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Musculoskeletal - Fibromyalgia

Cabrara, Chanchal

Medical Herbalism 07-31-94 6(2): 1, 6-10

This chronic, debilitating condition may also be called Myofascial Pain Syndrome, Muscular Rheumatism or Fibromyositis. It refers to a group of non-articular rheumatic disorders characterized by pain, tenderness, and stiffness of muscles and of the areas of tendon insertion and adjacent soft tissues.

The term `myalgia’ properly refers to muscle pain while `myositis’ refers to muscle inflammation, but as these symptoms so often occur concurrently the terminology has some overlap. To be absolutely correct, fibromyalgia is not an inflammatory disease per se, as heat, redness, and swelling are rarely present. Rather, it is a condition of muscle tenderness and stiffness with focal points of more acute actual inflammation.

Etiology

This condition is more common in women than in men, and may be induced or intensified by physical or mental stress, poor sleep, trauma, exposure to dampness or cold, and occasionally by a systemic rheumatic disorder. It may occasionally occur secondary to a viral or bacterial infection. Primary fibromyalgia (i.e. not secondary to another illness) is particularly likely to occur in healthy young women who tend to be stressed, tense, depressed, anxious, and striving. Men are more likely to develop localized fibromyalgia in association with a particular occupational or recreational strain.

Clinical features

Symptoms generally begin as diffuse aching and stiffness which slowly worsen over a period of weeks or even months. Eventually the muscle stiffness and pain become chronic and constant, and there are frequently `trigger points’ in the muscles. These are exquisitely tender nodules that are palpable. Symptoms also include local muscle spasm and low grade inflammation. The muscles have a `ropy’ feeling, especially those of the forearm. Frequently there will be poor sleep, overwhelming fatigue, irritability, anxiety, bladder and urethral irritation, irritable bowel symptoms, and general malaise. No abnormal blood pictures are usually present, except occasionally a slightly raised ESR.

Holistic Treatment of Fibromyalgia

Patients must be evaluated from a holistic perspective.. They should be evaluated for diet, nutrition, and lifestyle factors, and be put on a gentle detoxification program if necessary. Vitamins, minerals, and other supplements as appropriate should be considered.
 
 
 

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Medical Herbalism: Clinical Articles and Case Studies

The allopathic approach uses exercise and amitriptyline (aka Elavil), a tricyclic anti-depressant, often prescribed for the depression of chronic pain, which helps promote deeper sleep. Local applications of heat, gentle massage, and occasionally non-steroidal-anti-inflammatory-drugs (NSAID) may also be employed.

Herbal therapies for connective tissue pain

These should be aimed at promoting good immune function, soothing inflammation, and easing pain. It may be necessary to use a separate formula for pain relief and to assist sleeping.

Typical formula for Fibromyalgia

Echinacea spp.        15 ml

Cimicifuga racemosa    15 ml

Harpagophytum pro.     15 ml

Glycyrrhiza glabra    15 ml

Taraxacum off. radix     15 ml

Apium grav.        15 ml

Phytolacca spp.        10 ml

100 ml. sig. 5 ml tid. aq. cal. a.c.

(5 mls three times a day, before meals, in hot water)

Typical formula for pain and for poor sleep

Valeriana off.         25 ml

Lactuca virosa         10 ml

Piscidia erythrina     20 ml

Scutellaria lateriflora     20 ml

Chamomilla recutita     15 ml

100 ml. sig. 2.5 ml. aq. cal. prn.

(2.5 mls in hot water as needed)
 
 
 
 
 

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Medical Herbalism: Clinical Articles and Case Studies

Case history reviews

MRS. S.

First visit: 19 March 1993.

Presented with sleeping difficulties of 5 years duration (averaging 3-4 hours per 24). History of night shifts (nurse in a psychiatric hospital for 15 years). Fatigue and depression were major concerns. Had been on Amitriptyline and Prozac but at time of first visit was not taking any medication except Premarin (for menopausal symptoms associated with a hysterectomy done in 1980 for fibroids) and Orudis (ketoprofen, a NSAID) for knee pain of 4 months duration. Had been off work for a year with extreme fatigue but at time of first visit was able to run her household but was not able to work outside the home and felt too tired to exercise as desired to and had in the past. Impaired vision and hearing in the year prior to first visit and many canker sores and cold sores. Experiencing heartburn from the Orudis. `Floating’ pains all over the body in past year and recent weakness in hands (subjective). Poor memory and concentration as well as very severe headaches in past year. Significant energy drop after eating carbohydrates. Has had thyroid problem and has taken thyroxine in the past.

Initial recommendations

Reduce red meats and increase vegetable intake. Stop drinking coffee. Exercise as much as able.

