How Can I Manage My Fibromyalgia Pain?

Q. I have fibromyalgia, osteoarthritis, and facet degeneration in the neck. Several times a week, the pain is almost excruciating in the mastoids, below the skull, and in the shoulder blades. I take Boswellia as needed, which helps occasionally, and I recently started 100mg of magnesium four times a day, which unfortunately further exhausts me, although fatigue is preferable to pain. Among my daily modalities are an anti-inflammatory diet, utilizing Jon Kabat-Zinn’s mindfulness meditation, “moving” as much as possible throughout the day, asserting a very positive attitude, enjoying loving social support, fulfilling purpose, and starting coach training next month. Do you have specific recommendations for the pain?

Dr. Lisa Lilienfield: Thank you for the question. It sounds like you are quite enlightened and practicing many lifestyle habits that are beneficial for your condition.

Fibromyalgia and Chronic Fatigue Syndrome (also called Myalgic Encephalomyelitis), are complex conditions that need a comprehensive approach to diagnosis and treatment. There can often be associated sleep dysfunction, infections like Lyme disease or E-BV (Epstein-Barr Virus), digestive problems such as SIBO (Small Intestinal Bacterial Overgrowth), or Celiac Disease and other food allergies that can cause leaky gut and lead to autoimmune disorders such as Hashimoto’s thyroiditis or autoimmune arthropathies. People suffering from FM and/or CFS/ME may also exhibit reactions to environmental toxin exposure, like mold or heavy metals, which can be diagnosed through specialty labs looking at stool, urine, breath, and bloodwork.

We often find that fibromyalgia is related to a deficiency in delta wave deep sleep, and medications like Xyrem that promote deep wave sleep have been helpful in reducing chronic pain. In addition, in a few select patients with chronic fatigue, we have found chronic Epstein-Barr and HHV6 (human herpes virus 6) as possible triggers. In these cases, patients may respond to an antiviral treatment called Valcyte (a protocol from studies done at Stanford by Dr. Jose Montoya).

I also wonder if the pain is coming from the cervical spine. Have you had treatments like physical therapy, acupuncture, or considered injection therapy with prolotherapy, or PRP (platelets rich plasma)? Have you had your jaw evaluated for TMJ by a dentist specializing in temporomandibular joint problems? This can often cause referred pain in the head, neck, and shoulders.

Another treatment you may consider is Low-Dose Naltrexone (LDN). When chronic pain is a result of neuro-inflammation (brain inflammation), LDN can help by reducing the upregulation of the microglia that cause this inflammation.

Other supplements that may be helpful include D- ribose, fish oil, glutathione, and IV magnesium with B complex and Vitamin C (also known as Myers cocktail).
I hope this has been helpful.

– Dr. Lisa

Additional Resources:

Consumer Guide: 18 Things You Should Know Before Choosing a Doctor to Treat Your Fibromyalgia