From Fatigued to Fantastic!

by Jacob Teitelbaum

  Another important component of fibromyalgia pain is called central sensitization. This is when the pain signal actually is triggered or amplified by changes in the brain cells themselves. I liken it to babies in a nursery. When one starts crying, they may all start in. Similarly, when pain becomes chronic, brain cells in the area of the ones sensing the pain signal begin to fire as well, amplifying the pain. Even normal touch can then also become painful (this is called allodynia). Research has shown that when the same pain stimulus is given to someone with fibromyalgia and to a healthy person, a much larger area in the pain centers lights up on the brain scan in the person with FMS.

  For most people, the pain is a mix of the above, and many treatments described in this chapter will help several kinds of pain. As you know, I like to use natural therapies first but will prescribe prescription medications when needed. We will therefore discuss the natural therapies first, followed by medications. We will then briefly discuss the many other types of pain that are common in CFS/FMS, such as migraines, arthritis, and disc pain.

  Research shows that in half of those with fibromyalgia, treating with the SHIN protocol eliminates their pain after three to four months. During this time, the herbs used for sleep, such as those found in the Revitalizing Sleep Formula, act as muscle relaxants. Other herbs discussed later in this chapter are also helpful for pain. I also like to begin treatment with a prescription muscle relaxant medication called Skelaxin and a pain medication called Ultram. This way patients can get immediate pain relief while waiting for the SHIN protocol to begin working.

  I do not recommend using Motrin family medications (NSAIDs) in FMS, as they are minimally effective and are estimated to kill more than 16,500 Americans unnecessarily each year by causing bleeding stomach ulcers. Fortunately, there are safe and more effective natural alternatives. Long-term use of acetaminophen, found in Tylenol and many other over-the-counter medications, should be avoided because it depletes your body’s glutathione—an amino-acid compound that is a critical antioxidant for people with CFS/FMS.

  Natural Pain Treatments

  Many natural treatments available to help with pain. Some are taken internally, others applied externally. They can be used in conjunction with conventional medical treatments.

  HOMEOPATHIC REMEDIES

  Rhus toxicodendron (Rhus tox) is a homeopathic treatment that helps a small percentage of fibromyalgia patients with their pain. However, because it is homeopathic, it has almost no side effects and is inexpensive, so it may be a good place to begin. Follow the directions and dosage recommendations on the bottle for about a week to judge whether this remedy will work for you. The tablets are probably the easiest form to use. Be sure to let them dissolve under your tongue—don’t chew them. You can take a tablet every fifteen minutes for the first two hours and then four to six times a day. For inflammatory/injury pain, arnica homeopathic creams can be very helpful. My favorite is called Traumeel.

  HERBAL TREATMENTS

  Pain often disrupts sleep, which is critical for pain relief. As we discussed in Chapter 3, the best herbal/natural remedies for sleep include extracts of wild lettuce (28 to 112 milligrams), Jamaican dogwood (12 to 48 milligrams), Passionflower (90 to 360 milligrams), valerian (200 to 800 milligrams), hops (30 to 120 milligrams), and Suntheanine (50 to 200 milligrams). All six of these are combined in the Revitalizing Sleep Formula. Although the package says you can take one to four capsules an hour before bedtime, you can also take up to three capsules three times a day for muscle pain and/or anxiety. Even though these herbs help sleep, they will also leave you calm but usually not sedated during the day.

  Many other natural therapies can be helpful for pain, including inflammatory and muscle pain. My three favorite pain-relieving herbals are willow bark, boswellia, and cherry. All three of these can be found in combination in a number of products, including the End Pain formula by Enzymatic Therapy and the Pain Formula by ITI (see Appendix E: Resources). Begin with one to three tablets (even though the box says one to two) up to three times a day as needed. Although there may be some immediate relief, its most powerful effects begin at one week and build over six weeks. Continue treatment until maximum benefit is achieved, about four to six weeks, and then taper down to the lowest effective dose. These herbs may also be taken individually at the dosages recommended on Chapter 7.

