Scott Rollins, M.D.

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September 27, 2012
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ROLLINS: Fibromyalgia and Chronic Fatigue Syndrome

Imagine being so tired that you can't function. I'm not talking about being pooped at the end of a long day at work or exhausted after a big hike. I mean the kind of tired that prevents working a normal job or the kind of tired that only allows doing a few hours of chores before having to go back to bed from being so wiped out.Now consider having this type of fatigue all the time, for months to years on end without relief, and even rest won't help. To make matters worse, insomnia is usually present as well, so although one may be "dog tired" they can't even get a sound night's sleep. This is the definition of "chronic fatigue syndrome" (CFS) and it is called a syndrome because there is not one simple cause for the fatigue.As if this fatigue was not bad enough, now let's add pain. A deep, aching kind of pain that moves throughout the body, in the tissues and bones and joints, as well as isolating to 18 specific points about the body. These tender points, called "trigger points," are like epicenters of pain and touching them with just enough pressure to blanch your fingernail produces severe pain. The pain syndrome that centers on the tender trigger points is called "fibromyalgia."About half of people with fibromyalgia also have CFS and visa versa. Fibromyalgia affects an estimated 10 million people in the U.S. and an estimated 3% to 6% of the population worldwide, according to National Fibromyalgia Association. For some reason, about 80-90% of fibromyalgia sufferers are women. The good news is that effective treatment is possible for most of these patients.

Dysfunction in a few key systems seems to be the common denominator with fibromyalgia. Areas involved include the cellular energy-producing mitochondria, the "all controlling" part of the brain called the hypothalamus, and the immune system.Defects in the mitochondria powerhouses lead to the lack of energy, fatigue, muscle shortening and pain. Abnormal control signals from the hypothalamus leads to disrupted sleep, which then causes a lack of important healing hormones, physical rest and tissue repair. Further changes in the autonomic nervous system are related to the abnormal pain signaling. The immune system changes lead to altered balance of immune pathways that result in excess inflammatory chemicals called cytokines.We are finding that these dysfunctional systems are caused by a combination of conditions from genetic defects in metabolic and detoxification pathways, to external stressors such as infections, toxic chemicals or heavy metal accumulation in the body. Poor nutrition and stress are two very important lifestyle issues that play a role.

The first step for most patients is getting a proper diagnosis. Many physicians still doubt the diagnosis of fibromyalgia even exists and rather simply point to depression, pain or insomnia as the main issue. Fortunately, this is changing and along with it more and more patients are getting the correct diagnosis, followed by successful treatment that is rooted in integrative and functional medicine. That is, there are many different body systems to investigate and treatment modalities to integrate into a plan that gets to the root cause of this tricky syndrome.First of all, fibromyalgia is a purely clinical diagnosis. There is not a specific lab test or imaging study that makes the diagnosis. Many of us practitioners familiar with treating fibromyalgia and CFS have quit making such a big deal out of needing the recommended 11 out of 18 tender trigger points to make the diagnosis. At the end of the day, having widespread persistent pain, above and below the waist, on both sides of the body and along the midline of the body, meets the definition of fibromyalgia.Other symptoms that are often present with fibromyalgia include severe fatigue for more 4-5 months, fatigue that is worse after exercise, insomnia, depression or brain fog, bowel issues, recurrent or frequent infections, and multiple chemical or medication sensitivities.

Our general treatment goals are to "rest, fortify and restore." We restore function with natural supplements, nutrition, sleep control, nervous system balance and hormone supplementation. It is critical to eliminate energy drains such as stress, allergies, intestinal disorders, infections and heavy metal accumulations.Restoring cellular energy involves using numerous supplements that help heal and "tune-up" the energy-producing mitochondria. Specific brain neurotransmitter levels can be obtained through a simple urine test and imbalances may be treated with amino-acid precursors and natural compounds that increase or decrease production of certain neurotransmitters. As patients improve, most of the supplements for energy and brain chemistry support are usually discontinued.Treatment for hormone imbalances or deficiencies is frequently a cornerstone of treatment. A disturbed adrenal stress hormone system leads to alterations in cortisol regulation. Undetected low thyroid or thyroid resistance disorders are common. Imbalances in sex hormones such as estrogen dominance or menopause are triggers for fibromyalgia.The most important role of the immune system is to defend the body from invaders. The cytokines that are made help maintain a balance in the immune system. Cytokines influence mood, sleep, energy, cognitive function and many other important aspects of health. Physical triggers (infections, toxins, allergens) and psychological events (emotional trauma, mental stress) lead to the increased production of cytokines. If these triggers are not resolved, cytokine levels will remain high, resulting in chronic systemic inflammation, which may cause symptoms that are not immediately recognized as inflammatory in nature.Fibromyalgia is often started after an infection and is often associated with persistent, chronic infections. These infections can be yeast/fungal, parasitic, bacterial or viral. Most infections involve the respiratory tract including bronchitis or sinusitis, bowel infections, and chronic prostatitis. If the infections don't resolve with general treatment then direct treatment is advised.The exposure to heavy metals such as lead, mercury, arsenic or cadmium will lead to deposits in the body that are not detected in blood work (unless it is an acute exposure).Heavy metal accumulation is well known to disturb the neurologic, endocrine and immune systems. Chelation is a process of giving a substance that will bind to metals and pull the metals out of storage so they can then be eliminated in the urine.Working with nutrition, eliminating delayed food allergies, and healing the inflamed or leaky gut is absolutely critical. Lifestyle issues include removing stressors and aggravating factors - this might include situations, people, or toxins.Sleep, pain, and mood management can all addressed with combinations of natural supplements and prescription medications. We encourage time for relaxation, time out, laughter and modest exercise. Psychological counseling and support of friends and family is key just like with other chronic health issues.With fibromyalgia becoming less of a mystery, treatments based on integrative functional medicine are emerging to "lift the veil" of suffering for many with this perplexing syndrome.Scott Rollins, M.D., is board certified with the American Board of Family Practice and the American Board of Anti-Aging and Regenerative Medicine. He specializes in bioidentical hormone replacement, thyroid and adrenal disorders, fibromyalgia and other complex medical conditions. He is founder and medical director of the Integrative Medicine Center of Western Colorado (www.imcwc.com). Call 970-245-6911 for appointments or more information.


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The Post Independent Updated Sep 27, 2012 03:34PM Published Sep 27, 2012 03:32PM Copyright 2012 The Post Independent. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.