Fibromyalgia: clinical management improves outcomes, reduces treatment complications

Townsend Letter for Doctors and Patients,  April, 2004  by Russell Jaffe

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Fibromyalgia (FM) is a 'medical mystery syndrome' characterized by disabling, treatment-resistant pain localized in tender ('trigger') points. (1) The classic definition requires that 11 or more of 17 specific points show significant tenderness. (2) Concurrent substantial fatigue is common. (3) Chronic fatigue immune dysfunction syndrome (CFIDS) is also a 'medical mystery syndrome' characterized by disabling fatigue that persists for more than six months. (4) Concurrent substantial trigger point pain and tenderness is common. (5)

Both FM and CFIDS are generally recognized as immune dysfunction syndromes. (6) Our focus on integrated, comprehensive management of autoimmune and immune dysfunction syndromes' causes make these conditions of particular interest. (7) This first line comprehensive care approach to the causes rather than the consequences of FM and CFIDS has been studied in a successful community-based randomized controlled trial (CBRCT). (7)

A group of treatment resistant, multiple treatment failure people with fibromyalgia, many of whom had concurrent CFIDS, were recruited for study. This group was selected, in part, based on their expectation of failure due to their prior experiences. This was done to minimize extraneous effects. What has been called the placebo effect, more accurately an important aspect of the human healing response, is one such variable. (8) Selecting people with multiple prior treatment failures and an expectation of failure in this trial was part of the design to minimize the 'placebo effect.' Further, the trial was carried out for a full six months, longer than the so-called placebo effect usually lasts. Successful sustained remission in this group is encouraging for the general application of this comprehensive approach to causes of FM and/or CFIDS. While details of this approach have been published in the peer-reviewed literature, (7) an updated synthesis is presented here. This successful model is reported for the general reader in Fibromyalgia: My Journey to Wellness by Claire Musickant. (9)

In this article, focus is on what we have learned that is of general use to comprehensive care physicians and those seeking fundamental treatment for resistant, persistent muscle pain (fibromyalgia) and fatigue (CFIDS). Depending on the group, best efforts application of the protocol herein described results in 75-90% substantial to complete sustained remissions. With ten plus years follow up confirming sustained remissions, we are confident that these approaches, taken together, can achieve lasting results when consistently applied. (10)

Estimates of the prevalence of FM and CFIDS range from 5 MM (11) to 20 MM (12) Americans. Over one in ten Scandinavian women in the prime of life qualify for these diagnoses, according to recent careful surveys. (13) More careful studies find substantially larger numbers of people with these conditions. (14) Clearly, too many people suffer from these 'treatment resistant' syndromes. While the pain and/or fatigue usually do not respond to symptom suppressive treatments, a comprehensive approach to the causes yields better clinical and more cost effective solutions. (7), (10) While a precipitating trauma or distress can often be found, this event may primarily be the 'last straw' that breaks an already hospitable, predisposed host. (15)

A comprehensive care protocol for managing FM and CFIDS includes:

1. Functional, comprehensive, ex vivo assessment of all delayed allergy mechanisms. This addresses the basic burden on immune defense and repair systems. The more attention to defensive reaction from delayed allergies, the less ability the immune system has to devote to necessary repair. Cumulative deferral of repair results in increased permeability in tissues that have the greatest wear and tear ... those that are distressed. Cumulative repair deficits are clinically known as inflammation. Fundamentally, we can understand inflammation as incomplete or blocked repair.

Based on outcome results detailed below, it is clear that careful 'best efforts' to substitute for reactive items is sufficient using LRA by ELISA/ACT tests to determine reactivities. It appears that there is a threshold for each individual below which the body can neutralize foreign substances (probably based on dendritic, phagocytic cells) without depending upon or burdening lymphocyte responses with defense reactions that reduce repair competences.

Thus, while it is important to identify and substitute for as many of the reactive substances as feasible, perfect substitution is not necessary to achieve effective clinical results.

2. Restoration of digestive competence. This means redressing maldigestion, dysbiosis, and enteropathy. This includes:

a. Eating foods that can be digested more completely without triggering focal or systemic immune responses.

b. Eating in ways that enhance the degradation of food to healthy building blocks. These building blocks include aminoacids, di- and tri-peptides, sugars, glycerides, and fatty acids.