Herbal formula:

Fucus vesiculosis (Kelp) which I use as a thyroid regulator and nutritive tonic; Urtica dioica (Nettle) as a stimulating nutritive tonic; Cimicifuga racemosa (Black cohosh) as an anti-inflammatory for the muscles and an oestrogenic tonic; Verbena off. (Vervain) as an anti-depressant with a tonic effect upon the liver and all glands of the body including the thyroid; Rosmarinus off. (Rosemary) as an energizing herb, increasing blood supply to the head and limbs; Hypericum perforatum (St. Johnswort) as an anti-depressant, anodyne and nerve tonic; Avena sativa (Oat) as an anti-depressant, energizer and nutritive nerve tonic.

Second visit: 30 April 1993

Had reduced animal proteins and was down to 1 coffee per day. Tried to stop Orudis but after 5 days pain in knee was too severe so began again. General `low’ feeling (depression) had lessened and was feeling generally hopeful and positive despite continuing fatigue. She also complained at this time of a persistent wheezing and productive morning cough as a sequel to a bout of pneumonia in January. She had begun to use a ventolin inhaler for this.
 
 

Herbal formula:
 

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Echinacea spp. was added to the above formula as an immune tonic. She was also given the following lung tonic formula for a week: Glycyrrhiza glabra (Licorice), Plantago lanceolata (Plantain), Equisetum arvense (Horsetail), Thymus vulgaris (Thyme).

Third visit: 11 June 1993

No cold sores or canker sores since beginning herbs. Still fatigued and in pain (myalgia) but overall increase energy and feeling of being able to cope better. Lots of emotional stress in life — not sleeping well because of worrying. Cough had cleared completely but still a little residual wheezing for which she used the inhaler occasionally. Still using Orudis daily.

Herbal formula:

Herbal tablets containing Menyanthes trifoliata (Buckbean) as an anti-inflammatory for the joints and muscles; Galium aparine (Cleavers) to aid in the elimination of toxins from the body (via its diuretic action) and in stimulating lymphatic flow and hence the immune system; Arctium lappa (Burdock) as an alterative and blood cleanser specific for the musculoskeletal system; Zanthoxylum spp. to encourage blood supply to the muscles. Also given the following general tonic formula: Eleutherococcus senticosus (Siberian ginseng) as an adrenal tonic that stimulates energy in the body; Borago off. (Borage) also as an adrenal tonic but also as an anti-depressant and a general glandular stimulant; Turnera diffusa (Damiana) as a stimulating tonic; Ginkgo biloba (Ginkgo) to encourage circulation to the head; plus Cimicifuga racemosa and Urtica dioica.

Fourth visit: 17 Sept. 1993

Mrs. S. had had two weeks of feeling really good (“the best for years”) after the last visit. Unfortunately she had been so pleased with feeling well that she had tended to over-exert herself and was now feeling burned out again. However, she was greatly encouraged by this improvement in her energy and also by the fact that this time, when her health deteriorated, it didn’t plummet nearly as far as it had in the past. Her knees and wrists were still quite inflamed and causing considerable pain. She was having sporadic heartburn from the anti-inflammatory drugs she was taking. The breathing was improving but she still used the inhaler.

Formula:

The herbal anti-inflammatory tablets were repeated: 2 tablets tid.

A tea was given to alleviate lung congestion as well having some secondary action on inflamed joints: Glycyrrhiza glabra, Equisetum arvensis, Plantago lanceolata and Thymus vulgaris. This to be made with 1 teaspoon of herb per cup of water, 2-3 times daily.

General tonic formula was: Ginkgo biloba, Eleutherococcus senticosus, Turnera diffusa, Urtica dioica and Verbena off. taken at 5 mls. tid.
 
 
 

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I also advised her that if symptoms persisted I would refer her to an acupuncturist for treatment.

MRS. E.

First visit; 24 February 1993

Car accidents in 1989 and 1990. Diagnosed with Fibromyalgia in August 1992. Suffering from generalized body pain, especially in right neck, arm, and hand, with numbness in the right hand. Also poor sleep, chronic fatigue, stiffness in legs and pain in feet. All pain increased with fatigue and/or stress. Unable to work in past 6 months. Very erratic memory. Had just begun an exercise regime but was finding it very hard to manage. Rarely took painkillers but received regular chiropractic, massage and physiotherapy. Also complained of a hiatus hernia with acid reflux and heartburn. Chronic cough since `flu’ in november 1992 — non-productive cough with soreness below manubrium. A right sided ovarian cyst had been diagnosed in 1992 and caused sporadic pain in the right iliac fossa. A partial hysterectomy had been performed in 1989 for fibroids. The diet was quite unbalanced with a tendency to eat cakes and cookies as well as up to 6 coffees per day.

