Osteoarthritis and Fibromyalgia

By Tamara Mitchell

In this article, we discuss a couple of disorders that are not Repetitive Strain Injuries (RSI), but
they share some common symptoms, are compounded by RSI, and may be mistaken for RSI, at
least at the beginning. We should also point out that if you have unexplained musculoskeletal
pain including diffuse bone, joint, or muscle pain, there can be many sources of the pain. A
diagnosis from a medical professional is helpful in ruling out potential serious reasons for the
pain which can have similar symptoms such as Lyme disease, rheumatic fever, hepatitis, Paget’s
disease, sickle cell anemia, or bone cancer. 1,2 If you believe you are suffering from either
osteoarthritis or fibromyalgia, you will have no trouble finding an abundance of helpful
information online or through other sources. We offer some suggestions to help you better
understand and deal with these conditions as a starting point in your learning process.

Frequently overlooked diagnoses. Dietary, climactic, and emotional conditions can manifest as
diffuse joint, bone or musculoskeletal pain due in large part to inflammation, yet the medical
community rarely considers these factors in the diagnosis of health problems. For instance, if you
use the symptom checker for joint pain on MedicineNet.com, the only potential causes identified
are purely physical and the solutions are all in form of over-the-counter pain relief or
pharmaceuticals.3 Gluten intolerance, and other dietary intolerances can lead to inflammation and
a variety of physical manifestations.4, 5, 6

Osteoarthritis (OA)
OA is not a repetitive strain injury, but it definitely compounds the problems of RSI and shares
many of the same symptoms. OA was once considered the result of "wear and tear" to the joints,
however research now shows that heredity is also a factor. 7, 8 OA develops when your body
progressively loses cartilage at the ends of bones in a joint or in the spine. Cartilage is spongy
and filled with synovial fluid which lubricates the joints as they move. With OA, the water
content of cartilage increases, the protein of the cartilage degenerates, and the cartilage starts to
wear away, eventually causing bone to scrape against bone, triggering inflammation in the tissues
surrounding the joints.7,8 Inflammation of the cartilage can stimulate new bone outgrowths or
spurs called osteophytes. 8 Ligaments and tendons supporting the joints become loose and the
surrounding muscles grow weak, cracking, crunching, and creaking of the joint can occur. 7,9
Using the joint causes aches, pain and stiffness that wasn't there in younger days. 7

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 Illustration courtesy of MedicineNet.com 8

Primary osteoarthritis is due to aging and hereditary factors. Secondary osteoarthritis is brought
on by other factors including obesity, repeated trauma, surgery on the joint, abnormal joints at
birth, gout, diabetes, or growth hormone disorders. 8 Obesity is the second most powerful risk
factor for osteoarthritis of the knees after aging. 8 Every extra pound you carry can have the
impact of three pounds of pressure on your knees and hips as you move. 7 Over 50% of all the
cases of OA of the knee and 25% of the cases of OA of the hip are linked to excess weight. 7

Gout and pseudogout are buildup of crystals in the joints that cause inflammation. In a few cases,
both types of crystals can occur in the joints. 11 In the case of gout, the crystals are monosodium
urate which form in some people who have too high a level of uric acid in the blood. 10 In the case
of pseudogout, the crystals are calcium pyrophosphate. 11

Damage to the joints can begin at the age of 20 if someone participates in high impact sports like
football, soccer, tennis, basketball, and high-impact aerobics. Interestingly, long-distance
running has not consistently been shown to increase the risk of osteoarthritis. 8,12,13 Since running
is not an impact sport, injury to the knees less unlikely, however there appears to be other factors
such as being overweight, body structural differences, and hereditary predisposition to cartilage
deterioration, that make the effects of running unclear. In fact, it appears that in some cases
running increases the thickness and health of cartilage. 12 Most of this research was conducted on
rats or mice, so the effects on humans may or may not be similar, but in any event, if joint pain
and inflammation follow periods of running, damage may be occurring and another form of
exercise may be wiser to reduce the risk of developing OA.

Clearly, if you’re overweight, have played contact sports, and you’re getting older, the likelihood
of developing OA are going to be high. The most common symptom of osteoarthritis is pain in
the joint after repetitive use or after periods of inactivity, such as sitting in a theatre. Joint pain is
usually worse later in the day. 8

OA can affect the hands, feet, hips, knees, neck and spine. 7,8 OA of the feet and hands may have
genetic origin, with numerous female members of one family developing it. 8

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 Heberden’s nodes are hard bony enlargements in the fingers which may form with OA.
They are not necessarily painful, but do limit movement of the fingers. 1
Photo courtesy of Reference 1.