  WILLOW BARK is the original source of aspirin, but when used as the entire herb it has been found to be much safer and is often more effective. The active ingredient is salicin, and it acts as a COX (cyclooxygenase enzyme) inhibitor, decreasing inflammation. Yet unlike the aspirin and Motrin family medications, willow bark does not cause gastritis and ulcer bleeding. Although no studies have been performed specifically addressing fibromyalgia, the studies on willow bark are quite consistent in their effectiveness in reducing chronic pain, and their findings can be applied to FMS.

  In one study, 210 patients with severe chronic low back pain were randomly assigned to receive an oral willow bark extract with either 120 milligrams (low dose) or 240 milligrams (high dose) of salicin, or a placebo, in a four-week blinded trial. In the last week of treatment, 39 percent in the group receiving the high-dose extract were pain free, 21 percent in the group receiving the low-dose extract were pain free, and only 6 percent in the placebo group were pain free. The response in the high-dose group was evident after only one week of treatment.1 The researchers then studied 451 patients with low back pain, using salicin at 240 milligrams or at 120 milligrams, or standard orthopedic/NSAID (e. g., Motrin) care for four weeks. Forty percent of the patients in the 240-milligram group and 19 percent in the 120-milligram group were pain free after four weeks. In the standard treatment group using NSAIDs, only 18 percent were pain free. The study showed that willow bark was not just far more effective and safer than standard prescription therapies, but also decreased the cost of care by approximately 40 percent.2

  Another review found that willow bark extract has comparable anti-inflammatory activity to higher doses of acetylsalicylic acid/aspirin (ASS), in addition to reducing pain and fever. No adverse effects on the stomach lining (e. g., indigestion, ulcers) were observed, in contrast to aspirin. A daily dose of willow bark extract standardized to 240 milligrams salicin per day was also significantly superior to placebo in patients with osteoarthritis (the normal wear-and-tear type of arthritis) of the hip and the knee. In two open studies against standard active treatments as controls, willow bark extract exhibited advantages compared to NSAIDs, and was about as effective as Vioxx.3 Another placebo-controlled study found that willow bark (salicin 240 milligrams a day) was more effective than placebo in treating osteoarthritis after only two weeks of therapy.4 Other studies also show willow bark to be safe and effective for general pain.5–8

  All of this makes willow bark a wonderful natural pain medicine. It is safe and effective for arthritis, back pain, and likely many other types of pain. I would begin with six tablets of the End Pain daily (to get 240 milligrams of salicin) until maximum benefit is seen. At that point, you may be able to lower the dose to 120 milligrams or less a day and/or take it as needed.

  BOSWELLIA SERRATA, also known as frankincense, has been used in traditional Ayurvedic medicine for centuries. Boswellia has been found to be quite helpful in treating inflammation and pain9–14 and it also does this without causing ulcers, as aspirin family medications often do.15 It has been shown in studies to be helpful for both rheumatoid arthritis16 and osteoarthritis.17

  One study evaluated thirty patients with osteoarthritis of the knee. Patients were given 1,000 milligrams of an extract of Boswellia or a placebo for eight weeks and then the groups were switched for the next eight weeks. All of the patients on the Boswellia showed significantly decreased pain and improved ability to walk. In fact, the improvement was quite remarkable—the pain index fell by 90 percent after eight weeks, with a similarly dramatic increase in function.17 This is discussed at more length in the patient-oriented newsletter Nutrition and Healing
by Jonathan Wright, M. D. (www.wrightnewsletter.com).

  Boswellia has demonstrated significant anti-inflammatory properties, blocking two inflammatory chemicals—a quality that is unique to this herb and that makes it helpful for treating asthma and colitis, as well as pain.18–22 Boswellia does not appear to have any major side effects that resulted in people withdrawing from the studies but did rarely cause minor gastrointestinal disturbances or rash. A common dose is 150 to 350 milligrams three times a day.

  CHERRY FRUIT (Prunus cerasus) contains compounds that inhibit COX-1 (inflammation) 23 and has both antioxidant and anti-inflammatory properties. Although there are not as many human studies on the use of cherries as on the use of Boswellia, many people find that simply eating ten to twenty cherries a day helps relieve their arthritis considerably. Early research, as well as how many people continue to take this supplement (which to me is a significant indicator of effectiveness), suggests that cherry fruit holds a lot of promise.24, 25 Research even suggests that in addition to pain relief, cherry fruit may also inhibit colon and perhaps other cancers.25 About 2,000 milligrams of cherry fruit extract (present in six tablets of the End Pain herbal formula) contains the active components present in ten cherries or one quart of cherry juice.

