What Is Fibromyalgia?

There are some days when it almost "hurts too bad to move," or when you wake up from a full night's sleep "too tired to think straight."

For those who suffer from Fibromyalgia Syndrome, days like these happen on a regular basis. This throbbing, "aching all over" feeling often seems worse in the morning. And that makes it even more difficult to bear when you've just spent a seemingly endless night tossing and turning because restful sleep hasn't been seen in your bedroom for a long time. Fibromyalgia is also usually cyclical, with different symptoms from day to day, and changes in energy levels and pain. Sometimes everything may get worse for a while, and then there will be days where the patient feels nearly normal and symptom free. As the syndrome progresses, cycles of pain and fatigue may become longer and more severe.

Fibromyalgia ( FM ) is a chronic musculoskeletal condition causing widespread pain, fatigue and muscle stiffness throughout the body. One of the most difficult things about the disorder is that the symptoms mimic at least 46 other conditions. It is characterized by physical over sensitivity and pain responses to a wide range of triggers, sometimes seemingly without cause. With its wide variety of symptoms and its undeserved reputation as a "catch-all" diagnosis, fibromyalgia is a frustrating condition to manage.

One of the reasons is because those with fibromyalgia don't appear sick, even though they know something is very wrong. There's no swelling, no spots, no fever, nothing obvious, but.. They are in chronic pain. They don't sleep. They're tired. And quite often they are a little over weight because it simply hurts too much to move, or they find that exercise makes them tired. When they do finally seek medical advice, the typical blood tests come back normal. Because there is no blood test to detect FM, doctors often can't diagnose the problem until all similar disorders that CAN be detected by blood tests are first ruled out.

It can take up over 4 years for a diagnosis of fibromyalgia to be made, often while the patient gets worse and worse. Friends, family members, and even doctors may tell them that it's "all in your head," or that they just don't want to feel good. They may be accused of making it up, even though this condition has been documented in largely ignored medical literature for well over a century. The years that often pass until a proper diagnosis are often spent bouncing from doctor to doctor, trying to find someone familiar with fibromyalgia symptoms who won't ignore them.

Fibromyalgia affects as much as 4 percent of the U.S. adult population, making it the second most common rheumatological illness after osteoarthritis. It affects women more often than men by as much as a 10 to 1 ratio. The average age of a fibromyalgia sufferer is between 30 and 55.

It is a syndrome, not a disease, because it does not cause degeneration of body organs or tissues, nor does it deform. But the stress of living with a chronic, painful condition can be devastating ... to the patient, the family, work or social life.

Fibromyalgia Symptoms:

The most common signs and symptoms of fibromyalgia are: widespread muscle pain, morning stiffness, non restorative sleep and daytime fatigue. Cold, damp weather and and physical activity can severely aggravate conditions.

Other common symptoms often found in fibromyalgia patients include irritable bowel syndrome, myalgia ( muscle pain ), arthralgia ( joint pain ), generalized muscle weakness, stiffness, numbness, swelling, tingling, lightheadedness when standing, migraine and tension headaches.

Cognitive problems such as not being able to "think straight" or remember things are also frequently linked to FM. These 'forgetful' episodes of short term memory or concentration impairment are referred to as 'fibrofog.' It's a frustrating, often scary, situation when you find yourself unable to remember things you've known 'forever,' like your own phone number or even your children's names.

And it's certainly not hard to see why depression and anxiety are often common problems for those with fibromyalgia. Chronic pain and loss of sleep can cause even the most cheerful person to experience these feelings. And because it's often hard to diagnose, the frustration and feelings of isolation that follow remarks like 'this is all in your head' or 'would you like the name of a psychiatrist' often intensifies feelings of depression and anxiety. In fact, neurotransmitter deficiencies and imbalances are a common part of fibromyalgia. These may have something to do with the prevalence of mood disorders, but also sleep and digestive problems.

Another condition related to fibromyalgia is "subjective swelling," a feeling that an area is swollen even though there is no physical change in the site. And the list of symptoms goes on ... TMJ ( temporomandibular joint dysfunction - a painful disorder of the jaw joints ), dry eyes and mouth, eye twitching, temperature sensitivity such as intolerance to cold or dizzy 'fainting spells' in hot conditions, exercise intolerance, Raynaud's Disease ( sporadic attacks of blood vessel spasms resulting in interruption of the blood flow to the fingers, toes, ears and nose ), hearing problems, mitral valve prolapse, fever, osteoarthritis, polymyalgia rheumatica, Seasonal Affective Disorder ( SAD ), multiple food and/or chemical sensitivities, Rheumatoid arthritis, Sjogren's syndrome ( systemic autoimmune disease that affects the musculoskeletal system and organs ), sore throat, swollen lymph nodes, chronic rhinitis ( runny nose ), skin problems, vertigo, urinary problems, vulvar pain syndrome ( vaginal pain and spasms, painful intercourse ), PMS, menstrual cramping, eating disorders, digestive problems, weight gain, candidiasis ( yeast infections ), immune system weaknesses, ADD/ADHD ( Attention Deficit Hyperactivity Disorder ), Gulf War Syndrome, Post Polio Syndrome, etc.

Nearly half of the females who have fibromyalgia also have hypoglycemia ( low blood sugar ), or reactive hypoglycemia ( low amounts of usable sugar ). Studies indicate that 40 percent of females have fibroglycemia ( a combination of both ) and 20 percent of men with FM also have it. Symptoms of hypoglycemia include an intense craving of sweets, tremors, sweating, panic attacks, heart palpitations, faintness, confusion, and frontal headaches.

Tender Points:

The American College of Rheumatology bases the diagnosis of FM upon two major criteria: 1 ) widespread, diffuse pain lasting at least three months and 2 ) a minimum of 11 ( out of 18 possible ) specified tender points throughout the body. This is the strict definition for being included in a clinical study of fibromyalgia, but tender points may change from time to time, and may worsen or get better in the cyclical way that this syndrome seems to work.

These tender points will hurt when pressed, but the pressure will not cause pain in any other part of the body. The physician applies a standardized amount of pressure, about 4 kg ( enough to turn the thumbnail white ). Remember, a tender point has to be painful at palpation, not just "tender." When pressed, these areas tend to feel like bruises in various stages of healing.

Also, a tender point is different from what you may know as a trigger point. Tender points hurt, trigger points hurt and refer pain to other body parts. Trigger points cause myofascial pain syndrome, which often coexists with fibromyalgia, but can be treated with massage, physical therapy, or gentle stretching. When muscles feel hard and pressing on them causes a response elsewhere in the body, or even nausea, trigger points are responsible. Tender points are caused by an unknown mechanism, and their severity is often cyclic. Tender points do not generally respond to physical therapy, often becoming more painful with pressure.

Widespread pain is defined as having pain in both sides of the body and pain above and below the waist. In addition, pain must also be present in the cervical spine, anterior chest, thoracic spine or lower back.