OA is not related to rheumatoid arthritis or other types of arthritis. Rheumatoid arthritis is a

systemic autoimmune disease where the body’s immune system attacks it’s own tissues leading to
inflammation of the joints and around other organs. 14 Blood tests can show if rheumatoid arthritis
is likely, however no tests are available for osteoarthritis. Diagnosis of osteoarthritis is made by
determining if symptoms are present: cracking and popping, inflammation of joints, reduced
range of motion, pain and tenderness when joints are moved or pressed on. 15 X-rays of the
affected joints will show reduced space within joints, wear at ends of the bones and/or bone
spurs.15

Treatment
Evidence of osteoarthritis in humans dates back to 4500 B.C. and has been referred to as the most
common ailment of prehistoric people. 16 This ailment has been around for a very long time, so
attempted treatments abound from copper bracelets to prescription steroid shots. Basic treatment
that aims at improving biomechnics, injury prevention, weight control, strengthening and low-
impact exercises should always be the first line of defense. 17,18 Learning more about how to care
for the joints, participating in physical therapy, and wearing supportive devices can be helpful. 19
Treatment consists of attempting to aid the ailing joints through strengthening, support, reduction
of inflammation, and prevention of further damage to the cartilage, and secondarily to reduce
pain.

Exercise – Physical therapy, regular non-impact exercise, stretching, strength training, range of
motion, aerobic or endurance exercise, and movement like tai chi are all extremely important in
treatment of OA.7,18,19 Being physically active encourages the production and flow of lubricating
joint fluids, builds muscle strength, helps weight control, improves flexibility and joint
movement, and eases pain in joints. 7

Bicycling is great for strengthening the quadriceps above the knee and can help reduce symptoms
significantly in arthritis of the knee. 17 Swimming and water aerobics are great non-impact
activities which can improve strength without further damaging the joints. 17 Although not much
research has been done to verify, yoga is reported to be very helpful in reducing hand pain and
increasing range of motion.17

Diet – Nutrition is often regarded with skepticism by the medical community in dealing with
osteoarthritis, however, in reality since this condition is largely a result of long-term
deterioration, dietary factors over the years may actually play a significant role in the prevention
or the advancement cartilage and joint deterioration. Rather than resorting to drugs, especially
nonsteroidal anti-inflammatories (NSAIDS) with serious adverse side-effects in long-term use,

3
nutrition, functional foods, and neutraceuticals could provide a significant alternative because
they are devoid of adverse effects.20 Maintaining a healthy weight is critical. Drinking 64 oz of
water daily keeps the body's tissues hydrated and lubricated. Consumption of Omega-3 fish oil
will, over time, reduce inflammation. 7,21,22

Gluten sensitivity can result in very similar symptoms to arthritis including aching of bones,
joints, and muscles. With or without a diagnosis of OA, it is quite simple to follow a gluten-free
diet plan as part of the process to determine if there is relief from symptoms and pain. If not,
there is no need to continue with such a diet, but in many people, it has been quite helpful. 4, 5

Current research in England is looking at the benefits of eating broccoli and garlic on
osteoarthritis.23 A compound in broccoli, sulforaphane, has been found to block the enzymes that
cause joint destruction in osteoarthritis. 23 Eating broccoli leads to a high level of suforaphane in
the blood, but it’s not yet know if it gets into the joints in amounts large enough to be effective.
The three-year study starting in 2010 will also look at other effects of diet on osteoarthritis,
including diallyl disulfide found in garlic, which also appears to slow cartilage destruction in
laboratory tests.23 In general, the study found that a diets high in non-citrus fruits and alliums
(garlic, onions, leeks) showed the strongest protective effects on hip OA. 24
Acupuncture – Some people find pain relief in acupuncture. 17 Research findings are mixed as to
whether acupuncture helps, but in many cases, it does improve function and reduces pain. 17

It appears that acupuncture and fake acupuncture are equally effective in treating OA, and both
were more effective than no treatment at all. 24 ConsumerLab.com attributes virtually all of the
benefits of acupuncture to “placebo effect”. The placebo effect has been previously disregarded
as a fluke or purely imagination on the part of the patient. However if there is significant
improvement in symptoms, clearly something measurable is happening. No scientific study
should simply pass off a statistically significant finding as placebo effect. The symptoms are not
imaginary, nor is the improvement. Whether this is a state of relaxation, a different mental
attitude about the symptoms, or something else, is unknown. But if acupuncture (or fake
acupuncture) produces the desired reduction in symptoms, this treatment should certainly be
considered a reasonable and safer alternative treatment than some of the traditional medical
treatments.

Drugs - Acetaminophen, or Tylenol, may help relieve pain, but it does not relieve inflammation.
Nonsteroidal anti-inflammatories (NSAIDs) can be effective for short-term relief of inflammation
and pain, but may cause moderate to severe irritation of the stomach and intestines (GI), even
ulcers and bleeding. These over-the-counter or prescription-strength drugs include ibuprofen,
aspirin, and naproxen.7

Supplements and creams

Glucosamine and Chondroitin. 42 clinical studies have concluded that these treatments are
beneficial.17 Some very well-controlled studies have been conducted, but the findings are still
inconclusive, with these supplements sometimes indicating significant improvement in OA
patients and other times, not. 25 Glucosamine is thought to promote formation and repair of
cartilage, while Chondroitin is believed to increase water retention and elasticity in cartilage and
to inhibit enzymes that break down cartilage. 26 Looking at the sum of the evidence, it appears
that taking at least 1,500 mg of glucosamine for at least 3 years may help slow down the
degenerative process, increase the generation of new cartilage, prevent collagen from breaking
down, and protect the joints from damage. 17,25 Results for chondriotin are not as conclusive, but
both glucosamine and chondriotin are extremely safe to take and it appears to at least help those
with moderate to severe knee pain. 17

