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Fibromyalgia: Ayurvedic support for fibromyalgia

Dr. Imlikumba, Health Naturally Clinic, Mercy Building: Kevijau colony, Dimapur: Nagaland, +91948332
Published on 30 Oct. 2017 5:53 PM IST
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(Being able to walk pain-free is a blessing. Being able to walk without showing the pain is a skill)
Fibromyalgia is one of the most common pain disorders, second only to osteoarthritis as seen in rheumatology practices. Fibromyalgia is defined as a chronic pain syndrome with a complex, multi factorial and not completely known etio-pathogenesis that affects mainly women, It is characterized by generalized musculoskeletal pain and palpation specific tender points, often associated with sleep disorders, fatigue, somatic and cognitive symptoms, as well as psychic disorders . Due to this Fibromyalgia is a debilitating disorder that has negative effect on quality of life and thus impairing the patient's day to day activities. Disturbed sleep has been implicated as a factor in the pathogenesis. Other risk factors include life events that cause psychosocial distress such as marital disharmony, alcoholism in the family, injury assault, low income and self reported child abuse. Fibromyalgia is a clinical diagnosis based on the characteristic signs and symptoms . According to Ayurvedic view, it can be compared with certain conditions discussed under the umbrella of Vātavyādhi which occurs due to imbalance of Vata Dosha. Modern medications have a limited role in the management of fibromyalgia so patients prefer to use alternative medicine as well as in non-pharmacologic modalities that provide long-term disease management such as Ayurvedic system of medicine along with exercise, behavioral and education. Ayurveda provides a wide variety of time-tested dietary, herbal and lifestyle recommendations to help balance Vata and remove the symptoms caused by its aggravation. 
Signs and symptoms: Fibromyalgia is a syndrome that consists of the following signs and symptoms:  
• Chronic widespread pain (in the right and left side of the body, above and below the waist, and in the axial skeleton) of long duration (≥3 months) as the primary, hallmark symptom  
• Fatigue
• Sleep disturbance, including non-restorative sleep (feeling unrefreshed after a night's sleep) 
These 3 symptoms typically occur in most patients with Fibromyalgia syndrome. Other key associated symptoms include:
• Tenderness
• Stiffness
• Mood disturbances (e.g., depression or anxiety)
• Cognitive difficulties (e.g., trouble concentrating, forgetfulness, and disorganized thinking)
• Multiple other unexplained symptoms and functional impairment of activities of daily living. 
Diagnosis of fibromyalgia syndrome: Fibromyalgia is a diagnosis of exclusion and patients must be thoroughly evaluated for the presence of other disorders that could be the cause of symptoms before a diagnosis of fibromyalgia is made, such as Hypothyroidism, Rheumatoid arthritis, Systemic Lupus Erythematosus, Polymyalgia Rheumatic, Other inflammatory or autoimmune disorders etc. The diagnosis of Fibromyalgia is based on the criteria for the Classification of Fibromyalgia by the American College of Rheumatology, (ACR) 1990. The criterion involves:
• History of widespread pain has been present for at least three months.
• Pain in both sides of the body, above and below the waist.
• Pain is considered widespread when all of the following are present: Pain in 11 of 18 tender point sites on digital palpation (both side of the body): Occiput, Low cervical, Trapezius, Supraspinatus, Second rib, Lateral epicondyle, Gluteal, Greater Trochanter, Knee. However, not all patients with fibromyalgia meet these criteria, but still these are useful guide to make the diagnosis.
Investigations: Patients of fibromyalgia usually do not have characteristic abnormalities on routine laboratory testing or imaging studies, but it is important to screen for other diseases with similar manifestations and to assist in diagnosis of certain inflammatory diseases that frequently coexist with fibromyalgia. Such tests include the following: Laboratory testing, such as complete blood count, erythrocyte sedimentation rate, rheumatoid factor, antinuclear antibody, thyroid-stimulating hormone, T3, T4, creatinine phosphokinase, a serum muscle enzyme, vitamin D, ESR, CRP, renal function, and liver function tests are necessary to rule out other disorders. X-rays, specialized scans such as nuclear medicine and CT scan, muscle biopsy are normal in cases of fibromyalgia. 
Ayurvedic approach of fibromyalgia treatment: The aggravation of Vata Dosha or accumulation of Ama (toxins) are the primary causes and should be treated mainly. Associated weak digestion, constipation, and effects of chronic stress should also be tackled. So the treatment of fibromyalgia, which is primarily a Vātavyadhi disease, focuses on both Vāta Shamana (re-balance) and Samshodhana (purification) along with management of Ama. 