These tender points are located at:

• Occiput ( 2 ) - at the suboccipital muscle insertions ( near the base of the skull )
• Low cervical ( 2 ) - at the anterior aspects of the intertransverse spaces at C5-C7 ( the lower vertebra of the neck )
• Trapezius ( 2 ) - at the midpoint of the upper border ( the neck, mid back and upper back muscles between the shoulder blades )
• Supraspinatus ( 2 ) - at origins, above the scapula spine near the medial border
• Second rib ( 2 ) - upper lateral to the second costochondral junction ( the insertion of the second rib )
• Lateral epicondyle ( 2 ) - 2 cm distal to the epicondyles ( the side of the elbow )
• Gluteal ( 2 ) - in upper outer quadrants of buttocks in anterior fold of muscle ( the upper and outer muscles of the buttocks )
• Greater trochanter ( 2 ) - posterior to the trochanteric prominence ( the upper part of the thigh )
• Knee ( 2 ) - at the medial fat pad proximal to the joint line ( the middle of the knee joint )

During guaifenisin therapy, it is recommended that these tender points be mapped and monitored as treatment progresses.

Fibromyalgia Causes:

Although an exact cause of fibromyalgia is unknown, there are several underlying conditions that contribute to the disorder. Treatment is usually focused on reducing the severity of the symptoms related to the most prominent conditions.

Not getting enough "restful" sleep is thought to be one of the chief underlying causes of fibromyalgia. The body sleeps in stages. Stage four is when the body should be in a deep sleep. This deep sleep is the time that the body has set aside for healing. Tests show that stage 4 of the sleep cycle in fibromyalgia sufferers is interrupted. More conclusive results came about when researchers continuously interrupted the stage 4 sleep of people who had previously never had signs or symptoms of fibromyalgia. As a result of loss of sleep during this critical time, those who had never suffered with fibromyalgia before began to show signs of the disorder. These sleep studies also suggested a direct link between fibromyalgia and a deficiency in the Growth Hormone. This hormone is important in muscle maintenance and repair and is secreted during sleep stage 4.

Neurotransmitter ( chemicals that communicate between nerve cells ) levels in fibromyalgia patients are often disrupted, causing bodywide imbalances. Any of the following neurotransmitters may be disrupted in fibromyalgia, resulting in a wide range of possible symptoms, and requiring different treatments. All of these substances work together, starting and stopping different reactions to allow us to respond to our environment. If they are out of balance, certain reactions that are helpful in moderation may run out of control. The causes of this disruption are unknown.

• Acetylcholine - This neurotransmitter controls heart contraction, mucus production in the upper respiratory tract, digestive enzyme secretion, sweating, and the contractions of the stomach, intestines, and eliminatory organs. Involuntary motion and thoughts are also associated with improper levels of acetylcholine.
• Adrenaline and Noradrenaline - These complementary neurotransmitters are most known for their connection with stress, and the 'fight or flight' response system. They both regulate energy consumption in the body. Adrenaline is associated with sugar metabolism and insulin production, and is thought to be released into the body too quickly in response to carbohydrates in reactive hypoglycemics. Noradrenaline inhibits digestion, and lowers the body temperature and pain threshold. High levels of these chemicals can create a restless, oversensitive, high anxiety state that may quickly burn out the body's energy reserves. Low levels can cause an apathetic, low energy state, common in fibromyalgia.
• Dopamine - This neurotransmitter controls motor activity and concentration. Too much can cause muscle cramps and anxiety, while too little may lead to fatigue and lethargy. ADD and ADHD, more common in fibromyalgia patients, are sometimes associated with low levels of dopamine in certain areas of the brain.
• GABA ( gamma-amino-n-butyric acid ) - GABA affects both mood and muscle tone. Low levels can be responsible for muscle spasm and tightness, as well as mood and memory dysfunction.
• Histamine - This chemical is released in our bodies when we are exposed to either a trauma or a toxin. Sometimes histamine production is too high, raising the body's alarm system when there is no danger. This is how common allergies occur, and why antihistamines are so effective. ( A different mechanism is at work in food intolerance, as opposed to allergy. ) Excess histamine production may result in red, watery eyes, headache, stomach upset, or low blood pressure.
• Serotonin - A disruption ( usually a deficiency ) of serotonin is common in fibromyalgia. This chemical regulates mood, digestion, weight, sleep, blood pressure, pain sensitivity, and motivation. Individuals who are prone to migraine or nonrestorative sleep are especially likely to have deficiencies in serotonin. SSRIs ( selective serotonin reuptake inhibitors ) work by increasing levels of this chemical, and this may be why they are effective for some patients.
• Substance P - This chemical regulates pain sensations, stomach contractions, blood pressure and mucus production.
• Peptides - These chemicals are related to how individuals feel pain. Many people have heard of endorphins, which are the 'feel good' peptides released naturally during moderate exercise. A lack or surplus of any peptides may increase our likelihood of experiencing pain, or reduce our resistance to pain sensations.

Additional underlying factors include deficiencies of nutrients such as magnesium. This can cause muscle cramps upon exertion and upon awakening. It has also been suggested that a buildup of phosphorus in the body may be responsible for the condition. ( Guaifenisin treatment is thought to work by eliminating extra phosporus. ) If that is the case, it suggests an explanation for the normal blood test results often received by fibromyalgia patients. Other possible causes of fibromyalgia symptoms are hypoxia ( lack of oxygen in body tissues ), muscular injury, muscular atrophy, emotional stress, digestion, and mood disorders.

Still another possibility is the onset of infections or viral exposures. More than half of fibromyalgia patients said this occurred prior to the onset of their symptoms. Included among these are Lyme Disease ( infection that manifests itself as a multi-system inflammatory disease ), Human Immunodeficiency virus, Coxsackie Virus ( common source of infection in children that often causes flu-like symptoms ), Epstein-Barr ( member of the herpes virus family, often associated with chronic fatigue ), or Streptococcus and Parvovirus ( virus that can cause joint pain and swelling ).

Lack of regular physical exercise seems to be a factor although it is not known whether lack of conditioning promotes pain or vice versa. While exercise is often invigorating for healthy individuals, it can exhaust a fibromyalgia sufferer, sometimes for days.

Sometimes the symptoms began much earlier than the fibromyalgia patient realizes. Thirty percent of patients remember having 'growing pains' in childhood that seemed to disappear before puberty. These pains seem to reappear more severely later on in adulthood.

There is also some indication that fibromyalgia can be hereditary, as it tends to run in families. Incidence of sleep disorders, blood sugar difficulties, headaches or migraine, ADD or ADHD, Asperger's syndrome, irritable bowel, joint problems, and food allergy or intolerance may all be common in the families of fibromyalgia patients. It is unclear how these conditions interact, or what causes what, but in fibromyalgia it often seems like several conditions pile on top of each other.