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SAMe (S-adenosylmethionine). A substantial body of research indicates that SAMe can relieve
symptoms of OA, is about as effective as standard anti-inflammatory drugs at reducing
inflammation, and may protect the cartilage from damage. 27 SAMe appears to be quite safe, only
occasionally causing mild digestive distress, though not causing damage to the stomach. 27 SAMe
is expensive at the recommended dosage of 200 mg to 400 mg, 2 to 4 times daily. 27 The higher
dosage and frequency is indicated for severe symptoms, though a lower dosage may be required
to start if mild stomach distress is experienced. The lower dosage may be sufficient for
maintenance after symptoms are relieved and will make the supplement more affordable. A
lower dosage will likely not be sufficient to relieve severe symptoms, however. 27

Avocado/Soybean Unsaponifiables (ASUs). Several controlled studies have shown great

promise of ASUs in relieving symptoms of OA, particularly knee OA. There was no significant
difference between dosages of 300 mg or 600 mg daily, so the lower dosage would be
recommended.25 No evidence to date has shown that ASUs actually slow the progression of
OA.25

Cetylated Fatty Acids. These naturally occurring fatty acids can be used as either a topical
cream or as a supplement. Solid controlled studies have shown that either of these appear to
significantly reduce swelling and pain while increasing mobility. Results are preliminary, but so
far these look promising.25 A typical oral dose of Cetylated Fatty Acids is 1,000 to 2,000 mg
daily. Creams are applied 2-4 times daily. 28

MSM (methylsulfonylmethane ). Research on MSM is lacking, though the claim is that MSM is
supposed to help relieve the pain associated with OA. Chemically, it is related to DMSO
(dimethyl sulfoxide), a chemical solvent, which is no longer approved as a supplement because of
a large range of adverse reactions. 26 How MSM is used by the body is not well understood,
though it contributes to the sulfur in the body which can be used to synthesize certain amino acids
(protein building blocks), and it can act as an antioxidant. 26 Evidence does not strongly support
use of MSM as a supplement.

Ginger, turmeric, and galanga. Natural COX-2 inhibitors are found in ginger and turmeric.
These natural alternatives do not have the associated side effects of synthetic COX-2 inhibitors,
but do reduce inflammation, reduce pain, and increase mobility. 29 Turmeric is not absorbed easily
from the digestive tract when taken orally, but a turmeric formulation called Meriva has proven to
be very effective in treating osteoarthritis and reducing the need for other medications. 29,30 After
8 months of taking Meriva, patients showed significant improvement in treadmill walking
measures as well as biochemical improvement in inflammation markers in the blood. 29 Meriva is
available as a non-prescription supplement. Consuming turmeric with black pepper facilitates it’s
absorption (and other vitamins as well) during digestion by inhibiting some of the digestive
enzymes in the intestines and is a potential method of ingesting natural turmeric through dietary
means.31

Ginger and galangal taken in a standardized, concentrated extract proved to significantly reduce
knee pain in a large study of 261 patients as compared with a control group. 32 Aside from
occasionally reported mild digestive distress, ginger, especially in combination with galangal, is
potentially effective as a dietary supplement in relieving OA pain. 32

Capsaicin. The component of hot peppers is capsaicin and research shows that it does modestly
reduce pain sensation if used as a topical cream. 33 Although it causes a burning sensation, it
doesn’t actually damage any body tissues. The sensation created by causing the release of a

5
chemical in the body called Substance P, normally released when tissues are damaged. 33 When
capsaicin is applied regularly in one area, supplies of Substance P are depleted in that area,
resulting in a reduced sensation of pain.33 The effects are modest.

Pycnogenol. Research of one study has shown that pycnogenol, an extract from the bark of the
French maritime pine tree, was very successful in significantly improving performance of people
walking on a treadmill (p<0.05), decreased the use of other drugs (p<0.05), decreased
gastrointestinal complications, reduced treatment costs, and significantly reduced foot edema
(p<0.05).34,35 The control group, matched for age, sex distribution, mobility scores while walking
on a treadmill, walking distance, and use of anti-inflammatory drugs, received a placebo. 34 More
research is needed to replicate these findings and gain status as a potential treatment, but the
findings are quite promising.

Copper bracelets, magnets, etc. – No scientific evidence shows that these types of remedies are
effective at all.17

Supports
Wearing lightweight elastic wraps or supports can be quite helpful and has been shown to reduce
knee pain in one study by 40% after wearing the wrap for 3 weeks. 19 Wearing shock absorbing
insoles, shoes, or orthopedic shoes can help in daily activities and during exercise. 19

Lifestyle modification/assistive devices

Changing the way you do things, learning to rest or reduce stress on painful joints, and using
assistive devices can make everyday tasks easier to perform. 18 An online search for “arthritis
aids” will turn up many websites that offer devices that make all sorts of tasks easier to perform
with various types of arthritis issues.

