Introduction to the Holistic Treatment of Fibromyalgia
The Resilience Medicine Approach to the treatment of Fibromyalgia with holistic, integrative and cannabinoid medicine.
Introduction
Fibromyalgia is a complex chronic disease that is often poorly treated and poorly understood. It can be extremely debilitating and requires a holistic approach to get well again, since there is no single effective drug for all of the symptoms and underlying factors.
The Resilience Medicine Holistic approach to fibromyalgia incorporates cannabinoid (cannabis-based) medicines, specific mindbody techniques, therapeutic diets, prescribed combinations of nutraceuticals & medications, passion and connection and creating a resilience environment using evidence-based and evidence-informed interventions stacked together to create greater healing to help you feel better faster.
In this article you are going to learn about each of these holistic approaches in detail, how to use them for your healing journey as well as the latest research evidence and explore a case study for fibromyalgia to help remove the confusion and help provide a path to feeling better.
Many people with Fibro have other diagnoses too, such as depression, sleep issues, chronic fatigue and anxiety, problems with their digestive system, bladder and women’s health conditions like endometriosis. Without treating these symptoms and underlying factors together holistically, it is very difficult to get control over any of them because they all affect each other, pain levels and share some underlying mechanisms in the brain, gut and immune system
Holistic Fibromyalgia Treatment Improves Quality of Life
Many people with fibro experience a frustrating deterioration in their overall quality of life and ability to do ‘normal’ things from going for walks to seeing friends and going to work, due to a vicious cycle of physically debilitating pain on top of cognitive brain symptoms like brain fog, unpredictable depression and mental fatigue.
A Holistic Treatment approach helps to break this cycle to improve your quality of life and daily functioning.
What is Fibromyalgia
What is Fibromyalgia?
Fibromyalgia is a multi-symptom and multi-system chronic disease. It includes chronic widespread pain that can change location along with other difficult-to-treat symptoms like chronic fatigue, poor exercise tolerance and extreme post exercise malaise or PEM, sleep disturbances (feeling ‘tired but wired’) as well as cognitive, or brain thinking problems, symptoms including severe brain fog, memory issues and depressed mood.
How It Can Start
In some people, symptoms can start after a specific ‘trigger’ event, like after a physical trauma to the body, an infection or a significant brain stress event. In others, there is no identifiable single trigger event and symptoms gradually develop over a number of months or years, but may have a ‘prodrome’ phase when they look back on the lead-up to their symptoms developing. Some people suffer with another condition first, such as struggling with stress, burnout or depression before they get fibro or in the prodrome phase.
Who Gets It?
Anyone can get fibromyalgia but it affects women more than men. However, because it is more common in women, men are often not diagnosed as quickly or it is misdiagnosed for a longer time. It can come on at any age, but most people develop symptoms between the ages of 25 and 55 years old. However, even kids as well as older adults can develop symptoms. Although the exact number of people with fibro is not known, as many are undiagnosed, it is a very common chronic illness.
What Causes Fibromyalgia
What Causes Fibromyalgia?
The exact mechanisms are multifactorial and still not completely understood, but likely involves multiple genes and epigenetic changes after some kind of environmental trigger, inflammation, hormonal mechanisms and environmental factors. The cause of the pain is in part due to something called ‘central sensitization’ where the brain and nerve networks involved in pain-sensing and processing become jumbled and ‘smudged’ so that pain spreads through large regions. Inflammation may also play a key role, but is rarely seen on blood tests.
The ECS & Fibromyalgia
It also likely involves endocannabinoid system dysfunction (ECS), an overarching neuroregulatory system in the brain and body that helps to regulate pain signals, mood, fatigue and response to stress- all the things fibro affects. The ECS involvement may explain why medical cannabis helps with so many ‘treatment-resistant’ fibro symptoms.
Common Conditions that Go alongside Fibro (Comorbidities):
People who suffer from fibromyalgia are also more likely to have other pain conditions such as headache disorders, trouble with their jaw (TMJ) joint, IBS and anxiety and depression as well as a condition called POTs. Many of these conditions share similar underlying mechanisms in the brain, nervous system and gut-brain axis function. There is also a link with ADHD that is increasingly recognised which may be related to the way the brain processes pain signals.
Diagnosing Fibromyalgia
It can be hard to get a diagnosis because the symptoms can vary and fluctuate, and there are not blood tests to confirm the diagnosis. It is a clinical diagnosis and and there are other conditions like EDS that can overlap with it. Even if you do not meet the older ‘tender point’ criteria, you can still have fibromyalgia.
However, diagnosis is like if you have:
- Widespread pain above a certain score on a validated pain index
- Generalised pain, or pain in at least four of the five body regions
- Symptoms have been present for at least 3 months
Fibromyalgia can also exist alongside other pain and fatigue conditions such as autoimmune arthritis, chronic fatigue syndrome and other pain conditions too.