Standard Fibromyalgia Treatments:

Prescription medications that manage the symptoms of this syndrome are the most common method of treatment at present. None of these treatments is a cure for fibromyalgia, but all have seen some success in certain individuals in reducing pain, sleeplessness, ar other discomfort. The treatment goal is usually pain or fatigue management and allowing the individual to lead a less restricted life than they otherwise would.

Due to the upset in neurotransmitter levels seen in fibromyalgia, certain symptoms often respond to antidepressants. Note that this does not imply that the condition is merely psychological, nor is fibromyalgia the only physical condition that benefits from medications that adjust the levels of different neurotransmitters. Antidepressants often improve the regularity of the sleep-wake cycle and benefit digestion. They are taken in much lower doses for fibromyalgia than they would be if used to treat depression. Many fibromyalgics are also quite sensitive to drugs that affect the nervous system, and are likely to react strongly to high doses of antidepressants and central nervous system depressants.

Something that should also be noted is that there is a difference between physical withdrawal symptoms after long-term medication use and psychological dependence. Physical withdrawal is a fairly common consequence of long-term medication use, even if that medication is necessary to manage physical discomfort. Psychological addiction implies a desire to take a medication even when feeling healthy, and when the symptoms it is designed to treat are not present. Actual drug addiction rates are generally very low among patients using medication for chronic pain.

Because of the chronic nature of fibromyalgia symptoms, individuals with this condition may end up needing to manage ongoing pain, sleeplessness, and severe muscle tension for long periods of time. Many medications that affect the central nervous system are generally indicated for acute symptoms that resolve over a period of weeks, maybe months at most. Taking them for long periods of time increases the risk that the body will react to removing the medication. Speak to your doctor about drug holidays, rotation schedules, gradually decreasing dosage to end treatment and avoid uncomfortable symptoms that may result from the long-term use of a medication. Some medications may also become less effective the longer they are used, and the greater the dosage. It's very important to the continued effectiveness of many treatments that the minimum dose needed to successfully manage your symptoms should be used at all times.

Remember that pain control is a legitimate and important goal of medical treatment for fibromyalgia, or any condition. Severe, chronic pain and discomfort can be extremely disruptive to anyone's life. While a physician should pay attention to the possibility of unwanted side effects and dependence, the needs of the patient must be considered on an individual basis. If a treatment is ineffective, it is the duty of the physician to try alternate methods, and the duty of the patient to communicate their needs clearly. Appropriate treatment may vary widely among individuals, and it may be the case that several treatments will need to be tried before an effective medication with minimal unwanted side effects is found.

• Benzodiazepines ( a class of antidepressants, anti-panic agents, and muscle relaxants ) - These include Ativan ( lorazepam ), Valium ( diazepam ), Halcion ( triazolam ), Restoril ( temazepam ), Librium ( chlordiazepoxide ), Xanax ( alprazolam ), Tranxene-SD ( clorazepate ), Paxipam ( halazepam ), ProSom ( estazolam ), Klonopin ( clonazepam ), and others. Benzodiazepines are commonly prescribed for fibromyalgia, especially when a combination of anxiety and sleeplessness is present along with muscle tension. They should not generally be taken during treatment with any other antidepressant medication and should not be mixed with narcotics or barbiturates. Xanax may be of some use in treating irritable bowel syndrome, and klonopin may help individuals who experience restless legs or periodic limb movement during sleep. These medications reduce the effectiveness of opiate, or narcotic pain medication, as they block opiate receptors. Physical withdrawal symptoms are highly likely with this class of medications, especially with long-term use. If you wish to end treatment with a benzodiazepine, follow your doctor's advice about gradually reducing your doses over a period of time.
• Guaifenisin - This common expectorant ( thins mucus, making it easier to expel ) is found in many adult and pediatric cold medications. Some individuals finds that it reverses the symptoms of fibromyalgia ( after first increasing them ), sometimes dramatically. Guaifenisin treatment is safe enough for children, and has no significant side effects. It's effectiveness in treating fibromyalgia can be blocked by salicylates ( aspirin like compounds producted by plants ) absorbed through the skin, or taken in herbal supplements or extracts. While no special diet is required, avoiding plant extracts in skin care products, cosmetics, and toothpaste are a must. Taking herbal supplements and many teas will also block the effects. The guaifenisin found in cough syrups, however, does not contain high enough doses and may be adulterated with undesirable ingredients. Some pharmacies will have 200-600 mg tablets, but many do not carry this form. The 200 mg tablets can be ordered without a prescription. See the links at the bottom of the page to find doctor St. Amand's website where you can read about the details and find safe product lists.
• Muscle Relaxants - Flexeril, Robaxin, and Soma are all commonly prescribed as fibromyalgia treatments and may prove effective at relieving tender points and reducing achiness. They should be used cautiously with any medication that may make you drowsy, though fibromyalgics are commonly prescribed multiple central nervous system depressants. Benzodiazepines, narcotics, tricyclic antidepressants, and Ultram may all add to the sedative effect. Make sure that you discuss a medication schedule with your doctor that will not leave you oversedated.
• Narcotic pain medication - These include Codeine, Demerol ( meperidine ), Buprenex ( buprenorphine ), Darvon ( propoxyphene ), Dilaudid ( hydromorphone ), MS Contin or Kadian ( morphine ), nalbuphine, OxyContin ( oxycodone ), Percocet ( oxycodone, acetaminophen ), Stadol ( butorphanol ), Talwin compound ( pentazocine ), Vicodin Tuss ( hydrocodone, guaifenisin ), Vicodin ( hydrocodone, acetaminophen ), and Vicoprofen ( hydrocodone, ibuprofen ). The mild opioid Ultram ( Tramadol ), has been found to be fairly effective for fibromyalgia, and generally poses less risk of dependence and side effects than other opiates. There are many brand names for most of these, so look for the generic ingredients on the label. These medications should not be mixed with barbiturates, some antidepressants, or each other. Do not take these with cough medications containing alcohol or a narcotic ( codeine or hydrocodone ), or Tylenol with codeine. Do not mix them with over the counter pain medication unless your doctor specifically tells you it is safe to do so. These medications may increase constipation in some individuals.
• Non-Steroidal Anti-Inflammatories ( NSAIDs ) - Such as Motrin or Advil ( Ibuprofen ), or Naprosyn ( naproxen ). These medications can relieve pain without the strong central nervous system effects of narcotics and barbiturates. Ibuprofen, a common over the counter pain reliever, can be found as a generic ingredient in combination with some narcotic pain medications. These drugs can be hard on the liver and kidneys, and can increase the risk of ulcers or internal bleeding. They should never be taken in combination with aspirin, acetaminophen, or any other anti-inflammatory. You should avoid alcohol while taking it. Be sure to speak with your doctor about taking these drugs if you are taking blood pressure medication or a blood thinner. These medications can worsen digestive problems by damaging the linings of the stomach and intestines.
• Selective serotonin reuptake inhibitors ( SSRIs ) like Celexa ( citalopram ), Paxil ( parxetine ), Prozac ( fluoxeine ), Luvox ( fluvoxamine ), or Zoloft ( sertraline ) may sometimes be prescribed in low doses to normalize serotonin levels. They are usually taken in the morning, as these drugs can cause insomnia. They may sometimes be prescribed along with low doses of a tricyclic antidepressant, which will then be taken at night to promote sleep. Minor weight loss is a common side effect of these medications. If you are taking any of the triptans ( Amerge, Imitrex, Maxalt, Zomig ) for migraine, be aware that both classes of drug affect the availability of serotonin in your body, and could increase it to dangerous levels. This drug combination could be fatal. Do not use supplemental 5-HTP if you take these medications.
• Sleeping pills - Whether you use an over the counter or prescription medication for insomnia or another sleep disorder, you should know that some of them will actually increase the likelihood of migraine attacks ( while you should be aware of the possibility, you may not react the same to all these medications ). This is not usually the case with the newer prescription medications Ambien ( zolpidem ) and Sonata ( zaleplon ), though they also may result in an attack in some individuals. Be aware that these medications should not be mixed with either narcotic pain medications or benzodiazepines. Do not take a sleeping pill within several hours of narcotics, and check with your doctor or pharmacist to be sure to leave enough time between them. Do not combine any sleeping pill with alcohol, this could result in dangerous or fatal overdose.
• Tricyclic Antidepressants - These include Elavil ( amitriptyline ), Asendin ( amoxapine ), Anafranil ( clomipramine ), Pertofrane or Norpramin ( desipramine ), Sinequan ( doxepin ), Tofranil ( imipramine ), Aventyl or Pamelor ( nortriptyline ), Vivactil ( protriptyline ), and Surmontil ( trimipramine ). These medications may dangerously increase central nervous system suppressant effects when taken in combination with narcotic pain medication. They should not be mixed with alcohol, and you should not drink excessively while they are part of your treatment. They are usually prescribed in small doses for fibromyalgia, and taken at night to promote restful sleep. An SSRI may be prescribed along with them, to be taken in small doses in the morning. These are not all the same, and may react differently for each individual. If your doctor thinks these may help you, discuss possible complications and interactions with other health conditions. If you plan to quit taking them, step off your dosage gradually, or you may experience unpleasant side effects including rebound headaches. Also be aware that weight gain is a more likely problem with tricyclic antidepressants than with many other treatments. If you already have a weight problem or are prone to rapid weight fluctuation, you may want to monitor your weight more carefully on these medications. They also may increase carbohydrate cravings, which may account for the effect on weight, and may be worse for individuals with reactive hypoglycemia.