Weather and Climate

Interestingly, moving to a warm climate does not appear to help. 36 Most research has found only
a minor connection between weather and OA pain. 36,37 Low barometric pressure may actually
result in a bit of expansion of inflamed tissues, so this may be responsible for the effects
observed. An additional factor may be that when temperatures drop, blood flows toward your
core and away from your extremities and reduced blood flow in the muscles will make the joints
stiffer and more painful.36,38 Cold wet, rainy weather can affect mood and decrease the threshold
for pain perception.38 And bad weather tends to keep people indoors and more sedentary, so that
preventive exercise is reduced, and stiffness and pain results. 36,38

Fibromyalgia Syndrome (FMS)

Fibromyalgia is a chronic disorder characterized by widespread pain, fatigue, anxiety, and
depression.39,40,41 The best description we found states that it feels somewhat like having a bad
flu, where every muscle in your body hurts and you feel like all of your energy has been sucked
out of you. 42 About 5 million Americans over the age of 18 are affected by FMS. 80-90% of
these people are women, but it can occur in children, the elderly, and men. 39,40,41 Men tend to
develop FMS in only one area, such as the shoulder, while women typically experience more
widespread pain.40,41 Experts in the field of FMS and chronic fatigue syndrome (CFS) believe
that these two syndromes may be the same thing, but not enough is yet known to understand
either one of these disorders. 42 In fact, 33-50% of fibromyalgia patients also suffer from multiple
chemical sensitivity, so there is significant overlap with that disorder also. 41,42 Routine blood tests
and x-rays reveal no abnormalities with either FMS or CFS. 42 FMS is not related to arthritis
despite the fact that it is often considered and arthritis-type condition. 39 FMS does not cause

6
inflammation or damage to joints, muscles or other body tissues, but like arthritis, it does cause
significant pain and can interfere with daily activities. 39

Diagnosis of FMS involves testing of 18

specific tender points in the neck, spine,
shoulders, and hips. The test for FMS was
defined by the American College of
Rheumatology (ACR) in 1990.39,42,44 All of the
tender points are where muscles attach to
ligaments or bones and they tend to exhibit
pain with just the pressure of a thumb. Pain
must be in both sides of the body and pain must
exist in four specific quadrants of the body,
both above and below the waist for at least 3
months.39 According to the ACR test, pain
must exist in 11 of the 18 tender point
sites.39,42,44 Authorities feel that many people
have pain in less than the 11 required tender
points, but they have widespread pain and
many of the other common symptoms 1990 American College of Rheumatology criteria
associated with FMS.42 In fact, in May, 2010, for Fibromyalgia:
the ACR introduced a totally new preliminary 18 tender points for testing.
criteria for diagnosing Illustration from Reference 44
fibromyalgia based on pain in 19 different body regions experienced within the past week. 42 The
resulting score is called the Widespread Pain Index (WPI). 8 Some people feel that this new test
will dilute the criteria and result in diagnoses that are actually some other disorder and the criteria
are vague.42 Time will tell if this new test is adopted or refined.

The symptoms associated with FMS may include.39,40,41,42,44

 Pain - People describe the pain as deep muscular aching, throbbing, shooting and stabbing, or
intense burning. Pain and stiffness are often worse in the morning in muscle groups that are
used repetitively.
 Fatigue - The feeling of being drained of energy and unable to concentrate, varying from mild
to incapacitating.
 Sleep disorder - Sleep does not feel refreshing and the person wakes up feeling exhausted.
 Chronic headaches - Headaches similar to migraines or tension headaches occur in about 50%
of patients.
 Chemical sensitivities - Many patients experience sensitivities to noise, bright lights, odors,
medications, and certain foods.
 Irritable bowel syndrome - 40-70% of patients experience diarrhea, constipation, and
abdominal pain and gas.
 Jaw pain including temporomandibular joint dysfunction - Close to 75% of FMS patients
have a varying degree of jaw discomfort, typically related to the muscles and ligaments
surrounding the jaw joint rather than the joint itself.
 Other common symptoms - Premenstrual syndrome (PMS) and painful periods, chest pain,
morning stiffness, cognitive or memory impairment, numbness and tingling sensations,
muscle twitching, irritable bladder, skin sensitivities, dry eyes and mouth, dizziness, brain
fog, sensitivity to bright lights, sounds, or odors, and impaired coordination.