  I recommend beginning with both the End Pain and the Revitalizing Sleep Formula for six weeks. The dose can then be adjusted as needed. There are other herbs, in addition to the three found in the End Pain formula, that can be helpful for treating the CFS/FMS pain.

  GINGER can have substantial health benefits for people with CFIDS/ FMS. Sometimes, fresh ginger, high in the compound gingerol, and dried ginger, high in shogaol, have different effects. I will note the uses where this distinction is important. The benefits of ginger include the following:

  Relief of muscle and/or joint pain. Like aspirin and ibuprofen, many components of ginger are potent inhibitors of inflammatory substances such as prostaglandins. Ginger is also thought to inhibit substance P, a pain mediator that is known to be elevated in FMS. For substance P inhibition, dried ginger seems to be most effective. In a study of ten patients with muscle pain and forty-six patients with arthritis (both rheumatoid and osteoarthritis), 100 percent of muscle pain patients and 75 percent of arthritis patients noted relief. The recommended dose was 1,000 milligrams of powdered ginger a day. Many patients took 3,000 to 4,000 milligrams a day and noted quicker and better relief using the higher dose.1 Try using the fresh ginger and then a slice of dried ginger to see which works better for you.

  Decreased nausea, vomiting, and diarrhea. Ginger decreases bowel spasm while improving gastric motility (moving food from the stomach to the bowels). These are often major problems in CFS/FMS, resulting in bloating after eating. Ginger can also inhibit diarrhea. In addition, in several studies, fresh (for example, roasted) but not dried ginger was found to inhibit stomach ulcers caused by aspirin and ibuprofen. It is a strong antioxidant, and can inhibit certain bowel infections (salmonella and vibrio). Taking 500 to 1,000 milligrams of ginger is effective to calm general stomach upset.

  Increased thermogenesis (warming of the body). Fresh ginger works much better for this.

  Relief of migraine headaches.

  Disequilibrium (for example, motion sickness). Although likely not as effective for vestibular (inner ear) dizziness, in which you feel like you are spinning in a circle, ginger inhibits the nausea associated with dizziness. For motion sickness, it works best when you take 1,000 milligrams four hours before travel.

  Increased blood pressure. This can be helpful for people with CFS/FMS, who often have low blood pressure. Only dried ginger works for this purpose.

  Decreased risk of heart disease. Ginger is a platelet inhibitor (like aspirin and vitamin E) and may also lower cholesterol.

  Ginger tea preparations are among the most popular ways to take ginger. To make the tea, boil 10 grams of chopped fresh ginger (about a quarter-inch slice) and add stevia to sweeten it, as desired. Some people find the ginger brews better if they allow the chopped ginger to dry out slightly before using it (just keep a bag of ginger slices in your refrigerator). Once you finish drinking the tea, eat the ginger that remains. You can also purchase packets of ginger tea crystals. I wouldn’t worry very much about the small amount of sugar in these products relative to the amount of ginger—as long as ginger is the first ingredient listed on the package. These products supply about 5,000 milligrams of ginger per cup of tea.

  Minced ginger is also available in a liquid base for cooking (similar to jarred minced garlic). Or, if you like the sharp taste of ginger, candied ginger cubes might be a good choice. If you use fresh ginger in cooking or to make tea, do not peel it until just before use or some of the volatile (active) oils will evaporate.

  You can also take 1,000 milligrams of dried ginger extract one to four times a day or 500 to 1,000 milligrams of dry powder three to four times a day—with the dose decreased to the lowest effective dose in four to six weeks. These initial, higher doses can be more effective for pain; side effects of ginger are minimal, but include nausea and heartburn.

  DIETARY SUPPLEMENTS

  Ribose and magnesium kick-start energy production. In our CFS/FMS study, significant pain relief was experienced in those taking ribose. Magnesium is also critical for muscle relaxation, which in turn aids pain relief.