The Resilience Medicine Toolkit for Fibromyalgia
The Resilience Medicine holistic approach involves incorporating interventions from 6 main categories: Cannabinoids & Power Plants, Diet + Microbiome, Mindbody, supplements & botanicals, Passion and connection & creating a resilience environment.
In the clinic, we also use functional medicine tests and approaches to further personalise treatment based on biomarkers, gut markers and genomics in some cases. We also, where needed, use medications, often with prescribed combinations of nutraceuticals.
These categories were chosen based on Dr Dani’s 15 years of experience using this holistic treatment framework with her patients. Often it is when things from different categories are ‘stacked’ on top of each other to create a unique integrative plan or ‘stack’ that gives the most benefit in fibro, since everyone’s illness is slightly different.
Even if you have tried some of these things before on your own, it is often getting the right combination of things done at the right time that makes a big difference.
It can be very overwhelming and confusing trying to navigate all of the pieces of a holistic treatment plan on your own. Having expert guidance helps remove this confusion and overwhelm and makes sure you are on the best treatment path for your individual needs.
Medical Cannabis
Prescription Medical Cannabis in the UK
Medical cannabis is a a legal medication in the UK and is available now on private prescription from a specialist doctor. Medical cannabis are whole plant medicines which contain over 100 active cannabinoid compounds, which are thought to work together to deliver the medicinal effects although the main cannabinoids used for dosage currently are CBD and THC. The different strains or chemovars, can produce different therapeutic effects making it a highly personalised medicine.
Medical Cannabis helps patients with difficult-to-control symptoms & those who have failed other approaches, to get a quick win in terms of symptom control, relief from suffering and overwhelm.
It can help by starting of a positive neurological ‘cascade’ leaving you more able to engage with other aspects of a holistic treatment plan. For example, combining cannabis medicines with a specific mindbody relaxation training technique or with an exercise or diet change becomes easier due to the brain and body and the nervous system being in less distress.
Most patients see a significant improvement within the first month of therapy across multiple symptom clusters including pain, mood, fatigue, stress, sleep and global functioning.
Medical Cannabis for Fibromyalgia
Medical cannabis is emerging as a promising treatment for individuals with Fibromyalgia as part of a holistic approach. Unlike many other medications, medical cannabis is usually well-tolerated and can effectively treat clusters of symptoms with a single medicine.
It can help with Fibromyalgia pain as well as other sources of chronic pain, sleep disturbances, anxiety, gut symptoms, headaches, fatigue and mental function.
One reason medical cannabis may be effective in treating Fibromyalgia is that it works on our endocannabinoid system (ECS) dysregulation, as well as our serotonin system and inflammation pathways. Cannabinoids have neuroprotective properties and prescription preparations containing even a ‘microdose’ of THC can work as an effective chronic pain reliever, even when other drugs have not worked or been tolerated .
Additionally, some experts and researchers believe that Fibromyalgia may be a type of “endocannabinoid deficiency syndrome,” which means that using plant cannabinoids in the right doses and ratio may help restore balance in this system.
To maximise the benefits of medical cannabis, treatments should be tailored to each individual’s needs by an expert doctor. This includes factoring in different times of day and different effects. For example, uplifting medicine during the day can help with mental function, while calming medicine at nighttime can support sleep and reduce night pain.
Dr. Gordon is the most experienced cannabinoid medicine physician in the UK, has trained the first UK specialist physicians in the prescribing of medical cannabis for fibromyalgia and has treated thousands of patients with medical cannabis first in Canada and in the past few years in the UK since it has become legal. She uses a more holistic individualized approach to cannabinoid therapy, due to her expertise in Integrative & botanical medicine in addition to her conventional medical training as a physician.
How is Medical Cannabis Different to CBD I can buy in a shop without a doctor?
Hemp CBD oil wellness supplement products available over the counter at health shops are not the same as medical cannabis. Hemp CBD oil non-medical products do not contain any measurable THC and are not made as medicines.
Even a small amount of THC in medical cannabis prescription medicines makes a huge difference in the medicinal effect for patients.
For most people with Fibromyalgia, CBD hemp supplements own their own are not effective because they lack this THC which works on the pain signalling pathways in Fibromyalgia.
Therapeutic Psychedelics for Fibromyalgia & related symptoms
Ketamine therapy is another currently available therapy via a specialist doctor for severe chronic pain, although not available on the NHS.
Depression, which is often comorbid in fibromyalgia, often responds well to ketamine therapy even when other treatments have failed.
Currently, there are clinical trials and studies ongoing investigating the potential of psilocybin and other compounds for the treatment of chronic pain including fibromyalgia but no big studies have had results yet. However, many anecdotal case studies exist of benefit so this remains a promising area for more research.
Therapeutic Diets for Fibromyalgia
Although Fibro is not a nutritional illness as the core cause, certain types of diets can influence and improve symptoms such as fatigue, pain, inflammation and mood.
Therapeutic diets work via multiple mechanisms such as:
- Influencing multiple inflammation and pain pathways
- Affecting neuro-immune modulation
- Affecting gut-brain axis function
- Shifting microbiome health
For example, a modified ketogenic diet may improve symptoms for some people, which may work better for men as a generalisation.
