Because fibromyalgia is so complex, not everyone agrees on how to best treat it. Conventional doctors may treat it simply with antidepressants, muscle relaxants, and a careful balance of rest and exercise. But some doctors are taking bolder steps and attempting treatments that others might consider cutting edge.

One problem in treating fibromyalgia is that the disease is still not well understood. No one knows why the body becomes hypersensitive to pain or why it falls prey to fatigue. And it's still a mystery as to whether poor sleep is the cause or the result of fibromyalgia.

More and more, researchers are beginning to suspect that fibromyalgia is not the result of one problem but actually the consequence of several different dysfunctions in the body. In fact, it's even possible that FMS is more than one disease. So while one person may experience fibromyalgia as the result of a thyroid problem, another may develop it because of candida overgrowth.

Different causes of fibromyalgia would certainly help explain the diversity of symptoms and why different patients respond to different treatments. These schools of thought have resulted in various modes of treatment. Some doctors may consider these treatments revolutionary. But others have incorporated them into their practice.

Adrenal Depletion

Many people who develop fibromyalgia are high-strung, Type-A personalities, who are driven, highly motivated workaholics vulnerable to stress. Having fibromyalgia only worsens their stress.

One theory of fibromyalgia — which applies especially to those who have fatigue as their primary symptom — is that it stems from adrenal depletion or exhaustion. Adrenal depletion occurs in people with overactive sympathetic nervous systems. The sympathetic nervous system is the part of the autonomic nervous system that responds to danger, stress, and excitement by increasing heartbeat and blood pressure. When it's overactive, the adrenal glands are taxed.

As a result, these little thumb-sized glands — which are located on top of your kidneys — constantly churn out cortisol and adrenaline, the two stress hormones. In people who are overly stressed, do too much, or skip meals, blood sugar levels dip. The body releases cortisol, which then causes the liver to release glycogen (sugar or energy) stored in its reserves.

Eventually, if the stress persists, the prolonged demand for cortisol depletes the adrenal gland's ability to make it. If the adrenals can't make enough cortisol, your blood sugar will drop to the point where the backup system kicks in and your body starts to release adrenaline. As a result of this adrenal activity and low blood sugar, you may experience extreme fatigue, anxiety, and heart palpitations. You may be irritable and experience lightheadedness upon standing. You may also lose weight without even trying.

Diagnosing and Treating Adrenal Depletion

Most patients who have adrenal depletion tend to be thin and fatigued. But to figure out if you are suffering from adrenal depletion, your doctor may do a blood test to measure adrenal hormones. Blood tests may also reveal abnormally high levels of potassium and low levels of sodium, which can result from adrenal depletion.

Treatment usually involves low doses of cortisol, in amounts below what the body normally produces. Most patients will respond well and feel less fatigued. Treatment may also require stress reduction strategies, eating more frequently, and eating more complex carbohydrates and salt, which can restore proper electrolyte balance. Some patients are also treated with licorice root extract or adrenal support supplements, such as vitamin C, the B vitamins, and certain amino acids.

Candida Hypersensitivity Syndrome

The natural world has more than 1,000 types of yeast. In the human body, yeast inhabits the skin, the digestive tract, and the vagina, where its numbers are kept in check by our immune system, healthy bacteria (called probiotics), and the intact membrane of the digestive tract. The predominant disease-causing kind of yeast that lives in humans is called candida albicans.

It is believed that in some people, candida albicans proliferates when our natural defenses break down. Sometimes, the extended use of antibiotics can spur the growth of candida. Eating a diet high in sugar also appears to contribute. The yeast grows out of control, seeps into the blood, and sets the immune system into action. When white blood cells and immunoglobulins attack the yeast in the gut, chemicals are released into the blood, causing a spate of health problems.

Symptoms of yeast overgrowth mimic those of fibromyalgia. In people who have fibromyalgia, yeast overgrowth may cause symptoms of hypothyroidism — even though traditional thyroid tests are normal. Chemicals released by the yeast get absorbed into the body and disrupt the normal function of thyroid hormone by inhibiting the alpha thyroid receptor, which is found in skin, muscles, bones, connective tissues, and certain parts of the brain.