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Causes and Triggers
It is important to separate the causes from the triggers of FMS. Recent research suggests that an
imbalance of chemicals and hormones in the nervous system or brain that amplify sensation may
be the cause.39,40,41 The super-sensitivity to pain appears to be genetic; the disorder runs in
families, and researchers have identified genes believed to be involved in the syndrome. 39,41
People with FMS have higher than normal levels of a neuropeptide called Substance P that is
involved in pain signals and subnormal levels of serotonin and norepinephrine, hormones that
modulate pain and act as a messenger between nerve cells. 40,42 Substance P and nerve growth
factor are increased threefold and fourfold, respectively, in the spinal fluid of people with FMS,
though it is unknown why these elevations exist.42

Even with a genetic predisposition, however, a person usually experiences an event that triggers
the onset of FMS.39,41,42 A viral or bacterial infection, automobile accident, injury, rheumatoid
arthritis, lupus, emotional stress, or even exposure to certain drugs or chemicals may trigger the
disorder.39,40,42 Once the disorder has been triggered, certain aggravating factors may contribute to
flare-ups including changes in the weather, cold or drafty environments, hormonal fluctuations
(PMS or menopause), stress, depression, anxiety, and over-exertion. 42

Treatment
Treatment for fibromyalgia requires a comprehensive approach. There are many things that can
help manage the symptoms of FMS.39,40,41,42,45 It is important to find a doctor who is familiar with
treating fibromyalgia because not all doctors are, in fact some still deny that fibromyalgia is real
because it cannot be detected by traditional diagnostic tools such as blood tests or x-ray. 39,42 A
combination of exercise, medication, physical therapy, and relaxation works the best. 39,8, 42 Learn
what factors aggravate your symptoms and avoid them.

Exercise - Regular physical activity, at least 30 minutes daily, has been found to be one of the
most effective treatments. 39,40,.42 Muscle pain may increase during exercise, but the pain usually
dissipates within 30 minutes and will lessen gradually after the first few weeks as you become
more conditioned.42 Low impact aerobic activity such as warm water aerobics, swimming,
walking, tai chi, yoga, or bicycling is excellent. 42,5,42 ,45 High impact activities like jogging or
basketball are not adviseable. 40,41,42 Isometric exercises can help you increase strength without
draining your energy. 42 Stretching exercises can help reduce pain and fatigue while increasing
muscle strength and a sense of well-being.41,42

Hands-on treatments – Various types of manual manipulation have been found to be effective in
relieving muscle pain including gentle low-pressure massage, osteopathic manipulation, neuro-
muscular adjustment, manual lymph drainage, and connective tissue massage. 42,45
Results on balneotherapy (bath therapy) are not conclusive due to lack of adequate research,
however it may be of benefit in relieving pain.45

Almost all of the 18 diagnostic tender points are actually myofascial trigger points. 42 Knotted
muscles at the trigger points cause tremendous pain and shoot pain to other regions. 42 In addition
to other hands-on treatments, trigger point therapy is, not surprisingly, often helpful in releasing
the muscular tension and resulting pain of fibromyalgia. Lidoderm patches applied to trigger
points for 4 days, myofascial release and trigger-point therapies performed by a massage or
physical therapist, application of heat and subsequent stretching, or use of coolant topical
medications that act as anesthetic can bring relief. 42 For especially stubborn trigger points,
injection of lidocaine into the eye of the trigger point, followed by gentle massage and application
on/off of a cold pack can force release of knotted, contracted muscles. 42 Low level laser therapy

8
that brings energy deep into the tissues helps some people, not others, and it must be
professional-level laser therapy, not the inexpensive ones available to the lay person. 42
Alternative approaches - You can change your perception of pain using mind-body methods, and
since stress seems to be a major factor in FMS, relaxation techniques such as meditation,
progressive relaxation, and breathing exercises are critical. 41,42 Learn to reduce pain by changing
the way you think about life.41,42 Guided imagery is a very powerful way to use your mind to alter
your perception and ability to deal with pain. Belleruth Naparstek is one of the masters of guided
imagery and we recommend that you investigate her website for materials that will not only help
you deal with Fibromyalgia, but will help you sleep, deal with pain, mentally guide you to a
position of wellness.46

Several other alternative methods do not have enough research to determine if they are effective
for fibromyalgia including acupuncture, biofeedback, homeopathy, Reiki, chiropractic, hypnosis,
magnet therapy, or natural products and creams such as capsaicin, SAMe, or soy. 45

Drugs - In a recent survey of 3,500 fibromyalgia patients, over 100 different prescription
medications were identified as having been used in alleviating pain and other symptoms. 42 In all
cases, it is extremely important to tell your doctor about all other prescriptions you are taking, use
of nutritional and/or herbal supplements, previous medical and mental issues, chemical
dependencies, and addiction history. 47,48 All prescription medications have side effects, some of
them potentially life-threatening, interactions are common, and it is imperative that you take
prescription medications exactly as prescribed without increasing, decreasing, or eliminating
dosages.47,49 Drugs and medications do not do anything to cure fibromyalgia. They are used to
bring some relief from the most disabling of an individual patient’s symptoms.

The use of tricyclic antidepressants at lower doses than prescribed for actual depression, elevate
levels of serotonin and norepinephrine in the central nervous system. 39, 42 This can help promote
sleep, relax painful muscles, and heighten the effects of endorphins. These drugs have been
around for over 50 years and may be effective, especially in combination with other drugs,
though they do have side effects and cannot be used for some patients. 47,49 Other antidepressants,
selective serotonin reuptake inhibitors (SSRIs), taken in lower doses than for depression, can
reduce fatigue and some other symptoms. 42 Pregabalin (Lyrica) is a drug used to reduce pain by
reducing the number of pain signals sent out by damaged or oversensitive nerves in the body. 48

Use of aspirin to help you begin to tolerate exercise is OK for a little while, but do not depend on
pain killers for long term pain management.

