In 2017, Lady Gaga shared on Twitter that she suffered from fibromyalgia and “wanted to raise awareness” about the debilitating condition. She has since rescheduled tours due to the intense nerve pain she suffers from fibromyalgia, revealing to Vogue, “I get so irritated by people who don’t believe fibromyalgia is real,” the singer said. “For me, and I think for many others, it’s really a cyclone of anxiety, depression, PTSD, trauma, and panic disorder, all of which put your nervous system into overdrive, and as a result, you have nerve pain.” And she’s not alone.
According to the Centers for Disease Control and Prevention, fibromyalgia affects approximately four million American adults, or about 2% of the U.S. population. It can sometimes be difficult to diagnose because its symptoms mimic other illnesses. Fibromyalgia is a chronic condition that causes sleep disturbances and widespread pain throughout the body, which can severely disrupt a person’s daily activities and lifestyle.
What causes fibromyalgia?
Dr. Jacob Hascalovici, medical director of Clearing, a telehealth platform for patients with chronic pain, says, “Some people who develop fibromyalgia may have experienced a traumatic physical or emotional event. For others, fibromyalgia may appear without any discernible ‘trigger’ event. Previous infections appear to increase the risk of developing fibromyalgia, and the risk may also be increased when the body becomes highly sensitive to pain and must deal with pain triggers and memories of pain.”
Board-certified internist Dr. Jacob Teitelbaum, bestselling author of From Fatigued to Fantastic! says, “CFS, and its painful cousin fibromyalgia (CFS/FMS), represents an energy crisis that trips a key circuit breaker in the brain called the hypothalamus. This controls sleep, hormones, and autonomic function, so the shutdown causes widespread dysfunction and is often disabling. Anything that causes people to expend more energy than they can produce (including viral and other infections, including COVID) can trip the circuit breaker in the hypothalamus and trigger CFS/FM.”
Dr. Andrew Neville, ND, a leading expert on fibromyalgia and adrenal fatigue, explains, “Ultimately, it’s a malfunction of the stress response system, and it starts in the adrenal glands. Cortisol, your primary stress hormone, is your body’s primary anti-inflammatory function. Your adrenal glands produce this cortisol. If your adrenal glands are overloaded and you can’t produce adequate anti-inflammatory cortisol, you’ll become overly inflamed. Inflammation causes pain.”
Chronic inflammation also acts as an additional biochemical stress, perpetuating the body’s dysfunction and causing it to become overly aware of its surroundings. This is called “central sensitization.” If this continues over time, it progresses to chronic pain and/or chronic fatigue for others. This is commonly misdiagnosed as fibromyalgia.
Megan Anderson, APN nurse at the California Center for Functional Medicine, says, “A lot of recent research has shown that many of the symptoms of fibromyalgia syndrome (FMS) are caused by antibodies that increase the activity of pain-sensing nerves throughout the body. . . The findings show that fibromyalgia is a disease of the immune system, rather than the current view that it originates in the brain.
A study published in the Journal of Clinical Investigation demonstrated that the increased pain sensitivity, muscle weakness, reduced movement, and reduced number of small nerve fibers in the skin that are typical of FMS are all a consequence of the patient’s antibodies. From a functional medicine perspective, we tend to view it as a syndrome that falls somewhere on the autoimmune spectrum and likely has multiple triggers and therefore potentially multiple ways to treat it.
Generalized muscle pain lasting three months or more
“Fibromyalgia is characterized by widespread musculoskeletal pain, so you may have fibromyalgia if you have widespread muscle pain,” says Dr. Hascalovici.
Dr. Teitelbaum says, “Most of you have probably noticed that after a workout, when energy levels in your muscles are low, your muscles feel tense instead of loose and flaccid. This is because it takes more energy to relax a muscle than to contract it. The energy crisis in fibromyalgia causes chronic muscle shortening and secondary widespread pain. When muscle pain becomes long-term, it triggers secondary brain pain (called central sensitization and nerve pain).
Gita Castallian, MPH, Public Health Analyst at the California Center for Functional Medicine, says, “The primary sign of fibromyalgia is pain and tenderness in muscles and joints throughout the body, which often fluctuates and varies over time. It is an indicator of fibromyalgia when the pain lasts three months or more and often becomes chronic. It is often described as a constant, dull, widespread ache and often worsens after excessive activity, lack of sleep, insufficient exercise, stress, and changes in weather. Some people with fibromyalgia describe the pain as stabbing, stabbing, shooting, or aching.”
Confusion mentale
Dr. Hascalovici shares, “You may have fibromyalgia if the pain makes it difficult to concentrate. This symptom is known as ‘fibro-fog.’”