Other Medications

Some medication you might take for other conditions may not mix well with prescription treatment for fibromyalgia symptoms, or be effective for long term care. Be sure to read the list of drug interactions on your package inserts, and ask your doctor or pharmacist to check the safety of combining multiple prescription medications you may need. As always, over the counter medications or supplements are not beyond suspicion:

• Alcohol - It can be very dangerous to mix alcohol with certain prescription treatments for fibromyalgia. If your pain medication contains a barbiturate or narcotic, you could risk dangerous slowing of the nervous system, possibly coma or death depending on the amounts involved. It is similarly dangerous to take alcohol with muscle relaxants, tricyclic antidepressants, or benzodiazepines. Your doctor or pharmacist can advise you if it is ever safe to drink during your treatment, but be aware that alcohol is a common migraine trigger ( especially red wine ), and can interfere with both digestion and deep sleep. Many reactive hypoglycemics are unable to deal well with alcohol. Alcohol is one of the single most dangerous drugs to mix with other drugs or medications that act on the nervous system, and is implicated in many cases of fatal overdose due to drug interactions. Alcohol is especially likely to increase the likelihood of risk taking and aggressive behavior in combination with other medications. Many medications pose a risk of liver damage if used over long periods of time, and excessive alcohol use can greatly increase this risk. While moderate consumption of alcohol has been seen to have health benefits, be aware of possible interactions, and avoid drinking excessively.
• Aspirin ( or any salicylate, such as salicylamide, or salicylic acid ) can cause kidney or liver damage when taken in high doses, and over long periods of time, in combination with acetaminophen. When taken in the recommended doses for a short time, it has not been seen to produce this effect, but caution is still advised. Aspirin has also been reported to reduce the integrity of the upper gastrointestinal tract, particularly the stomach, with long-term use. Fibromyalgia patients may want to consider another treatment if they already experience digestive problems. Do not mix aspirin with other pain relievers. If you are taking aspirin as a preventive heart disease regimen, you should still not take it with other pain medications; speak to your doctor about alternate or non-interacting treatment. Vitamin E supplements can be as effective for some individuals at preventing heart disease at a daily dose of 400-1200 IU. If you are taking guaifenisin, aspirin will completely block its effects.
• Antacids - As indigestion is so common to fibromyalgia, you may find yourself resorting to antacids to reduce bloating and gas. This can create worse issues, as these problems are often caused by a low-acid condition in the first place. Your stomach needs to be highly acidic in order to digest your food properly, and to absorb minerals like calcium and magnesium ( see below ) which are often deficient in fibromyalgia patients. Try looking for a mixed enzyme supplement as a digestive aid, and add an acidophilus supplement or live yogurt to your diet.
• Oral Contraceptives - Birth control pills can be the cause of a number of fibromyalgia type complaints in some female patients, though these side effects are often dismissed. Increased migraine frequency, headaches, muscle aches, leg cramps, fatigue, anxiety, depression, and blood sugar alterations may all result from the use of oral contraceptives. While it's never been said that using the pill plays any direct role in fibromyalgia in women, some individuals find that certain symptoms clear up gradually within a month of stopping it, and come back once they resume use. If you suspect that side effects of your birth control option may be contributing to your poor health, speak to your gynecologist about trying another brand with a different, or milder, hormone make-up. Birth control pills can be made less effective by barbiturate sedatives and certain antibiotics, and may increase blood levels of some antidepressants.

Fibromyalgia Diet

While there is no specific diet for all fibromyalgia cases, different symptoms may suggest ways of improving your health through diet. As fibromyalgia sufferers often have one condition amplifying another ( or several others ), relieving even one can increase your quality of life, sometimes substantially.