Sleep - Establish regular sleeping habits to reduce pain and improve energy and mood. 39,40,42 Get
in the habit of going to bed and waking up at the same time every day, even on weekends and
vacations.39 Avoid caffeine and alcohol several hours before bedtime including coffee, tea, soft
drinks containing caffeine, and chocolate. 39 Although exercise is excellent for relief of
fibromyalgia symptoms, it should be done at least 3 hours before bedtime because it can have a
stimulating effect.39 If you need to nap during the daytime, do not sleep more than 1 hour. 39
Reserve your bed for sleeping. Watching TV or using your laptop in bed can stimulate you and
make it harder to sleep.39 Keep your bedroom as dark as possible, quiet, and cool. 39 Avoid spicy
foods and excessive liquids in the evening to prevent potential heartburn and trips to the
bathroom.39 Slow down your pace prior to bedtime. Reduce lighting, avoid using the computer
or watching TV, listen to relaxing music, and/or take a warm bath to relax, unwind, de-stress, and
relax muscles.39

9
Some of the medications prescribed for fibromyalgia help induce more restful sleep. In addition,
use of melatonin can regulate your body’s internal clock to improve the quality of sleep. 42
Valerian is an herbal supplement that has sedating properties and may help induce sleep. 42 5-HTP
is a molecule that is easily absorbed by the brain and converted to serotonin. 42 It should be
avoided if you are taking prescription medications that boost serotonin, but if you can take it, it
may boost mood and helps some people sleep.42

Diet and supplements - A diet low in animal fat and high in fresh fruits, vegetables, and whole
grains goes a long way to enhancing your health and sense of well-being. 39,41,42 No specific diet
has proven to be effective in influencing fibromyalgia. 39 To reduce inflammation, exclude
polyunsaturated vegetable oils and sources of trans-fatty acids such as margarine and
hydrogenated oils. Increase omega-3 fatty acids by eating fish (e.g., 2 to 3 servings per week of
high-Omega-3 fish such as salmon), ground flax seed (2-3 tablespoons daily), or pharmaceutical-
grade fish oil (2.5 grams of Omega-3 daily: half EPA/half DHA). 22,39 One small study found that
the antioxidants Vitamins E and C reduced symptoms. 42 Another small study found that 500 mg
of Acetyl L-Carnitine taken 3 times daily helped to ease pain and fatigue, though more research is
needed to confirm this.42

Boswelia and magnesium may be useful as supplements. 41 Women should take 250 mg of
magnesium and 500-700 mg of calcium daily to help relax and maintain muscles and nerves. 42
Calcium is not recommended for men. 42 A magnesium/malic acid/B vitamin complex shows
potential promise in reducing muscle pain of fibromyalgia patients. 42 Malic acid is a sugar that is
broken down in the muscles to make energy, but it must be in the presence of magnesium and
Vitamin B.42

Please read the section on diet in the OA section of this article, above. Following a gluten-free
diet may provide some relief from symptoms. 39,40 Elimination of gluten containing foods for a
week should determine if this will be helpful in reducing pain.

Lifestyle and Work Modifications – Most people with fibromyalgia continue to work and carry
on a fairly normal lifestyle, however it’s possible that changes will need to be made. Cutting
down on work hours, switching to a less demanding job, or adapting a current job is quite likely. 39
If your current job requires heavy lifting or if you are experiencing pain because of an
uncomfortable chair or workstation, changes can be made to accommodate you in the
workplace.39

Learn - There are several excellent resources for information on FMS.

 Fibromyalgia Network: Has an excellent website and a newsletter with information on recent
research and coping strategies. None of this information is funded by pharmaceutical
companies, so recommendations and research is independent and unbiased. (800) 853-2929,
http://www.fmnetnews.com
 National Institute of Arthritis and Musculoskeletal Diseases, National Institutes of Health:
http://www.niams.nih.gov/Health_Info/Fibromyalgia/default.asp
 National Fibromyalgia Association: http://www.fmaware.org
 National Fibromyalgia Research Association: http://www.nfra.net
 Books listed on our Books product webpage:
https://insider.sri.com/services/ehs/ergo/pbooks.html
 Guided imagery with Belleruth Naparstek: www.healthjourneys.com

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REFERENCES:

