Effective Treatment Approaches for Chronic Fatigue, Fibromyalgia and Myofascial

For years, many of us have dreamt of the day when we would see the headline: "Effective Treatment For Chronic Fatigue Syndrome, Fibromyalgia (CFS/FMS) and Myofascial Pain Syndrome (MPS) Developed." We are very excited to report that, using an integrative medicine approach, that day has arrived.

Our study, titled "Effective Treatment of Chronic Fatigue Syndrome and Fibromyalgia--the Results of a Randomized, Double-Blind, Placebo-Controlled Study" (Journal of Chronic Fatigue Syndrome--see the full text at www.vitality101.com), showed that over 90 percent of patients improved with treatment (p <. 0001 vs. placebo). After two years of treatment, the average improvement in quality of life was 90 percent. Many patients no longer even qualified for the diagnosis of CFS or fibromyalgia after treatment. Interestingly, many of the same principles for treating fibromyalgia also apply to myofascial pain syndrome.

A new day is dawning in how CFS/ fibromyalgia/MPS is being treated. In support of our work, an editorial in the Journal of the American Academy of Pain Management (the largest multidisciplinary society of pain specialists in United States) noted that the comprehensive and aggressive metabolic approach to treatment detailed in the Teitelbaum study are all highly successful approaches and make fibromyalgia a true treatment responsive disorder. Our study and years of clinical experience make this approach an excellent and powerfully effective part of the standard of practice for treatment of people who suffer from fibromyalgia and myofascial pain syndrome.

It is important to recognize that these syndromes can be caused and aggravated by a large number of different triggers. When all these different contributing factors are looked for, and treated effectively, patients improve dramatically and often get well.

What is causing these illnesses?
As we noted above, CFS/FMS/MPS is not a single illness. Our study has shown that it is a mix of many different processes that can be triggered by many causes. In our experience, CFS/FMS acts as a circuit breaker, with the hypothalamus decreasing its function to protect the individual in the face of what is perceived to be an overwhelming stress (just like a fuse in a house). This stress can be caused by any of a number of infections or injuries. In these situations, patients can often give the time that their illness began almost to the day. In others, the illness had a more gradual onset. This may have been associated with hormonal deficiencies (e.g., low thyroid, estrogen, testosterone, cortisone, etc.) despite normal blood tests. In others, it may be associated with chronic stress, antibiotic use with secondary yeast overgrowth and/or nutritional deficiencies. Indeed, we have found well over 100 common causes of and factors that contribute to these syndromes.

What these processes have in common is that most of them can suppress a major control center in the brain called the hypothalamus. This center controls sleep, the hormonal system, temperature and blood flow/blood pressure. When patients don't sleep deeply, their immune system also stops working properly and they will be in pain. When we realized this, the myriad symptoms seen in CFS/fibromyalgia suddenly made sense. It also gave us a way to treat patients effectively.

Four main categories of problems need to be treated.
A half-century of work by Dr. Janet Travell, the White House physician for Presidents Kennedy and Johnson and author of The Trigger Point Manual, showed that the same problems caused by hypothalamic suppression resulted in muscles getting stuck in the shortened position. Chronic muscle shortening then causes myofascial and fibromyalgia pain. Since she laid the groundwork For effective treatment of these processes, our research team dedicated our published study to her memory. These are the four key areas that need to be treated for the patient's "circuit breaker to turn back on" and for Fatigue and muscle pain to resolve:

1. Disordered sleep
Most patients with these illnesses find that they are unable to get 7-8 hours of deep sleep a night without taking natural and/or prescription sleep treatments. In part, this occurs because hypothalamic function is critical to deep sleep. Unfortunately, many of the most common sleep medications actually aggravate the sleep problems by decreasing the amount of time spent in deep sleep.

For patients to get well, for their pain to resolve, and for their immune system to recover, it is critical that they take enough of the correct sleep treatments to get 8 to 9 hours sleep at night. Although medications can help, I prefer to start with natural therapies. An excellent one is Revitalizing Sleep Formula by Enzymatic Therapies and includes theanine, Jamaican dogwood, wild lettuce, valerian, passionflower and hops. Taken one hour before bedtime, 1-4 capsules help patients to get eight hours of refreshing sleep.

Other natural sleep aids include taking calcium and magnesium at bedtime, 5-HTP (100-300mg), and melatonin (3/10-1 mg). Our experience with over 2000 patients and two research studies have shown that getting at least six hours of sleep a night is critical to people getting well. When one recognizes that CFS/FMS is a hypothalamic sleep disorder--not poor sleep hygiene--this approach makes sense.

2. Hormonal deficiencies
The hypothalamus is the main control center, via the pituitary, For most of the glands in the body. Most of the normal ranges for our blood tests were not developed in the context of hypothalamic suppression or these syndromes. Because of this (and for a number of other reasons) it is usually necessary to treat with natural thyroid, adrenal (e.g. glandulars such as Adrenal Stress End and DHEA), and ovarian and testicular hormones--despite normal blood tests. These hormones have been found to be reasonably safe when used in low doses.

3. Unusual infections
Many studies have shown immune system dysfunction in FMS/CFS. Although there are many causes of this, research suggests that poor sleep is a major contributor. The immune dysfunction can result in many unusual infections. These include viral infections, parasites and other bowel infections and most importantly, fungal infections.

4. Nutritional supplementation
Because the western diet has been highly processed, nutritional deficiencies are a common problem. In addition, bowel infections can cause poor absorption, and the illness itself can cause increased nutritional needs. A few of the most important nutrients include: a) vitamins--especially the B vitamins (most at 25-100 mg/day), vitamin B12 (500--3000 mcg/day), antioxidants (e.g., vitamin c and E); b) minerals--especially magnesium glycinate, zinc and selenium; c) amino acids and d) energizing and calming nutrients (e.g., malic acid and inositol). The Energy Revitalization System by Enzymatic Therapy replaces over 35 supplement tablets with one drink. Most Americans would find this product to be excellent for maintaining health and energy.

There are many other treatments available as well. Although space does not allow for a Full discussion of these in this article, I discuss them at length in my book From Fatigued to Fantastic! They can also be seen at my Web site (www.endfatigue.com), which contains a treatment protocol with over 270 effective therapies and detailed instructions for use. Treatments are broken down by category (e.g., sleep, yeast treatments, pain, etc.) with natural alternatives offered For all prescriptions.

So how do I make pain go away?
Pain is now very responsive to treatment. Pain is the red, flashing, warning light on your dashboard telling you that something urgently needs attention. Unfortunately, in medical school the full extent of most M.D.'s education about pain management was to give Tylenol or Motrin Family medications and, if the patient had cancer, to consider narcotics.

Our next article will teach you how to figure out what pain is telling you your body needs so you can both reclaim health and vitality and have your pain go away. How to get pain free now is discussed in my new book Pain Free 1-2-3! A Proven Program to Get YOU Pain Free Now.

One last note. It is not enough to get well so you can go back to a life you hate. My book, Three Steps to Happiness! Healing Through Joy, can teach you how to get a life you love in three easy steps.



By Jacob Teitelbaum, M.D.

Dr. Teitelbaum is medical director of the Annapolis Center for Effective CFS/Fibromyalgia Therapies in Annapolis, Maryland (410.573.5389) and author of the best-selling books From Fatigued to Fantastic!, Three Steps to Happiness! Healing Through Joy and Pain Free 1-2-3- A Proven Program to Get YOU Pain Free! Available at bookstores and on the Web at www.vitality101.com or www.endfatigue.com.

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