Approximately half of all adults in the United States report taking a dietary or herbal supplement in the past 30 days (Radimer et al., 2004). Among fibromyalgia patients, usage is also high, with recent studies reporting a wide range in the percentage of patients who use dietary or herbal supplements. Some studies have reported more modest use that approximates that of the overall United States population (42%) (Shaver et al., 2009), while others have shown usage rates to be as high as 73% (Arranz et al., 2011). A wide variety of dietary and herbal supplements have been used by fibromyalgia patients as treatments for various symptoms and for overall pain relief. A brief listing of common symptoms and the dietary and herbal fibromyalgia supplements commonly used to treat them is provided below, followed by a high-level overview of related research. Please see our in depth research based full articles on the most common and effective fibromyalgia supplements options.
Headaches are commonly experienced by fibromyalgia patients, and can result in significant impairment and debilitation. In addition to conventional medicinal pain relievers, such as aspirin, ibuprofen, and acetaminophen, a number of natural medicines have been used as a means of treating headaches. Examples of these include butterbur, capsicum, feverfew, peppermint oil, and willow bark. Research studies have suggested that the butterbur supplements may help prevent migraine headaches and even reduce their frequency and intensity (Grossman & Schmidramsl, 2000; Diener et al., 2004; Lipton et al., 2004). Some research also suggests that capsicum (chili pepper) extract may reduce the frequency of cluster headaches (Rapoprt et al., 1994; Fusco et al., 1994a; Fusco et al., 1994b). A related natural compound – capsaicin – has been shown to decrease headache symptoms when administered via an intranasal spray (Marks et al., 1993). Capsaicin is the component of chili peppers (and other ‘hot’ peppers) that gives them their spicy qualities and ‘heat.’ Other compounds that have been proven to help prevent migraines and their associated symptoms include Coenzyme Q10 (CoQ10) (Rosen et al., 2002; Sandor et al., 2005) and feverfew (Pfaffenrath et al., 2002; Johnson et al., 1985; Diener et al., 2005). Other supplements have been investigated for their use in preventing migraine, cluster, and tension headaches, with mixed results. These include magnesium, melatonin, peppermint, and riboflavin (vitamin B2).
Non-refreshing sleep and insomnia are hallmark symptoms of fibromyalgia, affecting upwards of 85% of patients. In fact, sleep difficulty is so prevalent among fibromyalgia patients that assessment of sleep quality is now included as part of the comprehensive diagnosis of fibromyalgia (Roizenblatt et al., 2011). A considerable number of dietary and herbal supplements have been studied for their effects on regulating and promoting sleep, including melatonin, lemon balm, tyrosine, vitamin B12, and L-tryptophan. Melatonin is a hormone naturally produced by the body that helps to regulate normal sleep-wake cycles. Melatonin supplements have been studied extensively for their use in treating disorders of the sleep-wake cycle in a number of different populations. Supplemental melatonin is currently approved by the FDA for treating sleep disorders in blind children and adults (Sack et al., 1991; Palm et al., 1997). In addition, research has shown that melatonin is helpful for treating sleep disturbances that are common in children with autism, mental impairment, and various disorders of the central nervous system (MacArthur et al., 1998; Lancioni et al., 1999; O’Callaghan et al., 1999; Jan et al. 1999). Melatonin has also been shown to be useful in treating sleep disturbances that occur due to depression (Dolberg et al., 1998). On a related note, melatonin levels have been suggested to be lower than normal in some fibromyalgia patients (Wikner et al., 1998) and a small study has suggested that melatonin may be useful to treat sleep disturbances and other common symptoms associated with fibromyalgia (Citera et al. 2000). A number of other supplements have also been studied, though to a lesser extent than melatonin. Lemon balm may be useful to improve sleep quality and duration (Cerny & Schmid, 1999), whereas tyrosine may help to improve cognitive function following sleep deprivation (Neri et al., 1995). Vitamin B12 and L-tryptophan have also been investigated for their effects on sleep, but have not shown to be effective in most studies (Okawa et al., 1997; Yamadera et al., 1996; Schmidt, 1983; Hartmann & Spinweber, 1979).
Widespread pain is the defining symptom of fibromyalgia, and for most patients, it is not easily treated with conventional prescription and over-the-counter pain relievers. Several natural supplements have been studied to determine their effects on muscle pain. These include bromelian, fish oil, arnica, ginger, glutamine, and Vitamin D. Although early studies have shown some promising findings for several of these, overall there is a lack of evidence to support the use of any one particular supplement as a primary means of relieving muscle pain. Both bromelian (pineapple stem extract) and fish oil have been investigated for their use in preventing exercise-induced muscle pain, but have not been shown to be generally effective (Stone et al., 2002; Lenn et al., 2002). Arnica, which is an extract of a daisy-like flower, has also been investigated for similar uses, and was shown in one study to actually worsen post-exercise muscle pain (Adkinson et al., 2010). Ginger has been investigated with mixed results (Terry et al., 2011), and a majority of research suggests that it is ineffective at preventing or treating muscle pain (Black et al., 2008; Black et al., 2010). Preliminary research suggests that glutamine may be useful to reduce muscle and joint pain that results from cancer treatment with the drug paclitaxel (Savarese et al., 1998). In addition, vitamin D supplementation has been shown to effectively reduce muscle pain in individuals who have low vitamin D levels and who take certain statin medications, which are commonly used to lower high cholesterol (Lee et al., 2008; Ahmed et al., 2009).