Initial instructions:

I asked her to reduce her meat intake and to stop consuming wheat, sugar, dairy products and coffee. This was intended to reduce the acid load in the body, thus alleviating inflammation of joints and muscles, as well as to boost overall immune function. I suggested that she greatly increase her intake of fresh fruits and vegetables. I also recommended regular epsom salt baths to remove toxic wastes from the tissues.

Herbal formula:

Harpagophytum procumbens (Devil’s claw) as an anti-inflammatory for joints and muscles and also for the hiatus hernia; Avena sativa (Oats) as a nutritive nerve tonic; Equisetum arvense (Horsetail) as a connective tissue regenerator; Rosmarinus off. (Rosemary) as a circulatory stimulant to the head and as a general stimulating tonic; Fucus vesiculosis (Kelp) as a nutritive energy tonic; Verbena off. (Vervain) as a bitter digestive tonic, glandular stimulant and relaxing nervine; Cimicifuga racemosa (Black cohosh) as an anti-inflammatory for the muscles and an ovarian tonic.

She also took a jar of Russian ointment which is a rubefacient and anodyne, and a bottle of Sleepeasy tablets (Jamaican Dogwood, Hops, Chamomile, Passionflower, Skullcap) to be used as needed.

Second visit: 13 April 1993
 
 
 

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Sleeping better and waking more refreshed. Significant improvement in energy and stamina. Exercising more and able to go on for longer. Reduced muscle pain although still some residual soreness in lower back and right loin with prolonged sitting. Memory still a problem. Feeling very impatient and irritable. Reduced coffee to 3 per day and reduced wheat, sugar, and dairy products.

Herbal formula:

The formula was repeated.

Third visit: 19 June 1993

Very little pain. Returned to work 3 days per week and also doing aerobic exercise 3 days per week. Reduced weight 7 lbs. Concentration improving although memory still a real problem. Still impatient and irritable — feels “ready to kill”. Still stiffness in right hip with prolonged sitting. Overall increase in energy although sleep still disturbed by vivid dreams. No more problems with hiatus hernia. Somewhat erratic with herbs — probably twice per day instead of three times as prescribed.

Herbal formula:

Centella asiatica (Gotu kola) as a stimulant of circulation to the brain and a stimulant of all brain function; Stachys betonica (Wood betony) as a relaxing yet stimulating brain tonic; Glycyrrhiza glabra (Licorice) as an anti-inflammatory and an energy booster; Fucus vesiculosis; Rosmarinus off.; Cimicifuga racemosa.

MRS. C.

First visit: 22 November 1992

A car accident in 1989 plus a fall off a garden swing in 1990 had resulted in two years of general `unwellness’ culminating in the diagnosis of fibromyalgia in Feb. 1992. At this time she was suffering from chronic neck tension and pain with lower back soreness. The left arm was painful from elbow to finger tips, the left arm was weak and both legs and feet were weak and sore especially in the morning. She felt fatigued all the time and slept poorly so was taking Elavil (Amitriptyline) 50 mg/night. Her memory and concentration had been very poor for the past 2 years. She had frequent morning headaches and occasional momentary feelings of vertigo. In 1974 she had a partial hysterectomy for an abnormal Pap smear and part of the left ovary was removed in 1988 due to an ovarian cyst. For the past 2 years she had also had night time hot flashes. She had a congenital heart murmur and frequently experienced cold feet as well as occasional pain from superficial varicosities in both legs. She had a lifelong history of constipation and suppression of the defecation reflex. To alleviate this she had been taking a laxative herbal tea containing Senna and Cascara. She had been unable to work for several months and felt some stress over this as well as general depression. She also felt guilt over her reliance on other people (especially her husband) and tended to push herself beyond her limits then suffer for it. She received regular physiotherapy and wanted to do some stretching and gentle aerobics but felt too tired.
 

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Initial recommendations:

Her diet was generally quite good although I did suggest that she minimize the intake of animal protein and stop drinking coffee and tea. I asked her to stop taking the laxative tea because a dependence can occur with long term use of the anthraquinone type of herbal laxatives. I also requested that she use her stationary bike and some light hand weights.

Herbal formula:

Glycyrrhiza glabra (Licorice) as an anti-inflammatory and adrenal tonic that raises energy levels; Harpagophytum procumbens (Devil’s claw) as an anti-inflammatory; Urtica dioica (Nettle) as a nutritive energizing tonic; Ginkgo biloba (Ginkgo) as a circulatory stimulant for the brain; Piscidia erythrina (Jamaican dogwood) as an anodyne and relaxing agent; Curcuma longa (Turmeric) as a warming anti-inflammatory; Hypericum perforatum (St. Johnswort) as an anodyne and anti-depressant.