1. Osteoarthritis. http://en.wikipedia.org/wiki/Osteoarthritis Modified Nov. 1, 2012.

2. What Are The Causes of Joint Pain Other Than Arthritis? By Diana K. Rodriguez.
http://www.livestrong.com/article/26825-causes-joint-pain-other-arthritis/
3. Joint Pain Symptom Checker: Symptoms & Signs Index. MedicineNet.com.
http://www.medicinenet.com/joint_pain/symptoms.htm
4. Gluten Sensitivity: A Gastroenterologist’s Personal Journey Down the Gluten Rabbit Hole,
Scott Lewey, M.D., ©Celiac.com, Jan. 30, 2007.
http://www.celiac.com/articles/1101/1/Gluten-Sensitivity-A-Gastroenterologists-Personal-
Journey-Down-the-Gluten-Rabbit-Hole-by-Dr-Scot-Lewey/Page1.html
5. Gluten Intolerance Symptoms – How Do You Know If Gluten Is Making You Sick? By Anna
Wilde. The Gluten Free Network. http://glutenfreenetwork.com/faqs/symptoms-
treatments/gluten-intolerance-symptoms-how-do-you-know-if-gluten-is-making-you-sick/
6. Inflammation. By Marcelle Pick, OB/GYN NP. ©1998-2012 Women To Women.
http://www.womentowomen.com/inflammation/jointpainorarthritis.aspx
7. Osteoarthritis: An Integrative Medicine Treatment Program, A special report from the
editors of Dr. Andrew Weil's Self Healing. © 2003, Thorne Communications, Watertown,
MA.
8. Osteoarthritis (OA or Degenerative Arthritis). ©1996-2010, MedicineNet, Inc.
http://www.medicinenet.com/osteoarthritis/article.htm
9. Osteoarthritis Symptoms. ©2005-2010 WebMD, LLC.
http://www.webmd.com/osteoarthritis/tc/osteoarthritis-symptoms
10. Gout and Hyperuricemia. ©1996-2010, MedicineNet, Inc
http://www.medicinenet.com/gout/article.htm
11. Pseudogout. ©1996-2010, MedicineNet, Inc
http://www.medicinenet.com/pseudogout/article.htm
12. Does Long-distance Running Cause Osteoarthritis? By Cymet, T.C. & Sinkov MD, J. The
Journal of the American Osteopathic Association ©2012 the American Osteopathic Assn.,
Sept. 1, 2009. http://www.jaoa.org/content/106/6/342.full
13. Long Distance Running and Knee Osteoarthritis A Prospective Study. Chakravarthy MD,
E.F., Hubert PhD, H.B., Lingala PhD, V.B., Zatarian MD, E., & Fries MD, J.F. American
Journal of Preventive Medicine, August, 2008, 35(2), 133-136.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2556152/
14. Rheumatoid Arthritis. ©1996-2010, MedicineNet, Inc.
http://www.medicinenet.com/rheumatoid_arthritis/article.htm
15. Osteoarthritis. ©2010, Google.https://health.google.com/health/ref/Osteoarthritis
16. Arthritis. http://en.wikipedia.org/wiki/Arthritis
17. Alternative Treatments for Arthritis. ©2005-2010 WebMD, LLC.
http://www.webmd.com/osteoarthritis/guide/alternative-osteoarthritis-treatments
18. Osteoarthritis Treatment Overview. ©2005-2010 WebMD, LLC.
http://www.webmd.com/osteoarthritis/tc/osteoarthritis-treatment-overview
19. Lifestyle Changes. MyOsteoarthritis.com ©2005-2010, The Health Central Network, Inc.
Reviewed: 04/19/2006 by Harvey Simon, M.D., Editor-in-Chief, Associate Professor of
Medicine, Harvard Medical School; Physician, Massachusetts General Hospital
http://www.healthcentral.com/osteoarthritis/index-000035_8-145.html?ic=506019
20. Osteoarthritis and nutrition. From neutraceuticals to functional foods: a systematic review
of scientific evidence. By Laurent G Ameye and Winnie SS Chee, 7/19/2006. Arthritis
Research and Therapy, http://arthritis-research.com/content/8/4/R127
21. Supplemental Relief. Arthritis Today ©2012 Arthritis Foundation.
http://www.arthritis.org/supplemental-relief.php

