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Fibromyalgia and EPA
Many studies have indicated that exercise is the most effective component in managing fibromyalgia, and patients must expect to undergo a long-term exercise program. Physical activity prevents muscle atrophy, increases a sense of well being, and, over time, and reduces fatigue and pain itself.
Graded Exercise. The basic approach used for fibromyalgia is called graded exercise, which typically uses strength training and regular low-impact aerobic exercise. Both are very important for raising the pain threshold, although it may take months to perceive benefits.
For example, in a well-conducted 2002 study, 35% of patients who engaged in graded aerobic exercise reported much feeling better or very much better after three months. Only 18% of patients who performed relaxation and flexibility exercises reported the same results. At the end of a year, 55% of the exercise group was no longer diagnosed with fibromyalgia compared to only 34% of the relaxation group.
In general, graded exercise involves the following:
Some patients are so disabled that they experience no benefits
over time and some feel even worse even after many attempts and different programs.
Such patients should not be discouraged.
Establish Regular Sleep Routines
Sleep is essential, particularly since pain is aggravated by disturbed sleep. Improvement is low in those who are unable to sleep consistently and at night. Swing shift work, for example, is extremely hard on fibromyalgia patients.
Fibromyalgia patients should maintain a healthy diet low in animal fat and high in fibre, with plenty of whole grains, fresh fruits and vegetables. Although everyone should be careful about calories in fats, some are healthy.
Omega-3 Fatty Acids. Oils containing omega-3 fatty acids are of particular interest for arthritic pain. Such oils are found in cold water fish and can be purchased as supplements called EPA or omega 3.
Omega-3 fatty acids are a form of polyunsaturated fat that the body derives from food. Omega-3s (and omega-6s) are known as essential fatty acids (EFAs) because they are important for good health. The body cannot make these fatty acids on its own so omega-3s must be obtained from food. These different types of acids can be obtained in foods such as cold-water fish including tuna, salmon, and mackerel. Other important omega 3 fatty acids are found in dark green leafy vegetables, flaxseed oils, and certain vegetable oils. Omega-3 fatty acids have been found to be beneficial for the heart. Positive effects include anti-inflammatory and anti-blood clotting actions, lowering cholesterol and triglyceride levels, and reducing blood pressure. These fatty acids may also reduce the risks and symptoms for other disorders including diabetes, stroke, rheumatoid arthritis, asthma, inflammatory bowel disease, ulcerative colitis, some cancers, and mental decline.
Vegetarian Diet. Some studies then have suggested that a vegetarian diet may be helpful. For example, in two small studies a vegan diet was associated with improved symptoms including pain, stiffness, and quality of sleep. In addition, the diet was associated with lower weight and cholesterol levels. (A vegan diet has no meat, dairy, or eggs and includes uncooked fruits, vegetables, nuts, and germinated seeds.) A 2000 study found no significant decline in symptoms except some improvement in pain, but not as much as with a tricyclic antidepressant.
Elimination of Allergens. A very small 2001 study eliminated common food allergens (corn, wheat, dairy, citrus, soy, and nuts) from the diets of 17 fibromyalgia patients. After two weeks, half the patients reported significant improvements in pain and other distressing symptoms. The gradual reintroduction of these foods, one by one, coincided with the recurrence of pain, headache, and gastrointestinal distress. The most commonly offending foods were corn, wheat, dairy, citrus, and sugar. While this study does not prove any causal association, patients might try this elimination diet approach to see if it helps.
Elimination of Additives. One case report found that four patients experienced complete or near resolution of symptoms after several months by eliminating monosodium glutamate (MSG) and the artificial sweetener aspartame from the diet. These substances are sometimes called excitotoxins because they stimulate neurotransmitters and, in excess, may damage nerve cells. Better research is needed to confirm these findings, although there is no harm in eliminating the additives if patients include them in their diets.
Stress Reduction Techniques
Relaxation and stress-reduction techniques are proving to be helpful in managing chronic pain. There is certainly evidence that people with fibromyalgia have a more stressful response to daily conflicts and encounters than those without the disorder. A number of relaxation and stress-reduction techniques have proven to be helpful in managing chronic pain:
Biofeedback. Evidence suggests that biofeedback techniques may be helpful for fibromyalgia patients. During biofeedback, electric leads are taped to a subjects head. The person is encouraged to relax using any method that works. Brain waves are measured and an auditory signal is emitted when alpha waves are detected, a frequency that coincides with a state of deep relaxation. By repeating the process, subjects associate the sound with the relaxed state and learn to achieve relaxation on their own.
Meditation. Meditation, used for many years in eastern cultures, is now widely accepted in this country as an effective relaxation technique. A number of studies are reporting its benefits for fibromyalgia patients who practice on a sustained and regular basis. The practiced mediator can achieve the following physical benefits:
An important goal for both religious and therapeutic meditative practices is to quiet the mind, essentially to relax thought. This redirection of brain activity from thoughts and worries to the senses disrupts the stress response and prompts relaxation and renewed energy. A number of meditation techniques are available; some may be more or less useful for fibromyalgia.
New practitioners should understand that it can be difficult to quiet the mind and should not be discouraged by lack of immediate results. Some recommend meditating for no longer than 20 minutes in the morning after awakening and then again in early evening before dinner. Even once a day is helpful. (One should probably not meditate before going to bed, which causes some people to wake up in the middle of the night, alert and unable to return to sleep.)
Hypnosis. In one controlled study, hypnosis was more effective than physical
therapy in improving function and reducing pain.
Because of the difficulties in treating fibromyalgia, many patients seek alternative therapies. Everyone should be wary of those who promise a cure or urge the purchase of expensive but useless and potentially dangerous treatments. Major analyses have indicated that mind-body therapies, such as biofeedback or hypnosis, are more effective than no treatment at all but less effective than moderate to intense exercise. In one analysis, evidence was weakest on the advantages of so-called manipulative (hands-on) approaches such as massage and chiropractic treatments.
Acupuncture. The ancient Chinese practice of acupuncture may be effective
for some patients. One 2001 study compared a group of fibromyalgia patients
who received real acupuncture, in which needles were inserted into specific
points on the body that practitioners believe promote the flow of healing energy
or chi, to a group receiving sham acupuncture, with needles inserted at random
locations. Those who received real acupuncture reported significant improvements
in pain, depression, and mental health after a month, while those who received
the sham acupuncture did not.
Herbal or Natural Remedies. Some alternative agents are being investigated for fibromyalgia:
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