Dr. Teitelbaum adds, “Difficulty with short-term memory and word search and replacement can be quite serious. This has been labeled brain fog and is caused by a number of factors. These include inadequate energy in the brain cells, decreased blood flow to the parts of the brain responsible for speech (temporal lobe), chronic infections due to the immune dysfunction of CFS and fibromyalgia (people have experienced brain fog when they have had the flu), and numerous other contributing factors.”
Castilian says, “Brain fog, sometimes called ‘fibro fog’ in this context, is common for people with fibromyalgia, making it difficult to focus and concentrate on mental tasks, lacking mental clarity, and affecting memory. They particularly have memory problems when dealing with complex tasks while multitasking or dividing their attention. One study showed that fibromyalgia patients have memory impairments that mimic about 20 years of aging. Because there are many causes of brain fog, it’s important to rule out other causes (such as vitamin B12 deficiency or iron deficiency anemia) before attributing it to fibromyalgia.”
Severe Fatigue
Dr. Teitelbaum says, “Usually with severe fatigue, people can sleep through the weekend. But because the hypothalamic circuit breaker that controls sleep malfunctions in CFS/FMS, severe insomnia accompanies fatigue. When both are present for more than three months, I would assume a CFS/FMS-related process is present until proven otherwise. Even if other conditions are present.”
Castilian adds, “A common sign of fibromyalgia is waking up tired, even after a full night’s sleep. Severe and chronic fatigue is often present. Other sleep problems are also associated with fibromyalgia, including restless legs syndrome, insomnia, and sleep apnea. Additionally, because lack of sleep can decrease your ability to process pain, insomnia and other sleep problems can aggravate and intensify fibromyalgia symptoms.”
Therapies aimed at pain management can help with sleep and vice versa – working to improve sleep can help make pain more manageable. Chronic pain can be exhausting in many ways.”
Pain in multiple areas weekly
“Fibromyalgia pain can change location or have an erratic pattern, so it can affect different areas of the body at different times,” says Dr. Hascalovici.
Stronger perception of smell/easy irritation with smells
Neville says, “With a dysregulated nervous system and a high-trigger limbic system, the sensory nerves connected to smell are always on high alert.”
Indecision
“Stress tolerance bottoms out with fibromyalgia, making even simple decision-making stressful and sometimes impossible,” says Dr. Neville.
Hypersensitivity to touch and physical sensations
Dr. Neville shares, “This is due to Central Sensitization, the phenomenon of a dysregulated nervous system and an overactive limbic system.”
Bouncy/easily shaken
According to Dr. Neville, “The heightened senses that result from fibromyalgia tend to put patients on high alert. A door slamming can feel like an earthquake. A telephone ringing makes the heart race.”
How Fibromyalgia Can Affect Your Overall Health and Well-Being
According to Dr. Hascalovici, “Fibromyalgia can cause widespread and often disturbing pain throughout the body, usually in the muscles and soft tissues. Difficulty sleeping, pronounced fatigue, and memory problems, such as difficulty concentrating, also frequently characterize fibromyalgia. It is not uncommon for people with challenging or traumatic backgrounds to develop fibromyalgia, and the condition is also often accompanied by depression, anxiety, TMJ, and IBS.”
Dr. Teitelbaum says, “While some people can continue to work, they are usually able to do little else. More severe cases often leave the person crippled and even bedridden.”
Castallian explains: “Fibromyalgia is a complex, chronic, painful syndrome that affects the musculoskeletal system and can result in widespread pain throughout the body, extreme fatigue, brain fog, sleep disturbances, and other physical and cognitive problems. These symptoms can be debilitating, preventing some with FMS from maintaining their ability to work or perform normal daily functions of life. Additionally, it is considered an invisible illness because it is not easily visible from the outside. It is not easy to recognize that someone may be suffering or in pain just by looking at them.
Because of this, there is an additional layer of stress on the impact that fibromyalgia already has on day-to-day quality of life. Invisible illnesses often do not receive the empathy or credibility that easily visible illnesses receive, often fueled by doubt, denial, stigma, and feelings of isolation. Additionally, because the symptoms of fibromyalgia are common to many other conditions, receiving an accurate diagnosis can be a challenging and frustrating process, taking many years to find answers for most people with this chronic illness.”
Stress and Fibromyalgia
Dr Neville explains: “There are many ways in which a chronically active stress response, as occurs in adrenal fatigue, can cause pain. The main stress hormone, cortisol, is also our main anti-inflammatory molecule in the body. When this hormone is out of balance, a variety of inflammatory and therefore painful physiological conditions can arise. Excess cortisol and adrenaline also ‘hyper-sensitise’ the peripheral nerves, which essentially turns up the volume on the nervous system, creating a situation where patients ‘feel’ all bodily sensations at a heightened level. This is a process called introception.