In healthy people, thyroid hormone works by stimulating the production of metabolic enzymes that produce energy and blocking excess production of substance P, which makes you sensitive to pain. But in people with fibromyalgia, whose alpha receptor has been inhibited, the levels of metabolic enzymes decrease, and levels of substance P increase. The result is the fatigue and pain associated with fibromyalgia. In addition, the yeast releases a substance called tartaric acid, which may inhibit metabolism of lactic acid, thereby aggravating fatigue.

The connection between yeast hypersensitivity and fibromyalgia is highly controversial. Not every physician believes it exists. But at Fibromyalgia Treatment Centers of America in Chicago, where Dr. Michael McNett treats fibro patients for candida, 70 percent of his patients test positive for candida hypersensitivity syndrome. When patients are treated for candida overgrowth, 75 percent of them experience at least a 25 percent improvement in their fibromyalgia symptoms. And in approximately an eighth of his patients, the symptoms of fibro disappear.

Diagnosing and Treating Candida Hypersensitivity

There are a number of tests available for candida hypersensitivity syndrome, but most are highly unreliable, including anticandida antibodies, stool candida counts, and skin tests for candida allergy. One test that does appear to be an accurate measure is a blood test for antibodies attached to a piece of the candida cell wall. You can also find a simple questionnaire at the Yeast Connection website.

If you do have yeast overgrowth, your doctor will recommend a diet low in refined carbs. You may also be given antifungal medication, such as nystatin, and acidophilus, a probiotic commonly found in yogurt. Treatment usually lasts six months.

Peripheral Thyroid Resistance

It's a fact that many patients with fibromyalgia have symptoms similar to those who suffer from hypothyroidism. Yet thyroid tests on most people with FMS reveal that their thyroid levels are normal.

But some experts believe that the underlying cause of FMS is a problem called peripheral thyroid resistance. Studies by Dr. John Lowe have found that as many as 40 percent of all fibro patients have peripheral tissue resistance to thyroid hormone. To support the connection between thyroid resistance and fibromyalgia, they point to the many fibro patients who have been successfully treated with the same treatments used for hypothyroidism.

In order to understand peripheral thyroid resistance, it helps to understand how a healthy thyroid works in conjunction with the pituitary gland. Every cell in our body depends on two thyroid hormones, T3 and T4, for regulation of metabolism. When blood levels of T3 and T4 fall, the pituitary gland produces thyroid-stimulating hormone (TSH), which signals the thyroid to produce more T3 and T4. Once the blood levels of T3 and T4 increase, the pituitary decreases its TSH production.

In people who have peripheral thyroid resistance, cells lose the ability to recognize thyroid hormone and become resistant to normal thyroid hormones in the blood. The cause of this resistance remains a mystery. So even though the communication between the pituitary gland and the thyroid is normal, and the amount of thyroid hormone in the blood is perfectly normal, resistance to the hormones slows metabolism in the peripheral body tissues. The result can be fibromyalgia or other conditions that resemble hypothyroidism.

Diagnosing and Treating Peripheral Thyroid Resistance

It isn't easy to determine whether a patient has peripheral thyroid resistance, especially since blood tests will reveal that thyroid hormone and TSH levels are normal. Often, in fact, the only way to know for sure is to treat the patient with progressively larger doses of T3.

When patients are treated with high dosages of T3, the TSH levels drop precipitously. Many physicians may find these low levels alarming, but they are not typically harmful if the dosage is raised slowly and the patient is closely monitored. Treatment will then reveal whether a patient did indeed have peripheral thyroid resistance. Those who have it will notice a significant reduction in their symptoms. Those who do not, however, may develop a condition called thyrotoxicosis, or severe hyperthyroidism. Thyrotoxicosis can be dangerous, which is why any patient who undergoes this treatment must be closely monitored.

