The US National Institute of Arthritis and Musculoskeletal and Skin Diseases (www.niams.nih.gov) defines fibromyalgia as a syndrome – a collection of signs, symptoms, and medical problems that tend to occur together but are not related to a specific, identifiable cause – that is characterized primarily by widespread pain and diffuse tenderness, as well as a number of other symptoms. A potential source of significant pain and fatigue, fibromyalgia is considered a rheumatic condition that impairs the joints and/or soft tissues.

Fibromyalgia is estimated to affect 5 million Americans age 18 or older, more than 80% of them women (men and children also can be affected). Most people are diagnosed during middle age, although the symptoms often become present earlier in life. Several studies indicate that women who have a family member with fibromyalgia are more likely to have fibromyalgia themselves, but the exact reason for this – whether it be heredity, shared environmental factors, or both – is unknown.

Affecting patients' social, personal, and working lives, fibromyalgia requires a multidisciplinary approach to address its persistent and complex symptomatology. In this column, we review recent studies that suggest natural approaches to help manage the symptoms of fibromyalgia, thereby maintaining quality of life among those affected.

US National Institute of Arthritis and Musculoskeletal and Skin Diseases. Questions and answers about fibromyalgia [Web page].  http://www.niams.nih.gov/Health_Info/Fibromyalgia/default.asp; accessed 25 Aug. 2011.

Tai Chi Alleviates Fibromyalgia           
Tai chi is a mind-body practice that originated as a martial art in China and combines meditation with slow, gentle movements, weight shifting, breathing exercises, and relaxation. Chenchen Wang and colleagues from Tufts Medical Center (Massachusetts, US) enrolled 66 patients with fibromyalgia, average age 50 years, in a 12-week long study in which each subject participated in either tai chi or a wellness education/stretching program (control intervention); each intervention was held as an hour-long session taking place twice a week. While both groups showed improvements in scores on the Fibromyalgia Impact Questionnaire, the tai chi participants had an 18.4-point greater reduction in severe symptoms after 12 weeks, with the difference sustained at 24 weeks. There were also significantly greater improvements in sleep quality, depression, and both physical and mental components of quality of life at 12 and 24 weeks, among the tai chi group. The team concludes: "Tai chi may be a useful treatment for fibromyalgia and merits long-term study in larger study populations."

Wang C, Schmid CH, Rones R, et al. A randomized trial of tai chi for fibromyalgia. N Engl J Med. Aug. 19, 2010;363:743–754.

Minimize Negative Emotions to Lessen Fibromyalgia Pain     
Some previous studies have suggested that negative emotions increase pain associated with fibro­myalgia. Henriet van Middendorp and colleagues from Utrecht University (Netherlands) studied 62 women with fibromyalgia and 59 women without fibromyalgia, examining the effects of anger and sadness on clinical pain assessment, pain threshold, and pain tolerance. The team found that negative emotions prompted an increase in pain, with the increase at similar levels in those women with and without fibromyalgia. Writing, "The experience of both anger and sadness amplifies pain in women with and without fibromyalgia," the researchers conclude: "The occurrence of anger and sadness appears to be a general risk factor for pain amplification."

van Middendorp H, Lumley MA, Jacobs JWG, Bijlsma JWJ, Geenen R. The effects of anger and sadness on clinical pain reports and experimentally-induced pain thresholds in women with and without fibromyalgia. Arthritis Care Res. October 2010;62(10).

Music Therapy Relieves Fibromyalgia Symptoms, Improves Quality of Life
Spanish researchers demonstrate that music therapy, in conjunction with other relaxation techniques, reduces significantly pain, depression, and anxiety, and improves sleep among patients suffering from fibromyalgia.  Maria Dolores Onieva-Zafra and colleagues from the University of Granada studied patients suffering from fibromyalgia from three regions in Spain. The researchers applied a relaxation technique based on guided imagery and music therapy to patients, in a series of sessions conducted by a researcher. Patients were given a CD to listen at home. Then, researchers measured a number of variables associated to the main symptoms of fibromyalgia – as pain intensity, quality of life, impact of the condition on patient's daily life, sleep disorders, anxiety, depression, self-efficiency, well-being. Music therapy, when combined with other relaxation techniques based on guided imagery, significantly reduced pain, depression, and anxiety, and improved sleep among patients suffering from fibromyalgia. As a result, music therapy enhanced the patients' quality of life. The team concludes: "The findings of this pilot study suggest the importance of music therapy as a nursing intervention and justify further investigation into music as a self-management intervention to reduce pain and depression."        