Irritable Bowel Syndrome
A common co-morbid condition of fibromyalgia is irritable bowel syndrome (IBS). A wide variety of herbal and dietary supplements have been studied for their role in improving IBS symptoms, and many have been demonstrated to be effective. Bifidobacteria has been shown to improve abdominal pain, bloating, and bowel movement difficulty within one week of starting treatment (O’Mahoney et al., 2005), and combination therapy with bifidobacterium, lactobacillus, and streptococcus has been shown to decrease bloating in individuals with diarrhea-predominant IBS (Kim et al., 2003). Lactobacillus acidophilus as an individual therapy has also shown promising findings as a treatment for pain, bloating, and stool quality (Halpern et al., 1996). Although some research has found no positive effects (Longstreth et al., 1981), a majority of studies have shown that blond psyllium helps to relieve constipation, abdominal pain, and diarrhea in IBS patients (Jalihal et al., 1990; Prior & Whorwell, 1987; Kumar et al., 1987; Misra et al., 1989). Research also suggests that guar gum may also provide similar benefits (Parisi et al., 2002). Considerable research has also looked at peppermint oil, and although numerous studies have shown benefit for relieving pain, bloating, flatulence and improving bowel movements (Liu et al., 1997; Kline et al., 2001; Dew et al., 1984; Rees et al., 1979; Grigolet & Grigolet, 2005; Capello et al., 2007), others have reported less encouraging findings (Nash et al., 1986; Lawson et al., 1988). Numerous other supplements have also been studied, but no association with improvements in IBS symptoms have been found.
Bladder pain can result from many factors, including infections or kidney stones, as well as more formal conditions such as interstitial cystitis (IC). Interstitial cystitis involves frequent discomfort or pain in the bladder and other areas in the pelvis and is diagnosed using defined criteria set forth by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Many fibromyalgia patients experience painful bladder symptoms, and many patients eventually receive a dual diagnosis of both fibromyalgia and IC. A small number of supplements have been investigated for their use in treating bladder pain, including L-arginine, superoxide dismutase, and dimethylsufoxide (DMSO). DMSO is a substance that occurs naturally in wood pulp. It has a wide variety of uses, including as an industrial solvent and preservative for use during organ transplantation. It is also FDA-approved for the treatment for interstitial cystitis (Sant & LaRock, 1994; Sant, 1987). L-arginine has also been shown to be effective at reducing pain associated with interstitial cystitis (Ehrin et al., 1998; Wheeler et al., 1997; Korting et al., 1999), in addition to superoxide dismutase (Kadrnka et al., 1981).
The overwhelming pain and fatigue that fibromyalgia patients face on a daily basis can have a profound impact on their emotional well-being. As a result, many fibromyalgia patients suffer from depression. In fact, it has been estimated that as many as 30% of fibromyalgia patients have clinically significant depression at the time of their diagnosis. Although a variety of conventional medications are available to treat both depression and anxiety, a number of natural therapies have also showed considerable promise. Several studies have evaluated the use of SAMe as a treatment for depression specifically in fibromyalgia patients. While some studies have shown positive effects (Tavoni et al., 1987; Jacobsen et al., 1991), others have failed to do so (Volkmann et al., 1997). Beyond the realm of fibromyalgia-specific research, SAMe has also been shown to be effective at treating depression in depressed individuals (without fibromyalgia) (Bressa, 1994; Salmaggi et al., 1994; Janicak et al., 1988), as well as in depressed individuals who do not respond well to conventional antidepressants (Bell et al., 1994; Delle et al., 2002; Papakostas et al., 2010). In light of these positive research findings, SAMe is supported by the American Psychiatric Association as an alternative treatment to traditional antidepressant therapy.
Despite the fact that no research has investigated the use of St. John’s Wort to treat fibromyalgia symptoms, it is another supplement of interest for many fibromyalgia patients, primarily for its demonstrated usefulness in treating depression. A large body of evidence has demonstrated that St. John’s wort can improve mood, decrease anxiety, and improve sleep quality in people who have major depressive disorder. In fact, the short-term use of St. John’s wort as treatment for mild depression is approved by the American College of Physicians (ACP). Their recommendations are based on several well-designed research studies that have shown that St. John’s wort is equally as effective as several mainstream tricyclic antidepressants, such as Tofranil, and selective serotonin-reuptake inhibitor (SSRI) antidepressants, including Prozac and Paxil. Therefore, individuals who suffer from depression and who have difficulty taking conventional medications due to unwanted side effects or other problems with tolerability may find St. John’s wort to be a useful alternative (Kim et al., 1999; Linde et al., 1996; Philipp et al., 1999; Snow et al., 2000; Galapai et al., 2001).