Other people may respond better to a different therapeutic diet including one of 3 different types of plant-based diets.
Choosing the best therapeutic diet is based on things like symptom cluster profile, gut and blood biomarkers and other individual factors which are assessed & taken into account as part of your treatment plan.
Mindbody Medicine for Fibro
Mindbody practices help to actually change the brain structure and function in multiple ways, turn down the volume on stress, anxiety and pain signals and help our brains become more resilient. Utilising the bi-directional brain-body communication link can be very effective at reducing pain signalling.
For example, specific Mindfulness for pain practices has been shown to be highly effective for improving quality of life, pain and coping in patients who suffer from chronic painful conditions. This is because chronic pain becomes ‘wired’ into the brain and nervous system, not just in the place you feel the pain, like a shoulder. This starts a cycle of brain amplification of pain signalling and chemical messengers involving the limbic system, which mindfulness practices can help to regulate.
Techniques to activate the Relaxation Response, based on Dr. Gordon’s experience studying these techniques at Harvard University, as well as other targeted techniques, have been shown to have great benefits for Fibro patients.
Neuromodulation home devices including CES devices, vagal nerve stimulators and other noninvasive techniques are often incorporated into the mindbody approach and monitored with the doctor over time to track progress.
Creating a tailored mindbody practice to suit you best at each stage of the healing journey and making it easy and unburdensome to stick to is important to making mind-body medicine parts of your treatment most effective, since many patients may have tried some of these things previously and not noticed an improvement.
Supplements & Nutraceuticals for Fibromyalgia
Supplements including nutraceuticals, botanical extracts, medicinal fungi, adaptogens and amino acids and minerals can all be helpful for different aspects of fibromyalgia. Each person will likely have a slightly different ‘stack’ of supplements based on their specific case and likely won’t need all of these, but options include:
- Magnesium Glycinate
- Cordyceps, Reishi and Lions mane Mushrooms
- Gut support including specific probiotics, enzymes and short chain fatty acids depending on the patient
- Alpha lipoic acid
- Mitochondrial support nutraceuticals including lipid membrane support (NT factor lipids,alpha-keto glutaric acid, etc)
- phosphatidylcholine
- NAC
- Acetyl L Carnitine
- PEA
- Thiamine
- B complex
- B 12
- Liposomal curcumin
- Boswellia
- Highly purified krill or high EPA fish oil in cases of high inflammatory markers
- sleep support botanicals which may include passionflower, hops, valerian and skullcap
Medications for Fibromyalgia
There are different medications that may be tried for the different symptoms of fibromyalgia including antidepressants, painkillers, muscle relaxants and sleeping pills, but everyone responds differently and there is no single medication that works well for everyone. Many people cannot tolerate these medications due to the medication sensitivity common in fibromyalgia so other more holistic options may work best in these cases. Medical cannabis is usually well tolerated even in cases where other medications were not, which makes it a bit unique.
Functional Medicine Tests for Fibromyalgia
We can use functional medicine testing to look at factors such as genetic stress tolerance, gut microbiome and gut-brain axis function, inflammatory biomarkers, circadian rhythm dysfunction, and more, based on specific clinical assessments. They can help further customize your treatment based on your biochemistry, since no two people with fibro are exactly alike. We also know now that fibromyalgia involves changes in the gut brain axis, autonomic nervous system and stress control and the immune system including inflammation pathways so addressing these at root cause level can be very beneficial for many people. These are optional.
Case Study for Fibromyalgia
Sarah’s Story
Sarah, 39 years old. Diagnosed with fibromyalgia 5 years ago
Goal: get control of her pain and stiffness which kept her at home and in bed part of the day as well as associated symptoms like fatigue and brain fog so she could do the job she loved again.
History: After failing multiple medications including different painkillers, antidepressants, sleeping pills and physiotherapy, Sarah felt like she had tried everything. She had been told by multiple doctors there was ‘nothing more’ they could do for her and that she would have to learn to live with her symptoms they way they were.
The plan: after a thorough integrative assessment, Sarah underwent functional medicine testing and started on a specific medical cannabis plan to help with her daytime symptoms and also help regulate her sleep at night. Based on the results of her tests, she was started on a specific nutraceutical and dietary protocol, brain-gut axis support based on some inflammatory and gut markers and given a short progressive muscular relaxation practice to help relax the muscles alongside her evening medical cannabis dose.
Outcome: 6 months later, she had returned to work, started going to yoga classes again and was able to go out socially and live a ‘normal’ life again. Her pain had gone from 8/10 most days to 1/10 most days and she felt more clear-headed and had more energy. She also slept more deeply.
Next Steps
In summary, using a specific, evidence-based holistic approach to treating fibromyalgia and fibromyalgia-like syndromes can dramatically improve quality of life, relieve pain, improve energy & cognitive function and remove the confusion and overwhelm of trying to navigate this complex illness on your own. To take the next step in your journey, book an initial consultation with our expert physicians.