Onieva-Zafra MD, Castro-Sanchez AM, Mataran-Penarrocha GA, Moreno-Lorenzo C. Effect of music as nursing intervention for people diagnosed with fibromyalgia. Pain Manag Nurs. 26 November 2010.

Yoga Improves Arthritis and Fibromyalgia Symptoms
Researchers from United Arab Emirates (UAE) report that yoga helps to ameliorate the disease activity of rheumatoid arthritis and fibromyalgia. Humeira Badsha from the Emirates Arthritis Foundation (United Arab Emirates) enrolled 47 subjects (26 yoga patients and 21 controls), and demonstrated that patients who completed 12 sessions of Raj yoga, a gentle style that combines exercise and breathing techniques, showed significant improvements in disease activity scores. Results of a separate study show the positive effects of yoga on the quality of life in patients with fibromyalgia. Results of one further study investigating the effects of yoga on the quality of life (QoL) of patients with fibromyalgia demonstrated that QoL scores, after an eight-session classical yoga program which combines gentle yoga postures, breathing techniques, and meditation, were better than scores obtained before the program; as well, the anxiety levels of patients decreased significantly.    

Badsha H et al. Abstract Number PARE0004; AB0402-HP. European League Against Rheumatism (EULAR) 2011 Annual Congress; 26 May 2011.

Yoga Boosts Stress-Busting Hormone
Cortisol is a steroid hormone that is produced and released by the adrenal gland and functions as a component of the hypothalamic-pituitary-adrenal (HPA) axis in response to stress. Previous research has found that women with fibromyalgia have lower-than-average cortisol levels, which contributes to pain, fatigue, and stress sensitivity. Kathryn Curtis and colleagues from York University (Canada) enrolled 22 subjects from the community to participate in a 75-minute yoga class twice weekly for 8 weeks. Questionnaires concerning pain, anxiety, depression, and mindfulness were administered pre-, mid-, and postintervention. The team collected salivary cortisol samples three times a day for each of two days, pre- and postintervention. The researchers found that a program of 75 minutes of hatha yoga twice weekly over the course of eight weeks improved the subjects' levels of mindfulness, whereby they were better able to detach from their psychological experience of pain. In concordance, the salivary cortisol samples revealed elevated levels of total cortisol, with the team positing that because hatha yoga promotes physical relaxation by decreasing activity of the sympathetic nervous system, thereby lowering heart rate and increasing breath volume, the technique exerts a positive effect on the HPA axis.

Curtis K, Osadchuk A, Katz J. An eight-week yoga intervention is associated with improvements in pain, psychological functioning and mindfulness, and changes in cortisol levels in women with fibromyalgia. J Pain Research. 4:189–201. Epub July 2011.

As a chronic condition, fibromyalgia can affect people their entire adult lives; however, fibromyalgia is not a progressive disease, is not fatal, and will not cause permanent damage to the joints, muscles, or internal organs. In many people, the condition does improve over time. In that quality of life among fibromyalgia patients is a major concern, natural approaches that may help to manage the symptoms of fibromyalgia merit consideration.

To stay updated on the latest breakthroughs in natural, nutritional, and lifestyle approaches to manage the symptoms of fibromyalgia, visit the World Health Network (www.worldhealth.net), the official educational website of the American Academy of Anti-Aging Medicine (A4M) and your one-stop resource for authorita­tive anti-aging information.  Be sure to sign up for the free Longevity Magazine e-Journal, the A4M's award-winning weekly health newsletter featuring wellness, prevention, and biotech advancements in longevity.