Fibromyalgia affects 4 to 11 percent of the population. It is more common in women and can run in families, suggesting that some people may be more "predisposed" to it. The first recorded cases date back to the 1800s. Because many of the symptoms are vague and varied, there has been debate whether fibromyalgia is a real disease or not. Some physicians prefer to relegate it to the realm of psychosomatic illness. I side with those who believe that this is a real illness.

Fibromyalgia often occurs after a viral illness or a traumatic event such as a motor vehicle accident. Or, the symptoms may appear for no obvious reason at all. Because there is no blood test that can determine if a person has fibromyalgia, the American College of Rheumatology has issued criteria to use in diagnosing this illness. The diagnosis is based on a history of symptoms and the presence of two findings: (1) widespread pain of at least three months duration, occurring above and below the waist and on both sides of the body and (2) 11 out of 18 tender points at specific sites.

Typical symptoms of fibromyalgia are cyclical in nature, progressing from intermittent "normal" periods to acute exacerbation. In the early stages of fibromyalgia, there are more "good" days than "bad" days. However, as the disease progresses, the time between these periods becomes shorter and shorter until one merely cycles from bad to worse.

For those of you who do not have fibromyalgia, think back to when you had a bad case of the flu -- feeling sore and achy all over, general malaise, not having any energy. Well, this is how many fibromyalgia patients feel, except they feel this way all the time with symptoms waxing and waning in severity!

Fibromyalgia symptoms are numerous and varied but may involve the following:

Musculoskeletal symptoms (preponderance of symptoms)

"Brain" symptoms

Irritable Bowel symptoms

Miscellaneous symptoms

Many physicians are frustrated by fibromyalgia because they do not know what causes it, there are no diagnostic tests for it, and it is difficult and time consuming to treat. At AFWC, we take a special interest in fibromyalgia patients and believe that fibromyalgia is real. We also understand that there is no cookbook approach to treating patients. What works for one patient may not be helpful for another.

One interesting theory of fibromyalgia is that it may be a phosphate retention disorder. It is believed that there is a defective kidney enzyme in the patient with fibromyalgia, which causes excess phosphate to accumulate within the cells. This interferes with energy formation in the mitochondria, leading to fatigue. Excess phosphate also causes calcium retention. Together, they cause all the manifestations of fibromyalgia.

If phosphate retention were a cause of fibromyalgia, then removing these excess phosphate deposits would be beneficial. Treatment is a medication that is more potent than all of the other drugs that have been used for treating fibromyalgia. It is both cheap and extremely safe. It causes the kidneys to excrete phosphates, pulling it from tissues and cells where it has accumulated. This leads to a reversal of symptoms and it is estimated that one to two months of treatment reverses one year of fibromyalgia.

As regression occurs, the cycles of good and bad days slowly reverse themselves. As phosphates are removed from the tissues, symptoms reoccur that were felt when these abnormal accumulations were first deposited, but in reverse order. During treatment, good days appear and, eventually over time, become more frequent as symptoms lessen. Eventually, many patients report having more energy and fewer symptoms as the time between flares gets longer. When patients become symptom free they may need to go on a maintenance regimen to prevent the reaccumulation of phosphates.

The phosphate retention theory is only one of many theories of what causes fibromyalgia. The actual cause is probably an interaction of many processes involving viral action and neurohormonal conditions that affect blood flow, sleep, muscle use and brain function, as well as transmission of pain.

Whatever the cause of fibromyalgia, there are multiple factors that often need to be addressed when treating it. These involve pain control, improving sleep, specific exercise programs, evaluating and improving endocrine and hormonal functioning, physical therapies addressing the myofascial system, stress management, and nutritional therapies to improve functioning at the cellular level.

In my experience, working with fibromyalgia patients can be challenging and very rewarding. Like other chronic diseases in which there is no miracle cure, helping a patient regain control over their disease and improve the quality of their life is a very satisfying experience.