Panchakarma therapy: This is the main line of treatment in this disorder and ideally is the initial intervention in fibromyalgia if the patient has no contraindications. Purification measures namely 'Snehan' and 'Swedan' are very effective to balance 'Vata' and helps to dissolve toxins. Medicated oil is applied to the entire body followed by fomentation therapy with herbal decoction. This Snehana and Swedana therapy provides a deeply soothing and balancing effect to Vata. The friction and movements massage creates heat which enhances circulation and helps cleanse the Ama or other impurities that could be aggravating and hypersensitizing nerve tissues. For these purpose –Bala Taila / Ksheerbala Taila / Mahanarayana Taila / Kottamchukadi Taila / Dhanvantara Taila etc can be used. Patients with predominance of Kapha can undergo Vamana by using Madanphala Yoga. Similarly with Pitta aggravation, Virechana can be planned with Trivritta Avaleha, Avipattikara Churna, Eranda oil or Triphala Churna depending on Koshtha. In stress prone individuals who have sleep and mood disturbances, Sirovirechana or Nasya can be planned. 
Patients with constipation, debility and other Vata predominant features may undergo Matra Basti or a schedule of Kala or Yoga Basti.
 Ayurvedic palliative medicines: If there is pain or stiffness or tenderness-Dashamula Kwath / Dashamularishtam, Rasnadi Guggulu, Yograj Guggulu, Simhanad Guggulu can be prescribed. If pain is associated with fatigue – Rasayana Churna, Chayvanaprasha, Bala Churna, Ashvagandha Churna or Gokshura Churna can be given with milk or water twice or thrice daily. If there is mood swing / sleep disturbances then Mansyadi Kwath with Brahmi Churna + Sankhapusphi Churna + Jatamansi Churna can be prescribed along with other medicines as per requirement. 
Suchi karma (acupuncture): This ancient therapy gains its success by providing balance and energy to the body by means of fine needles inserted into the skin. The idea is that the puncture will change the flow of blood and neurotransmitters to the brain, thus alleviating pain.
Practice of yoga:  It is documented that fibromyalgia is often worsened by excessive stress, anxiety and mental fatigue. There are hormonal changes and other biochemical responses to stress that can aggravate the nervous system, and the immune response and affects quality of sleep pattern which in turn aggravates the fibromyalgia syndrome. Various stretching exercises are known to have a positive effect on fibromyalgia. Regular practicing of different yogic postures are helpful. Shavasana (Corpse posture) brings about a relaxed state of mind, Pranayama (Yogic breathing practices) create a state of restful alertness in mind and body. 
Diet and nutrition: The diet normally advised for patients of fibromyalgia is a modified Vata-pacifying diet (Pathyam). It should include:
• Vegetable juices and soups prepared  from Guard, bottle guard, carrot, tomato, pumpkin, spinach, beet root.
• Coconut water.
• Kichadi (recipe made by cooking red/bran rice and mung dal.) 
• Warm milk with spices like cinnamon,cardamom, ginger and clove
Fibromyalgia patients should avoid the following food articles (Apathyam) and behaviors:
• Hot (spicy) and fried foods; processed, excessive salt or sugar; very bitter and astringent foods, cauliflower, brinjal, potatoes.
• Excessive tea, coffee, alcohol, curd, chocolate, cocoa, milk.
• Sleeping during the day and staying up late at night. 
• Mental tensions like worry, anxiety, fear, stress and grief. 
Conclusion: Fibromyalgia is a clinical condition comparable to the to Amavata, Vatarakta, Mansagata vata, Rasagata Samata etc. A careful analysis of the above conditions have revealed involvement of Ama as a common factor in all clinical syndromes. 
Ayurved believes that Mandagni plays an important role in the manifestation of most of the diseases and its sluggishness results in the production of Ama. The proposed principles of treatment for fibromyalgia can be Langhana, Swedana, Pachan with drugs having Tikta-Katu Rasatmak properties and Deepana action , Virechana, Snehapana and Anuvasana as well as Ksharabasti. Topical therapies like Abhyangam, Upanaham etc. can also prove to be helpful.
Note: Ayurvedic medicines and treatments should be taken under Qualified Ayurvedic Doctor/Physician. The drugs described in this article are for general information/educational purpose only. Anyone should not use these without consulting a qualified Ayurveda doctor/physician.

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