malic acid is widely distributed in the vegetable kingdom and is one of the most important of the acids found in apples and other fruits. Due to the high concentration in apples, it is best known under the name of apple acid.

Malic acid plays an essential part in sugar metabolism and in the formation of ATP, which is the energy currency for physical activity and other body functions. The energy we use is obtained from the combustion of these digested food products combined with oxygen and is stored as ATP, which is then utilized when energy is needed for all kinds of activities.

ATP requires magnesium, oxygen, phosphates and substrates from the breakdown of food products. When low oxygen conditions occur (hypoxia) and magnesium is below optimum levels, the body accumulates excessive levels of certain products which block the complete utilization of sugar for the manufacturing of ATP. Then the body switches to a very inefficient system of generating ATP. The breakdown of protein occurs in muscles and other tissue, resulting in damage to the affected parts of the body. This is associated with pain, decreased function and fatigue. Muscle spasms occur in hypoxic tissues, which creates a vicious cycle that worsens the condition by further decreasing the oxygen supply and food substances needed for ATP production.