• Food Intolerance - If your body overreacts to certain foods, it could worsen conditions ranging from digestive troubles ( gas, bloating, constipation, or diarrhea ) to fatigue, headache or migraine, joint pain, mood disorders, muscle aches, and skin problems. Beef, citrus, chicken, corn, dairy, eggs, gluten ( protein in wheat, barley, rye, spelt, and kamut ), soy, sugar, tomatoes, wheat, yeast, etc., are common problems for individuals with food intolerance. Trying an elimination diet may reveal that you feel much better after removing certain foods from your diet, often things you eat commonly. If you avoid them for a while, you may discover that you can eat certain ones in moderate quantities, or that some will always produce a reaction. Rotating your diet, and not eating too much of any one food can be beneficial for fibromyalgia patients who identify food intolerance as a major cause of symptoms. For guidelines on discovering any hidden allergies and managing a balanced elimination diet, try the book 'Food Allergies and Food Intolerance' by Brostoff and Gamlin.
• Hypoglycemia or Reactive Hypoglycemia - Sometimes called fibroglycemia when it occurs with fibromyalgia. Reactive hypoglycemia will not show up on a standard fasting blood test, but you could have all the hypoglycemia symptoms; cold or tingling extremities, dizziness, fatigue, headache, impaired thinking, irritability, muscle weakness, palpitations, tremors, and unusual hunger or cravings for high carbohydrate foods like sweets, bread, or pasta. Weight gain is common, though not universal, among reactive hypoglycemics. These symptoms may present themselves when you are hungry, or after you have a high carbohydrate meal or snack. They may range from mild to severe, with particularly severe symptoms usually occurring when it's been too long since you've eaten. Individuals may be more prone to midnight snacking, or even to compulsive, unconscious night eating ( similar to sleepwalking, see sleep disorders fact sheet. ) This is caused in part by poor tolerance of a high carbohydrate diet, and is best managed by diets like the Zone diet ( Sears and Lawren, 1995 ) which balance carbohydrate intake with lean protein and healthy fats. A diet high in refined sugar, refined flour, and starchy foods like potatoes and pasta, will make this condition worse, even though you may crave them. Higher lean protein intake ( fish, poultry, soy or tofu, cottage cheese ), and healthy, unprocessed fats ( raw nuts or seeds, avocados, olive oil, fish, and flaxseed ) will help control the symptoms and diminish the cravings.
• Irritable Bowel - Many fibromyalgia patients start off getting diagnosed with irritable bowel syndrome, which is characterized by alternating constipation and diarrhea, though one or the other may persist for some time. A feeling of general abdominal discomfort, persistent stomach upset, fatigue, mood disorders, or bloating and gas may be present as well. Dairy or gluten intolerance may contribute to this condition, you may check to see if removing them from your diet improves matters. Also, large amounts of sugar or sweeteners can worsen the problem, as can hard to digest foods such as beans and cabbage. An imbalance of gut flora ( beneficial bacteria ) can be responsible in some individuals, and this condition can sometimes be much improved by eating live yogurt or taking a live acidophilus culture if you can't tolerate dairy ( only use acidophilus cultures that require refrigeration, as the bacteria quickly die out at room temperature ). Psyllium husks, taken on an empty stomach, and according to the package directions, can improve regularity as well by adding needed fiber to the diet. Exercise and plenty of plain water are recommended as long term self care measures.
• Migraine - ( See migraine fact sheet ) Migraine is a particularly severe type of headache which is likely hereditary, and common in fibromyalgia. It is a disorder, or biological predisposition, that causes a painful overreaction to certain stimuli. In the early stage of a migraine, sufferers may experience visual disturbances, fatigue, light and noise sensitivity, nausea, disorientation, or mood changes. They are commonly linked to food intolerance, and many individuals find that removing a certain culprit type of food ( varies from person to person ) from the diet will reduce sensitivity to former triggers. The most common triggers are cheese, chocolate, red wine, sugar or artificial sweeteners, sulfites, amines ( found in aged foods ), and MSG. Nuts can cause migraine, but usually not all nuts. Almonds are the most common trigger, but cashews should be avoided because they're high in carbohydrates. Sugar intolerance is particularly important to consider in individuals who have symptoms of reactive hypoglycemia, and a low or no sugar, low starch diet should be tried.
• Sleep Disorders - ( See sleep disorders fact sheet ) Fibromyalgia sufferers often experience non-restorative sleep for a variety of causes, which makes any physical symptoms worse. Healthy individuals deprived of restful sleep for a while begin to develop many fibromyalgia symptoms such as muscle aches, increased headaches, daytime fatigue, etc. Common sleep disorders that may be present in FMS patients are Restless Legs Syndrome ( RLS ) and Periodic Limb Movement During Sleep ( PLMS ). With RLS, a person often feels as though their arms and legs just can't stay still. PLMS is described as the sensation you have when you think you have reached the last step in a flight of stairs and you try to regain your balance when you discover there is another step left. Both of these sleep disorders can cause continuous arousal movements during sleep, thus keeping you from getting the rest you need. Individuals may have excessive REM and other brain wave patterns that disrupt their sleep, instead of physical movements. These mini-wakenings may be completely unconscious, and not accompanied by movement, though non-restorative sleep can still result. Also, narcoleptic type incidents may occur from excessive daytime sleepiness. These conditions can respond to moderate exercise, elimination of caffeine, problem foods, or low doses of an appropriate antidepressant ( typically much lower than required to treat depression. )
• Vulvar or Pelvic Pain - This is very common in fibromyalgia, and can sometimes be worsened by plant estrogens. Try removing soy from your diet, and do not take supplemental yam extracts or primrose oil. These plants are high in what are called phytoestrogens, or estrogen-like chemicals found naturally in plants.
  
• Yeast Infection - An oversensitivity to yeast, persistent thrush, red or itchy skin, and digestive problems are all sometimes ascribed to yeast overgrowth. There is much disagreement in medical circles about the actual role of yeast in digestive and skin problems, but some individuals respond very well to antifungal treatments when all else fails ( this may be due to other properties of antifungal drugs, which can strengthen the digestive tract ). If nothing else has worked, trying a 'no sugar, no yeast' diet for a month or more may indicate that a yeast problem is a possibility. If it helps you feel better, you might consider extending the diet and consulting a physician about a prescription antifungal treatment. These medications come in oral preparations ( tablets and capsules ) which should be effective in treating systemic infection, and should work within a few weeks at most. You should be sure that the beneficial result is not entirely related to the common fibromyalgia difficulty in dealing with high carbohydrate foods. This symptom will not always improve with treatment for other conditions.

A common thread in many cases of fibromyalgia seems to be a tendency to feel better when refined sugar, caffeine, alcohol, fried foods, red meat, and highly processed foods, are kept to a sound personal minimum in the diet. Many people benefit from cutting out all sugar for a month, which can severely reduce the craving for sweets, and allow your body to better manage its sugar intake when you add it back in. Sharply reducing your intake of caffeine in all forms, and fried, processed fatty foods, can improve cravings for these items in the same way and allow you to see if they are contributing to your health problems.

Even if you do not have severe food triggers, eating a healthier diet can have long-term benefits for any fibromyalgia sufferer. Try supplementing your current diet with greater quantities of raw or lightly cooked fruits and vegetables. Try substituting meats that are high in fat with fish or lean poultry. Drink plenty of water and take a good vitamin supplement to be sure that you are getting proper nutrition.