  The supplement 5-Hydroxy-L-Tryptophan (5-HTP), a form of the amino acid tryptophan, raises serotonin levels, and can be very helpful for pain. In two studies in which fibromyalgia patients were given 100 milligrams of 5-HTP three times a day, their symptoms markedly improved, so it is well worth trying. It can also help you lose weight. Give it six to ten weeks to work.

  Glucosamine is a cartilage compound that has been shown in several controlled studies to be helpful for osteoarthritis. Although the exact way it works is not certain, it appears to stimulate cartilage production by bone cells. It tends to be more helpful for arthritis pain than for fibromyalgia pain, but it is worth trying. Take 750 milligrams two times a day for six weeks—it takes that long to find out if it is going to help. When the maximum benefit is seen, reduce the dose to the lowest dose that maintains the benefit.

  To give just one of many examples of glucosamine’s effectiveness, in a head-on study of two hundred osteoarthritis patients using 1,500 milligrams a day of either glucosamine sulfate or 1,200 milligrams a day of ibuprofen (Motrin), the Motrin worked better for the first two weeks. After that, the glucosamine was as effective as the Motrin. The glucosamine group also had significantly fewer and milder side effects than the Motrin group.

  Another important point is that Motrin and other nonsteroidal anti-inflammatory drugs do not slow down the progression of arthritis, and may actually make the arthritis worse. Glucosamine may actually help heal the arthritic joint, and benefit often persists after the glucosamine is stopped. I would use glucosamine sulfate (not chloride), as the sulfate may also be helpful in both joint repair and improving the body’s mitochondrial function.

  Methylsulfonylmethane (MSM) is a form of sulfur that has been reported to be helpful for some people with fibromyalgia. It can take as much as 12 to 15 grams a day (12,000 to 15,000 milligrams, or twenty-four to thirty capsules) to see the benefit. I usually use 6 grams a day in the beginning, as it is best to always use the lowest dose possible of any supplement. If MSM helps within three to six weeks, then you can reduce the dose to the lowest dose that maintains the benefit. Taking it with vitamin C probably helps the absorption of the MSM.

  Essential fatty acids (EFAs), which are the building blocks of fats and oils, have an anti-inflammatory effect and can be beneficial for pain. Symptoms of EFA deficiency are many and varied, and include fatigue, poor memory, recurrent respiratory infections, gas, bloating, arthralgias (aches and pains), constipation, cracking nails, depression, dry hair and skin, and inadequate saliva, tears, and vaginal lubrication. If you have dry eyes, dry mouth, dry hair, and/or dry skin, these symptoms may suggest an essential-fatty-acid deficiency, a
nd taking these in the form of mercury-free fish oils can be very helpful for pain and inflammation. Because of their importance, I am going to discuss them in more detail.

  Essential fatty acids play an important and yet poorly recognized role in human health. They are involved in many functions, including hormone production, immune function, the regulation of inflammation and blood flow, and the amount and wateriness of saliva, tears, and other bodily fluids. EFAs also are part of the makeup of the membranes surrounding every cell in the body.

  Most Americans get only about 10 percent of the amount of EFAs they need for optimal well-being. This is despite the fact that the average person’s fat intake has increased by about fifty pounds a year in the last century. Unfortunately, food-processing techniques have essentially removed the EFAs from our food supply because oils are produced at high temperatures, and previously healthy vegetable oils are hydrogenated, or saturated, to harden and stabilize them. These processing steps both eliminate the EFAs and make it difficult for your body to use the EFAs it does get.

  Fats and oils are not the same thing. Fats usually refer to saturated fats, which are solid at room temperature. Saturated means that the hooks (bonds) that connect each of the atoms in the fat molecules are all in use, and there is no room for any new atoms to attach. This makes the fat molecules straight and rigid, and thus hard. Oils usually refer to unsaturated fats, which are liquid at room temperature. These unsaturated fats are either monounsaturated or polyunsaturated. Monounsaturated fats have one open hook, and polyunsaturated fats have several open hooks where molecules can attach. This makes them more flexible (fluid). This is where things begin to get technical: If the first open hook (double bond) is six carbon atoms from the end of the fat molecule, it is called an omega-6 fatty acid. Most vegetable oils are omega-6 oils. If the first open hook is three carbon atoms from the end, the molecule is an omega-3 fatty acid. Fish oils and flaxseed oil are omega-3 oils.