Other supplements that have been shown to be possibly effective at treating depression include 5-HTP (Nakajima et al., 1978; Shaw et al., 2002), EPA (Nemets et al., 2002; Peet & Horrobin, 2002), folic acid (Coppen & Bailey, 2000; Taylor et al., 2003; Godfrey et al., 1990), and saffron (Akhondzadeh et al., 2004; Akhondzadeh et al., 2005). Studies have suggested that 5-HTP may even be as effective as the conventional antidepressants Luvox (fluvoxamine) and Tofranil (imipramine) (Coppen et al., 1972; Poldinger et al., 1991). Beyond these supplements, a number of others have been investigated for their use in treating depression but none have shown substantial therapeutic benefit.
Approximately one in five fibromyalgia patients suffers from generalized anxiety at the time they are diagnosed. Behavioral modifications and stress-management techniques are often suggested to help relive anxiety associated with fibromyalgia, as well as for those who suffer from it for other reasons. In addition, some supplements may also be able to help improve symptoms. Kava extracts have proven to be useful at improving anxiety in a number of studies (Pittler & Ernst, 2000; Volz & Kieser, 1997; Lehmann et al., 1996), and some studies have even offered evidence to suggest that kava may be comparable to that of conventional low-dose anti-anxiety drugs (benzodiazepenes) (Woelk et al., 1993). Melatonin has been proven to be useful as a pre-anesthesia sedative (Naguib & Samarkandi, 2000), and passionflower extract has also demonstrated anti-anxiety properties in some patients (Mori et al., 1993; Miyasaka et al., 2007).
A number of other supplements have been investigated for use in treating anxiety, including 5-HTP, bergamot oil, California poppy, ginkgo biloba, hawthorn, kava, magnesium, rhodiola, skullcap, theanine, and valerian. However, findings vary between studies and the overall lack of supporting research is low. Therefore, more research is needed to determine the effectiveness of these supplements in terms of treating anxiety disorder.
Cognitive impairment, or “Fibro Fog” is a common side effect experienced by many fibromyalgia patients. It can be difficult to manage and often only improves when other symptoms are relieved, such as pain, stiffness, and disrupted sleep. A few supplements have been investigated to evaluate their utility in improving cognitive impairment in various populations. Acetyl-L-Carnitine has been shown to improve memory and various measures of cognitive decline in elderly individuals (Cucinotta et al., 1988; Salvioli & Neri, 1994; Passeri et al., 1990), as well as in alcoholics (Tempesta et al., 1990). Furthermore, citicoline has been shown to improve verbal memory in middle aged to elderly individuals with memory deficits (Spiers et al., 1996). Both bovine (cow)- and plant-derived phosphatidylserine (a type of fatty acid) have been shown to improve attention, speaking, and memory in aging individuals who suffer from cognitive declines (Cenacchi et al., 1993; Crook et al., 1991; Villardita et al., 1987; Palmieri et al., 1987; Schreiber et al., 2000). Ginko Biloba has also shown promise as an effective treatment for age-related memory impairment (Brautigam et al., 1998; Mix & Crews, 2000; Solomon et al., 2002; Nathan et al., 2002; Mix & Crews, 2002). Sage, soy, and vinpocetine may also be effective at improving memory, however more research is needed.
Another hallmark symptom of fibromyalgia is fatigue, and it occurs in nearly all fibromyalgia patients. It is difficult to treat, as it is impacted by negative feedback from other fibromyalgia symptoms, including non-restful sleep, chronic pain, and limited mobility. A number of supplements may be useful in treating fatigue. Magnesium has been shown to be effective at treating the fatigue associated with Chronic Fatigue Syndrome (CFS), a condition that often overlaps with fibromyalgia (Cox et al., 1991). Other supplements have also been investigated as treatments for CFS. These include DHEA, evening primrose oil, fish oil, melatonin, NADH, propionyl-L-carnitine, and ribose. However, research studies regarding these compounds have produced conflicting findings which precludes the ability to determine their effectiveness at this time (Himmel & Seligman, 1999; Behan et al., 1990; Warren et al., 1999;van Heukelom et al., 2006; Williams et al., 2002; Forsyth et al., 1999; Vermeulen et al., 2004; Teitelbaum et al., 2006).
Fibromyalgia Specific Research
In addition to the general research described above, a number of supplements have been studied specifically in fibromyalgia for the treatment of various symptoms and co-morbid conditions. These include 5-HTP, alpha hydroxy acids, melatonin, capsaicin, carnitine, ginko biloba, magnesium, ribose, SAMe, vitamin D, vitamin B12, CoQ10, and GHB. Our website contains individual articles directed to all of these supplements and their specific use in fibromyalgia patients.
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