Last but not least, excess stress hormones “sensitize” the brain, including the limbic system (the CEO of the stress response system). This phenomenon is called Central Sensitization. It also occurs in the sensory nerves, so many of my adrenal fatigue patients are also overly sensitive to bright lights, loud sounds, and strong chemicals and smells. Even the sensation of touch is heightened; someone can simply touch one of my patients, and the patient’s brain registers it as pain. We know from functional MRI studies that PTSD notably originates in the amygdala, which is part of a person’s limbic system. As I mentioned earlier, the limbic system is the CEO of the stress response system.
Since we have only one stress response system to deal with any and all stress, I compare it to a bucket. All the stress in our lives—past and present—is in the bucket, including past trauma and abuse. It is well documented that past trauma and abuse of any kind predisposes someone to stress-related illnesses in adulthood, such as anxiety, depression, insomnia, and even fibromyalgia and chronic fatigue syndrome.
When we take this into context, Lady Gaga is absolutely correct in saying that her fibromyalgia was triggered by her PTSD. (The singer told TODAY that she has PTSD from being sexually assaulted by a producer when she was 19.)
Adrenal fatigue, like fibromyalgia, can be effectively treated when we view it in terms of an overactive stress response system. Comprehensive holistic treatment can desensitize the system, creating space in the stress bucket so that the system becomes less and less engaged. When this happens, we turn off the chronic stress response—or fight or flight—that perpetuates chronic wear and tear on the body.
During treatment, we are also activating the healing and repair mechanisms in our bodies. As this occurs, the symptoms of an overactive stress response (such as fatigue, pain, anxiety, depression, and insomnia) gradually decrease over time in intensity, frequency, and duration, until they eventually disappear completely.
Fibromyalgia does not reduce life expectancy
Dr. Hascalovici states, “Fibromyalgia does not necessarily shorten your life expectancy. With treatment, you can maintain your mobility, manage your symptoms, and practice healthy ways to change the way your body perceives pain . People with fibromyalgia can experience the best that life has to offer with proper treatment and support.”
Having a strong support system is important and can be one of the biggest predictors of your treatment success. You can take control of your pain by educating yourself and building a team of friends and medical professionals who can support you.”
You will have good days and bad days
Dr. Neville says, “Fibromyalgia is medical jargon for chronic, transient pain of unknown cause with no known effective treatment. Doctors recommend general health advice and painkillers. You will have good days and bad days, and they say you just have to learn to live with it. After years of researching and treating fibromyalgia patients, and dealing with it myself, I have discovered that the cause of chronic pain is a dysfunction of your stress response system, commonly known as adrenal fatigue. Adrenal fatigue can be treated appropriately, effectively ridding your body of fibromyalgia.”
Doctor’s Insights on Fibromyalgia
Dr. Teitelbaum reveals, “I had CFS/FMS myself in 1975, which forced me out of medical school and left me homeless for a year. I have devoted the last 45 years to researching and teaching effective treatments. Anything that triggers an energy crisis in the body can cause fibromyalgia. For example, about 11 to 30 percent of people with lupus, rheumatoid arthritis, and multiple sclerosis will have secondary fibromyalgia.”
Dr. Teitelbaum also shared his additional thoughts on fibromyalgia.
“Lady Gaga has been blessed to have excellent doctors who are familiar with the disease, which is part of what (along with her determination) allows her to continue. But as I mentioned, fibromyalgia comes in a wide spectrum of severity. Some, like Lady Gaga, are among the “walking wounded” who are still able to function. Whereas others are homebound or bedridden. But having successfully treated thousands of people with these conditions, the vast majority of people can benefit from proper treatment and support.
Often dramatically. The problem is that the treatments tend to be low-cost (relative to patentable drugs) and so no one teaches them to doctors. There are literally dozens of treatments that are very effective. Most fall under the acronym SHINE, as discussed earlier. It is important to start by addressing sleep. This can be done with a range of natural and prescription therapies, usually in low doses and combined until the person is getting eight hours of sleep every night.
Nutritional support is key to optimizing energy. This starts with eliminating sugar and increasing salt and water intake. Then add a high dose of vitamin B complex along with magnesium 200 mg per day. Our published research has shown that Ribose 5 g 2-3 times per day, red ginseng, Ashwagandha, Rhodiola and other herbal supports can also be very helpful.
If the person is becoming hungry (irritable when hungry), adrenal support is helpful. Cold intolerance and thyroid support suggestive of weight gain may be needed despite normal tests. Worsening fatigue and insomnia during menstruation suggest the need for bioidentical estrogen and progesterone. It is helpful to remember that the hypothalamic switch that goes offline controls virtually the entire hormonal system. Resulting in hormonal deficiencies despite normal blood tests. There are numerous other treatments that need to be considered, but the above is a good start.”