Chiari Malformation and Cervical Stenosis

Some experts wonder whether malformations of the brain might be the cause behind the symptoms of fibromyalgia. Scientists are particularly intrigued by Chiari malformation and cervical stenosis. In people with Chiari malformation, the cerebellum protrudes through the bottom of the skull into the spinal canal, compressing the spinal cord and causing poor circulation of cerebrospinal fluid between the spinal cord and the brain. Cervical stenosis occurs when the spinal canal is too narrow for the spinal cord and presses on it. Symptoms of Chiari malformation and cervical stenosis, which may resemble those of fibromyalgia, include pain, fatigue, headaches, dizziness, and difficulties with cognitive function. Like fibromyalgia, Chiari often is not evident until a head or neck injury is sustained.

In recent years, many patients diagnosed with fibromyalgia have found relief from their symptoms after surgeries to correct Chiari malformation or cervical stenosis. The surgery has also relieved dizziness, pain, headaches, poor sleep, and numbness. In addition, it has alleviated irritable bowel syndrome, memory or cognitive problems, vision difficulties, weakness, and fatigue.

Although surgeons have been correcting Chiari malformations and cervical stenosis for many decades, the connection between these conditions and fibromyalgia is relatively new and fairly controversial. Some members of the medical community now recommend MRIs and neurological tests for people diagnosed with fibromyalgia. But critics say the surgery provides false hope to fibro sufferers desperate for relief.

Whether fibromyalgia is always — or ever — the result of Chiari malformation or cervical stenosis is uncertain. It's also unclear whether surgery can always benefit people with fibromyalgia. But based on the success of many patients, the link between fibromyalgia and Chiari malformation and cervical stenosis certainly warrants more research and consideration.

Diagnosing and Treating Chiari Malformation

To determine whether you have Chiari malformation or cervical stenosis, you will need an MRI of your brain, the base of your skull, and the spinal cord. Your doctor may recommend an MRI if you have overactive reflexes of the arms and a general lack of coordination.

If a deformity or malformation is detected, your doctor may recommend surgery. However, not every patient requires surgery to treat these deformities. Some people may achieve relief by wearing a neck brace. Others may benefit from short-term steroid treatment. Postural training can also help reduce the pain.

Guaifenesin

Most people know guaifenesin as the main ingredient in the cough syrup Robitussin, where it is used to loosen mucus. For years, Dr. R. Paul St. Armand has recommended guaifenesin as a treatment for fibromyalgia. The drug is believed to work by promoting the excretion of phosphate through the urine and ridding body tissue of harmful phosphate deposits.

But the treatment has been fraught with controversy. The only valid study ever done, which was conducted by Robert Bennett, found no difference between women with fibromyalgia who took guaifenesin and those who took a placebo. The study also found no evidence that guaifenesin promotes the excretion of uric acid and no indication that phosphate excretion helps relieve fibromyalgia. Still, a significant number of fibro patients have had success using guaifenesin, which is why the subject deserves more research and study. The key may be to first identify patients who excrete low amounts of phosphate in their urine and to then treat them with guaifenesin.

Subclinical Infections

Days before you develop the first signs of a cold, you feel fine. You're energetic, busy, and appear perfectly well. You don't feel bad until the cold actually strikes. In reality, however, the infection was lingering in your body for some time before any symptoms first appeared. That's a subclinical infection.

It's possible that people who have fibromyalgia are living with a subclinical infection, or even several at a time. The infection could be lurking in body tissue and cells and wreaking havoc with the body's immune system.

Infections have already been found to play a role in illnesses such as HIV-AIDS and some autoimmune diseases. Researchers have found evidence of many types of infection in the blood of people with fibromyalgia, among them mycoplasma, Chlamydia, Lyme, and HHV-6. These findings suggest that these microorganisms may play a role in causing the symptoms of CFIDs and fibro.

Although these agents may not be the sole cause of fibromyalgia, their presence certainly warrants more research and attention. Treating these infections could in some cases reduce or even eliminate the symptoms.