Also note that non-steroidal anti-inflammatories ( NSAIDs ) like aspirin, ibuprofen, or acetaminophen, can tear down the lining of the gut and intestinal tract. They are also found combined with narcotic pain medications, in preparations such as Vicodin or Vicoprofen. If narcotic pain medication is a necessity for you, or you must use it frequently, look into a medication that is not combined with a NSAID like Vicodin Tuss. If you have any predisposition to food intolerance or digestive disturbances, heavy use of these medications may make them worse, and these symptoms are very common in fibromyalgia. If you have never had digestive problems before, a steady regimen of NSAIDs may cause them to develop. Infrequent or occasional use should not be a problem, but consistent or daily use will likely pose a health risk over time. NSAIDs can worsen the vitamin deficiencies and digestive problems so common in fibromyalgia, while often doing little to relieve pain in the long term. It may be a good idea to minimize your use of these treatments.

Alternative Treatments:

Breathing: In proper breathing, the diaphragm and stomach expand, and the chest stays more or less still. While most people can get away with shallow chest breathing, if you have fibromyalgia it may be creating muscle tension and depriving you of oxygen. It feels odd at first, but setting aside a few minutes a day when you can concentrate on breathing from the stomach is a good start. Eventually, you will retrain yourself into a healthier breathing pattern.

With digestive trouble, such as irritable bowel syndrome, abdominal breathing is very helpful if you stay with it. It provides similar benefits to aerobic exercise in promoting strong, healthy intestines. The constant, gentle motion of breathing gradually strengthens the whole abdominal area.

Exercise: For fibromyalgics, extensive body-building regimens and boot-camp style fitness programs can create complete exhaustion where there was once only fatigue. Most fibromyalgia patients first notice their illness when they discover with regret that they can't be as active as they once were, gradually becoming less able to exert themselves. Nonetheless, symptoms will progress rapidly without exercise, leaving the need to establish a balance. Without a moderate amount of activity, sleep and digestive cycles may slow down, leading to insomnia and intestinal sluggishness. The important thing is being active every day.

A good way to start is with low-impact aerobics or brisk walking, swimming or biking. Exercises like these are easier to handle than others that "jar" the body. If you're just starting out, remember not to over do it. Begin with as little as five minutes a day and gradually build up to 30 minutes three to four times weekly. Swimming, particularly in a heated pool, is an excellent way to combat the pain of FM. And although this type of treatment, which allows for greater mobility with less effort, is most commonly used for lower extremity FM pain, it is possible to treat the upper body by doing something as simple as placing a chair in the water, setting down, and allowing the warm waters to work their magic. Keep a daily stretching regimen to maintain flexibility and reduce muscle cramps. Learn some calisthenics or floor exercises that you can do at home if you don't feel up to going out.

Resistance, or weight training, can be very beneficial if you make sure to only exercise on 'good' days and get plenty of protein. Slow repetitions at a comfortable weight can produce good results without straining joints. Take 2-3 days between exercising the same muscle group, so that you don't cause an injury. Be aware that resistance and weight training are very healthful in combination with stretching exercises, and that a moderate routine poses no danger of creating outsized muscles, only improved muscle tone and firmness. Overly muscular physiques take years of specific daily training and diet to achieve, so you should not worry that this type of exercise will make you 'bulk up' by accident. Often, this is a very good way to lose excess weight, as muscle mass burns energy even when resting and helps regulate blood sugar.

But no matter what exercise program you try, always stop and rest immediately if you become tired. If you keep pushing, you may find yourself unable to exercise the next day. Remember that it's far more important to get some extra daily activity than to prove to yourself that you can do one more repitition or walk a few blocks farther. The bodies of individuals with fibromyalgia often have atypical responses to exercise, becoming easily drained and worn out instead of energized. Drink extra water, and maintain a protein rich diet that will improve energy use and the creation of healthy muscle tissue.

Hypnosis: Hypnosis can be highly effective for managing sleep disorders and reducing the effects of chronic pain in fibromyalgia. Sometimes chronic muscle tension can be released, especially if it's worsened by anxiety and stress.

A tape promoting restful sleep played at bedtime, recorded by a professional hypnotist, is a simple and inexpensive way to try improving your rest.

Posture: Correct posture can help relieve some pains and cramps, though it may require a lot of attention to maintain in the beginning. The basic idea is to evenly distribute pressure to both sides of the body, and not maintain unnecessary tension. It's practically a given in fibromyalgia that there will be plenty of muscle tension, but it can be minimized.

If you try to pay attention to your body, you will begin to notice that slouching, holding your head forward, crossing your legs, and standing with all your weight on one leg, cause tension and discomfort. If you carry a wallet in your back pocket, this can create lower back pain simply by tilting you a little to one side when seated. If you find that you pull your shoulders up, or forward, this creates additional tension in the shoulders and neck that can increase the frequency and severity of headache or migraine. Relaxed shoulders should naturally fall down and back.

When you stand, try to stand evenly, and leave the knees unlocked, or ever so slightly bent. Just enough that in the beginning you feel a little tension in the muscles just above the knee, but not so much that your knees appear bent to an outside observer. This will help relieve tension in the calves, and slowly strengthen the muscles in the thighs. You may find that it becomes easier to maintain correct upper body posture when the knees are relaxed, tipping the hips back slightly. It can reduce both knee and lower back pain, though it may feel a little uncomfortable at first. Try it every once in a while for as long as you can stand it, until you find that it becomes your normal standing posture.

When you sleep, pillows or rolled up towels that give support to the knees and neck may prevent cramps from developing while you are in bed. It's common in fibromyalgia to have a low tolerance for uncomfortable sleep posture, and for aches, tingling, or numbness to develop at pressure points. If you sleep on your side, extra neck support may prevent arm and shoulder cramps, while a pillow between the knees may maintain proper back alignment.

We don't often think of our faces as having a posture, but many people hold their facial muscles in uncomfortable positions that result in long-term pain. Fibromyalgia patients are especially prone to nasty headaches that are worsened by clenched jaws and scrunched foreheads. Try to notice your jaw more often, and see that it's loose enough that your lips just touch. Your teeth should not be touching each other when the jaw is relaxed.

If you find that your forehead is tight, try a little self massage to help decrease tension, especially if you wear glasses. Use small, circular motions, or slow, firm strokes going toward the hairline. Commonly, a great deal of tension may be stored in the temples, and this type of massage is very helpful for that. Also, you may find that simply pressing and holding one or more fingers gently and firmly into the center of the forehead just above the brow releases tension in the forehead, and sometimes across the face.