11
22. The Omega Rx Zone: The Miracle of the New High-Dose Fish Oil, by Barry Sears, PhD,
©2002, Regan Books/Harper Collins, New York. ISBN: 0-06-098919-X
23. Broccoli blocks joint destruction in osteoarthritis: Research The Medical News, News-
Medical.net, 9/15/2010, http://www.news-medical.net/news/20100915/Broccoli-blocks-
joint-destruction-in-osteoarthritis-Research.aspx
24. Dietary garlic and hip osteoarthritis: evidence of a protective effect and putative mechanism
of action. Williams, F. MK, Skinner, J., Spector, T.D., Cassidy, A., Clark, I.M., Davidson,
R.M., MacGreggor, A.J. BMC Musculoskeletal Disorders. 2010, 11:280.
https://ueaeprints.uea.ac.uk/30145/1/Williams_et_al_2010.pdf or
http://www.biomedcentral.com/1471-2474/11/280
25. Osteoarthritis. ©2010, ConsumerLab.com, LLC. http://www.consumerlab.com/tnp.asp?
chunkiid=21505
26. Joint Health Supplements with Glucosamine, Chondroitin, and/or MSM. ©2010,
ConsumerLab.com, LLC.
https://www.consumerlab.com/reviews/Joint_Supplements_Glucosamine_Chondroitin_MS
M_Review/jointsupplements/
27. S-Adenoylmethionine (SAMe). ©2010, http://www.consumerlab.com/tnp.asp?
chunkiid=21460
28. Cetylated Fatty Acids. ©2010, ConsumerLab.com, LLC.
http://www.consumerlab.com/tnp.asp?chunkiid=104660
29. Special Turmeric Extract Benefits Osteoarthritis Patients. ©2010 American Botanical
Council, http://cms.herbalgram.org/press/2010/TurmericBenefitsOsteoarthritis.html?
t=1285777112
30. Efficacy and safety of Meriva, a curcumin-phosphacylcholine complex, during extended
administration in osteoarthritis patients. Belcaro, G., Cesarone, M.R., Dugall, M.,
Pellegrini, L, Ledda, A., Grossi, M.G., Togni, S., and Appendino, G. Alternative Medicine
Review, Dec. 2010, 15(4), 337-344. http://www.ncbi.nlm.nih.gov/pubmed/21194249
31. Does Black Pepper Help Absorption of Curcumin? Smith, D. Aug 1, 2011.
Livestrong.com, ©2012 Demand Media, Inc., http://www.livestrong.com/article/506827-
does-black-pepper-help-absorption-of-curcumin/
32. Effects of ginger extract on knee pain in patients with osteoarthritis. Altman, R.D., and
Marcussen, K.C. , Arthritis and Rheumatology, Nov. 2001, 44(11), 2531-8.
http://www.ncbi.nlm.nih.gov/pubmed/11710709
33. Cayenne. Herbs & Supplements, Natural and Alternative Treatments. Update 8/2/2012.
©2012 EBSCO Publishing/ConsumerLab.com, LLC.
http://www.consumerlab.com/tnp.asp?chunkiid=21645&docid=/tnp/pg000451
34. Treatment of osteoarthritis with Pycnogenol. The SVOC (San Valentino Osto-arthritis
Study). Evaluation of signs, symptoms, physical performance and vascular aspects.
Phytotherapy Research, April 2008, 22(4), 518-22.
http://www.ncbi.nlm.nih.gov/pubmed/18386255
35. Pine Bark for Osteoarthritis Pain. Arthritis Today.©2012 Arthritis Foundation.
http://www.arthritistoday.org/treatments/alternative-therapies/pine-bark-extract.php
36. Does Weather Affect Arthritis Pain? Arthritis Special Report, Johns Hopkins Health Alerts,
©2012 Remedy Health Media, LLC.
http://www.johnshopkinshealthalerts.com/reports/arthritis/44-1.html
37. Osteoarthritis pain and weather. Wilder, F.V., Hall, B.J., and Barrett, J.P. Rheumatology,
2003: 42. 955-958. http://rheumatology.oxfordjournals.org/content/42/8/955.full.pdf
38. Osteoarthritis and weather – are they really linked? Hardy, S. Natural Treatments and
Exercises for Osteoarthritis Pain Relief. June 1, 2012.
http://exercisesforosteoarthritis.com/degenerative-osteoarthritis/osteoarthritis-and-weather-
are-they-really-linked/#comment-2221

12
39. Questions and Answers About Fibromyalgia, National Institute of Arthritis and
Musculoskeletal and Skin Diseases, National Institutes of Health, Department of Health &
Human Services, July, 2011.
http://www.niams.nih.gov/Health_Info/Fibromyalgia/default.asp
40. Fibromyalgia Treatment, Health Centers. Copyright 2012, Weil Lifestyle, LLC.
http://www.drweil.com/drw/u/ART00701/fibromyalgia
41. Q & A: What Are The Symptoms of Fibromyalgia? Copyright 2012, Weil Lifestyle, LLC.
http://www.drweil.com/drw/u/QAA269355/symptoms-of-fibromyalgia
42. Fibromyalgia Network, Tucson, AZ. http://www.fmnetnews.com
43. "Fibromyalgia", Health Centers. Copyright 2012, Weil Lifestyle, LLC.
http://www.drweil.com/drw/u/ART02975/Treatment-of-Fibromyalgia.html
44. Fibromyalgia Syndrome: Diagnostic Criteria, ©National Fibromyalgia Research
Association, Salem, OR. http://www.nfra.net/Diagnost.htm
45. Fibromyalgia and Complementary Health Approaches, National Center for Complementary
and Alternative Medicine, National Institutes for Health. Updated Sept. 2012.
http://nccam.nih.gov/health/pain/fibromyalgia.htm
46. Health Journeys: Resources for Mind, Body, and Spirit. Guided imagery with Belleruth
Naparstek. www.healthjourneys.com
47. Tricyclic Antidepressants: How Tryicyclics Work, Side Effects. HealthyPlace: Depression
Community. ©2000-2012 HealthyPlace.com.
http://www.healthyplace.com/depression/antidepressants/tricyclic-antidepressants-how-
tricyclics-work-side-effects/
48. Pub Med Health: Pregabilin. Sept. 1, 2009. ©National Center for Biotechnology
Information, UlSl National Library of Medicine.
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000327/
49. Tricyclic antidepressant. Updated Oct. 16, 2012.
http://en.wikipedia.org/wiki/Tricyclic_antidepressant#Side_effects

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