Dr. Seth Torregiani

Disclaimer: The following protocol, or any protocols or other medical information published on this site, is intended for informational and/or educational purposes only and is NOT intended for self-diagnosis or self-treatment. None of the information published on dr-seth.com is meant to replace the evaluation or opinion of a qualified physician. Patients who feel they may have symptoms resembling the conditions discussed on dr-seth.com or believe they may be suffering from any of these conditions are advised to seek the opinion of a licensed physician or other qualified practitioner.

Fast Facts

• Fibromyalgia (FM) primarily affects women.  Over 90 per cent of those who suffer from FM are women between 25 and 65 years of age.
• Fibromyalgia affects two to four per cent of the population of the United States. 
• There is a close association between insomnia, poor sleep hygiene and fibromyalgia.  Improving sleep often improves fibromyalgia symptomatology.
• The American College of Rheumatology (ACR), has developed a set of objective criteria for the diagnosis of fibromyalgia, based on the presence of a certain number of “tender points,” areas that are painful to the touch, throughout the body (see diagram). 
• Fibromyalgia and chronic fatigue syndrome are linked, and may represent different points on the same disease continuum.

Causes, Contributing Factors

• A single, specific cause of this condition has not been identified.
• Factors contributing to the development of fibromyalgia appear to be high levels of stress (divorce, job-related stress, family stress, financial hardship, etc.), and/or a history of physical and/or emotional trauma (such as a motor vehicle accident, emotional, physical or sexual abuse)
• People with fibromyalgia have higher levels of Substance P, a neurotransmitter involved in the transmission of pain throughout the body, in their cerebrospinal fluid.
• They also have lower levels of serotonin in their nervous system, which has been linked to depression.

Symptoms

• Overwhelming fatigue
• Diffuse muscle soreness
• Disabling pain
• Muscle tenderness and the presence of tender points at certain areas around the body
• Poor sleep hygiene, insomnia
• Irritable bowel syndrome
• Cognitive dysfunction (also known as “fibro fog”)
• Incontinence, urinary retention
• Anxiety
• Depression

Conventional Treatment

• Tri-cyclic antidepressants
• Non-steroidal anti-inflammatory medications
• Continuous positive airway pressure (CPAP) for patients with obstructive sleep apnea
• Opioid painkillers
• Exercise
• Psychotherapy

Integrative Therapies

Mind-Body

• Yoga, done properly, gently stretches and lengthens the muscles (without overtaxing), and unifies the body and mind.
• T’ai Chi, Qi Gong also bring together mind and body while gently exercising muscles and lubricating joints.  These techniques should be practiced daily or nearly everyday.
• Meditation enhances mood, decreases depression, improves sleep, and may decrease pain and/or change your relationship to pain.
• Pranayama, an Indian technique for deep breathing, also unifies mind and body, may diminish pain, improve sleep, and open the airways and sinuses.

Bodywork

• Craniosacral treatment may release muscle tension and inflammation, accelerate healing, improve sleep and foster well-being.
• Light Massage offers relaxation and may reduce pain.
• Myofascial Release can also improve muscle pain and relax the body.

Diet

• Eat an anti-inflammatory diet (see chapter on diet)
• Maintain a food journal and note associations between certain foods and intensity/frequency of symptoms
• Consider elimination diet if any associations between foods and symptoms are discovered

Nutritional/Functional Medicine

• Gut rejuvenation protocol
• Probiotic supplemention – Take at least 1 billion CFUs (colony-forming units) per capsule of mixed species to enhance gut function up to three times daily.  Best taken with or shortly after meals.

Spiritual

• Development of a spiritual practice may ease feelings of isolation, elevate mood and foster healing.

Vitamins/Supplements

• Magnesium 400-800 mg daily as tolerated (decrease dose if you develop loose stools), a mineral essential to proper muscle function.
• Malic Acid (Malate) 1000mg daily, increasing to 2000mg daily over 1 to 2 weeks, works to energize the muscles and reduce muscle soreness and fatigue.
• Note: Magnesium and Malate are often available as a single combination pill.
• Bromelain 1-2 capsules daily for its anti-inflammatory properties.
• Co-enzyme Q10 100 mg -120 mg daily for its anti-inflammatory and anti-oxidant properties.
• Fish oil capsules or cod liver oil.  2-3 capsules daily (equivalent to 2-3g of EFAs daily or 1-2 tablespoons of cod liver oil.  Make sure that fish oil is certified to be free of mercury, PCBs and other contaminants by the manufacturer.
• d-Ribose Three to five grams of powdered ribose supplement.
• Multivitamin – to enhance immunity, enzyme function, and allow for micro nutrition deficits. 
• Potassium – Best ingested from food sources such as bananas, potatoes, tomatoes.
• Vitamin B12 1000mcg daily for one week, then 1000mcg weekly sublingual (under the tongue).
• Vitamin D3 800-1000 IUs daily.
• B-Complex vitamin 50 mg daily.

Traditional Medical Systems

• Acupuncture – May reduce muscle pain, increase energy levels and decrease depression.
• Ayurveda – Can balance the body nutritionally, eliminate toxins and provide nutritional basis for healing.

Content Copyright ©2006-2008 Seth D. Torregiani, D.O.,P.A.
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