Remember, for posture to become good all the time, it must first become good sometimes. Check your posture several times throughout the day. Observe how you stand, sit, and walk. It may be uncomfortable to maintain straight alignment at first, but this is because you've been using the wrong muscles for so long. Poor posture creates too much tension in muscles that should be relaxed, and atrophies the muscles that should be working. This is a common symptom in fibromyalgia, as the posture tries to accomodate new cramps and aches. Don't become frustrated if you find yourself slipping into habitual slouches, just try to be more aware of it when it happens. It may take a while to form good habits, but the results will please you.

Supplements: Certain supplements are recommended as part of a natural preventive treatment for fibromyalgia symptoms. Please remember that while supplements are typically very safe, not all of them should be combined with prescription therapies or with certain medical conditions. Certain supplements can cause adverse effects if taken in large quantities. No food supplement should be taken as though it were candy. Look for hypoallergenic supplements that are labeled as being free of common allergens, as individuals with fibromyalgia may be at increased risk of food intolenance.

These statements have not all been approved by the FDA, as per their guidelines on food supplements, no claims are made regarding the ability of these supplements to cure fibromyalgia or any of its symptoms.

• 5-HTP - This supplement improves your body's ability to manufacture serotonin, which regulates sleep and digestive cycles. This chemical is often depleted in fibromyalgics, which may account for the frequency of mood disorders, as serotonin levels are connected to our sense of well-being. 5-HTP supplementation has also been known to reduce chronic pain, though this may have something to do with its beneficial effect on sleep. A dose of 150 mg taken with your evening meal is recommended if you have sleep, migraine, mood, or digestive problems. It is best absorbed when some fat content is present in your meal ( a few nuts, some salad or cooking oil in one of the dishes, or the natural fat in some meats will do. ) This supplement may make you drowsy during the day if taken in the morning or afternoon. 5-HTP is not recommended for use if you currently take a selective serotonin reuptake inhibitior like Paxil, Prozac, or Zoloft, or any other medication that changes serotonin levels. Do not take if you use an MAO inhibitor like Nardil or Parnate.
• Acidophilus - These are the live bacteria found in yogurt, and in healthy digestive tracts. They are essential for the production of B vitamins from food and for the digestion of carbohydrates. If you suspect a yeast infection, this supplement is vital for replacing damaged bacterial populations in the intestine. It is also often recommended for irritable bowel and other digestive troubles. If you suspect that you have a dairy allergy, or are trying an elimination diet, you should look for a non-dairy supplement.
• Alpha-lipoic acid - A powerful antioxidant that aids in sugar metabolism, helps the body recycle other antioxidants like vitamins E and C, and aids production of glutathione and absorption of Coenzyme Q10. This antioxidant is especially important for individuals who experience reactive hypoglycemia, or other blood sugar difficulties.
• Amino Acid Formula ( Free Form Amino Acids ) - Helpful protein for muscle and nerve repair. While eating enough lean protein can be a challenge sometimes, a free form amino acid complex can make sure you get a balanced amount of all the essential amino acids. You can find this in a capsule or as a liquid; either is fine, but avoid liquids with lots of sugar or dye additives. Individuals with fibromyalgia may find these supplements particularly useful because they are simple for the body to digest and absorb.
• B vitamins - These vitamins are essential for energy and are involved in almost every function of a healthy body. Fibromyalgics are often deficient in these nutrients, and those with a vegetarian or low protein diet may be especially lacking. While some sources may recommend taking a particular B vitamin in large quantities, the B complex vitamins need to be taken in balance, with large doses of one possibly interfering in the function of the others. If you have severe absorption problems, getting twice weekly B complex injections from your physician may be the most effective option. Otherwise, you should take a balanced B complex supplement.
• Calcium and Magnesium - Calcium and magnesium are suggested to regulate muscle tone and the transmission of nerve impulses, they are natural muscle relaxants. If you have ever been diagnosed with ADD, these may be helpful in aiding relaxation. Taking large doses of calcium or magnesium by themselves for long periods of time is not recommended. For best results, take them together, as these minerals work together and need to be in balance. A ratio of no more than two parts calcium to one part magnesium is common, but some nutritionists recommend identical doses of these minerals. Fibromyalgia patients are likely to be magnesium deficient for reasons that are unclear. Magnesium may be especially important for reducing muscle tenderness, so be sure to get enough, even if you must get an additional supplement to balance all the 'extra' calcium found in foods and supplements. While magnesium can be taken at any time, avoid taking large doses of calcium with food, as it may block absorption of certain minerals. Look for these minerals in a chelate form.
• Carnitine ( use L-Carnitine or Acetyl-L-Carnitine forms ) - This supplement aids fat metabolism, muscle development, and helps improve energy levels. It is somewhere between being a B vitamin and an amino acid. Carnitine helps your body use fat as an energy source, aiding maintenance of a healthy weight. It is often deficient in diets low in animal proteins, and requires sufficient B vitamin intake for the body to create it. Supplemental L-carnitine can be taken in doses of 1000-4,000 mg per day in divided doses.

  Acetyl-L-carnitine works in a similar way to regular carnitine, but has been suggested as a boost to the nervous system for individuals who often experience mood and concentration problems associated with fibromyalgia. Acetyl-L-carnitine can be taken in doses of 500-2,000 mg along with L-carnitine. Some individuals with fibromyalgia can experience notable improvements in concentration and energy on a 500 mg dose of acetyl-l-carnitine, so start with a moderate dose and note your results.