Blue-green algae was also prescribed as an energy booster and general nutritive tonic.

Second visit: 15 December 1992:

She reported having felt quite good for the first week of using the herbal formula. She then developed an eye infection and was taking Cephalaxin plus using a topical steroid cream which were just beginning to be effective. She had stopped using the herbal laxative tea and was having a bowel movement approximately every other day. The stool was hard and dry and she had to strain to pass it and then usually didn’t feel empty. She had decided not to exercise until the New Year.

Herbal formula:

The herbal formula was repeated as was the blue-green algae. She was also given Psyllium powder with powdered Arctium lappa, Rumex crispus, Ulmus fulvus, Berberis aquifolium, Trigonella Foenum-graecum & Althea off., 1 teaspoon in water 2x/day to replace the laxatives.

Third visit: 25 March 1993

Her brother had been killed in January so she had been under great stress and had stopped the herbal medication for some weeks and had felt very ill for a while. She was now taking the herbs again and noticed a definite improvement in her symptoms. She was exercising for 1 hour three times a week and continued to receive regular physiotherapy. She felt an general increase in energy and enthusiasm but was unhappy taking the Elavil because she had gained 25 lbs. since starting it and it caused her to wake feeling hung over. She was experiencing an increase in the hot flashes. Her diet was improving with a reduction of caffeine, dairy foods, meat, and alcohol. Her body was beginning to reject meat and coffee (feelings of nausea and crampy abdominal pain after consumption). Her physical pain was not reduced. She was having a bowel movement almost every day and the eye infection was healed except for a small hard lump on the lid.
 

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Herbal formula:

Salvia off. (Red sage) as an oestrogenic and antihydrotic; Lobelia inflata (Lobelia) as a muscle relaxant and antispasmodic; Eleutherococcus senticosus (siberian ginseng) as an adrenal tonic and energy tonic; Rosmarinus off. (Rosemary) as a circulatory stimulant to the head and limbs; Cimicifuga racemosa (Black cohosh) as an oestrogenic and an anti-inflammatory for the muscles; Harpagophytum procumbens; Hypericum perforatum; Glycyrrhiza glabra.

She was also given Bach Flower Remedies to alleviate some of the mental stress she was experiencing particularly around issues of guilt for her illness and difficulties accepting the healing process she is in.

Fourth visit: 11 May 1993

The last herbal formula had seemed to aggravate the hot flashes (this reaction is opposite to the normal effect of sage) so she had not been taking the full dose. Her level of physical discomfort had not improved significantly but her energy was much better and she was able to exercise quite easily and was much more functional around the home. Her memory and concentration continued to be poor and her sleep was still disturbed by hot flashes as well as some physical pain. She was taking 75 mg. of Elavil at night and waking feeling groggy.

Herbal formula:

Vitex agnus-castus (Chaste berry) as a pituitary regulator and hormonal balancer; Angelica sinensis (Dong quai) as an ovarian tonic and an oestrogenic agent; Verbena off. (Vervain) as a glandular stimulant, a bitter digestive tonic and a relaxing anti-depressant; Glycyrrhiza glabra; Hypericum perforatum; Cimicifuga racemosa; Eleutherococcus senticosus.

Fifth visit 9 July 1993

With the most recent formula the hot flashes had reduced noticeably. Her energy continued to be good, even with considerable activity but the pain in the back, arms and legs continued. Her feet however, were no longer sore at all. Formula:

She was given a herbal tablet for stress containing Humulus lupulus, Scutalleria lateriflora, Passiflora incarnata and Chamomilla recutita. The dose was 2 tablets as needed. The tincture formulation from May 11 was repeated. She was also given a Warming Embrocation for topical application.

Sixth visit 17 Aug. 1993

This time Mrs. C. reported that she had managed to wean herself off the Amitriptyline and had replaced it with the herbal `stress tablet’. She also reported that the warming embrocation had given some relief but that she was experiencing a new pain in her right shoulder and arm similar to that in the left arm. She had also fallen and chipped a bone in her hand so I recommended a poultice of Symphytum radix. The hot flashes were minimal and she was sleeping through the night.
 

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I did refer her to an acupuncturist for further treatment of the arthritis.

Formula:

The herbal tablet for stress was repeated at a dose of 2 tablets prn.

She was also given herbal anti-inflammatory tablets containing Menyanthes trifoliata, Galium aparine, Zanthoxylum americanum and Arctium lappa. These were prescribed at a dose of 2 tablets 2 or 3 times daily as necessary.
 

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