• Coenzyme Q10 ( CoQ10 ) - Aids energy metabolism in all cells, especially helpful to the immune and cardiovascular systems. This vitamin is especially helpful to individuals like fibromyalgia sufferers who are constantly in a 'low-energy' state.
• Enzymes - As an aid to digestion, these supplements assist the body in breaking down different types of foods more easily. This can improve absorption and reduce allergic reactions in some individuals. Look for a multiple enzyme supplement whose enzyme components break down all three major types of foods; starches or carbohydrates, fat, and protein. Separate enzymes may be needed to break down dairy products if you have difficulty with these. Pregnant or nursing mothers, and individuals with bleeding problems, are urged to consult their doctor or nutritionist before taking these supplements.
• Essential Fatty Acids ( EFAs ) - Found naturally in oily fish, flaxseeds, avocados, raw nuts or seeds, minimally processed nut butters, and unsaturated vegetable oils. These healthy fats improve the health of the nervous system and are necessary for proper brain function. EFAs are also beneficial for the joints, the skin and hair, the intestinal lining, healthy blood pressure and cholesterol, and relieving pain and inflammation. If you have ever been diagnosed with attention deficit disorder ( ADD ), often experience 'fibrofog', or experience skin or digestive troubles, this supplement can be especially beneficial.
  EFAs are destroyed by heat and light, so only raw, uncooked vegetable sources are useful. ( Fish oil is still beneficial after cooking fish, but you can also get raw fish oil in capsules. ) Hydrogenated or saturated fats are not helpful, and can create damaging compounds in the body. Encapsulated primrose oil, grapeseed oil, fish or emu oil, or a combination EFA supplement can ensure that you get enough of these important nutrients in your diet. If you suspect a soy allergy, or are trying an elimination diet, avoid products containing soybean oil. If you try an EFA supplement, always refrigerate the container after opening, and keep bottles of flaxseed oil refrigerated at all times. Keep flaxseed meal in a cool, dark place before opening, and refrigerate after.
• Malic acid - Improves energy production and sugar metabolism. It is found naturally in apples, but may also be taken as a supplement.
• SAMe ( S-adenosylmethionine ) - This supplement is considered a natural way to improve mood, as well as being beneficial to the joints and liver. It promotes antioxidant activity in the body and is thought to aid fat metabolism. If you have ever been diagnosed with ADD, this may be a particularly useful supplement. It should always be taken on an empty stomach, and at least half an hour before eating. For fibromyalgia, the recommended dose is 200-800 mg. While SAMe is considered to be very safe, it is not recommended for individuals with manic-depressive disorder, individuals taking prescription antidepressants, or children under 12.
• Vitamin A and Carotenoids - Vitamin A, and the carotenoids, are powerful antioxidants and important to the skin and eyes. Some reports indicate that carotenoids like beta-carotene, lutein, and lycopene among others, may be a better way to take vitamin A, as the body can then make as much as it needs out of these useful compounds. Vitamin A is fat soluble, which means that it can accumulate too quickly in the body if large doses are taken. A safe guideline is no more that 10,000 IU per day from supplements, though larger doses are sometimes recommended for short term treatment. You cannot overdose on supplemental carotenoids. Never exceed 10,000 IU of vitamin A daily if you are pregnant, and try to take carotenoids instead. Diabetics and individuals with hypothyroidism may have difficulties converting carotenoids into vitamin A, and may strain their livers if they take high doses of carotenoids. Vitamin A can be found naturally in dark green, leafy vegetables, vegetables with red, orange, or yellow coloration, salmon, and animal or fish livers.
• Vitamin E - Known to protect against heart disease and cellular damage, vitamin E is helpful for preventing over 70 different diseases. It is also beneficial for skin, reproductive health, and wound healing. If taken as a supplement, use the natural d-alpha-tocopherol form, not the synthetic dl-alpha-tocopherol form. The natural variety is far more effective. It can be found naturally in brown rice, eggs, kelp, liver and organ meats, milk, soybeans, sweet potatoes, and whole wheat.
• Zinc - If you have ever been diagnosed with ADD, this may be a useful supplement, as individuals with this condition are often zinc deficient. Zinc promotes a healthy immune and reproductive system, as well as being beneficial for the skin. Zinc is necessary for the body to use the important antioxidant, vitamin E.

Tai Chi or Qi Gong: Both of these forms of exercise are very gentle, promoting flexibility and high energy levels. They are 'no impact,' and are widely reported to improve digestion, posture, and restful sleep. Muscle tone usually improves as well, but not bulk. Some Qi Gong exercises can be done from a sitting position, very useful if one of your fibromyalgia symptoms is not being able to stand for long periods of time. Classes can be found in most cities.

Yoga: While yoga is excellent for increasing stamina and muscle tone, be sure to speak to your instructor before class about any limitations you may have. An experienced instructor can help you get the most out of the class without hurting anything. Be especially sure to ask about ways to relieve pressure on the knees if this is commonly a problem for you. Eventually, continued yoga practice may draw out the kinks in your system.

Fibromyalgia and Children:

'Growing pains' in childhood are common recollections of fibromyalgics. They could be considered an early warning of problems to come. Often, children aren't good at communicating about physical problems, like achy joints, headaches, or stomach cramps. They may come to see chronic pain as normal, but are more likely to develop behavior disturbances, 'acting out' not emotional, but sometimes physical pain. It may happen that they complain of physical pain to get out of disliked activities, but are later dismissed when they are truly uncomfortable. Sometimes it can be hard to tell whether a counselor or a physician is the right person to consult about childhood problems.

For children with fibromyalgia type symptoms, especially if accompanied by behavior problems or social withdrawal, removing refined sugar, citrus fruit, and food colorings from the diet can sometimes create improvement. With an ADD or ADHD diagnosis, wheat or dairy intolerance should be carefully looked into, and vitamin and essential fatty acid supplementation considered ( see above ). Speak with a nutritionist about an elimination diet to find any food intolerances before they cause chronic problems. It can be dangerous to remove too many items from a child's menu without ensuring that any missing nutrients are replaced, as they need balanced nutrition and a varied diet.

If a child also falls asleep during the day or seems lethargic, an early onset sleep disorder ( See sleep disorders fact sheet ) such as insomnia, sleep apnea, or restless legs might be involved. If reactive hypoglycemia is present, it could either cause or worsen daytime sleepiness.

If accompanied by respiratory or skin problems, runny nose, or itchy eyes, look into various allergies that can be found on a common skin test, like pet dander, pollen, dust, or mold. Wall-to-wall carpeting can sometimes harbor these allergens, and be an unsuspected source of contamination. If steam cleaning doesn't help, wood, tile, or linoleum floors covered by washable rugs prevent allergens from gaining a foothold in your flooring.

Guaifenisin treatment can sometimes create a dramatic improvement, and it's often easier for children to avoid the plant extracts that block it. It requires no special diet ( unless reactive hypoglycemia is suspected, in which case sugar and starch must be sharply reduced ), and does not have significant side effects. It is considered to be quite safe for children, and is a common ingredient in children's cold medication. ( Note: The form found in cough syrup is no more suitable for daily use in children than in adults, largely because it may have other problem ingredients, including large quantities of sweetener and food coloring. The doses are too small to be effective, and are more expensive than buying the plain capsules from a pharmacist. )

It may be a good idea to avoid making a big deal of any special diet to your child. With younger children especially, it may be easier to gradually change their diet without discussion and see how they respond. Children may be prone to see eating healthier as a punishment, or come to think that they can blame bad behavior on what they eat.

Fibromyalgia and Pregnancy:

Some symptoms of fibromyalgia may decrease in pregnancy, thought to be attributed to increased serotonin levels. However, the tender points of this syndrome can be made worse during this time.

If you or your partner are prone to food intolerance, some evidence suggests that avoiding allergenic foods during pregnancy and breastfeeding may reduce the likelihood of an infant developing intolerance to these foods. As some evidence suggests that fibromyalgia may be hereditary, and may be worsened by food intolerance, you may want to discuss it with a knowledgeable nutritionist.

The prescription medications used to treat fibromyalgia are largely unsuited for pregnancy and nursing. Diet and natural food supplements are probably the best treatment options at this time, but you should consult your doctor or nutritionist about them. You will need additional nutrition and protein, and there are cautions that need to be taken with certain supplements and types of diet.

Gentle exercise classes designed for pregnancy, pool exercise, tai chi, qi gong, or yoga ( there are special yoga postures for pregnant women ) may be helpful in managing muscle tension and pain during pregnancy.

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