Fibromyalgia is present in as many as 2% to 8% of the population and is characterized by widespread neuropathic pain, and is often accompanied by fatigue, insomnia, and cognitive problems (Clauw et al., 2014). However, it is far from well-defined and it has been suggested fibromyalgia may be characterised as a kind of ‘bodily distress syndrome’, along with chronic fatigue syndrome, irritable bowel syndrome, and similar overlapping disorders (Wolfe et al., 2014). There are numerous nonpharmacological therapies for fibromyalgia such as exercise and cognitive behavioural therapy and also pharmacological therapies, such as tricyclics (e.g. amitriptyline), serotonin norepinephrine reuptake inhibitors (e.g. cymbalta), and gabapentinoids (e.g. lyrica) that may prove effective (Clauw et al., 2014). Amitriptyline and cymbalta have anti-depressant actions, while lyrica is an anti-convulsant. However, while some patients are satisfied with conventional approaches, many are left without anywhere near satisfactory relief. This article will discuss alternative approaches to treating fibromyalgia, mainly diet and herbal medicine.
The Paleolithic diet has become popular with the mantra ‘eat the foods you were designed to eat’, this is a good option for individuals with fibromyalgia (Cordain, 2012). The idea is to return to foods similar to those we ate when evolving in the Paleolithic era, 2.6 million years to 10,000 years ago. This is when our bodies adapted genetically to eating a certain diet. The Paleo diet includes vegetables, fruits, nuts and seeds, grass (not grain) fed meats, and wild seafood. It is a plant based diet, around 80% vegetables and fruits, 20% meats. All grains (including breads, pasta, gluten-free, etc), legumes, diary, refined sugar, added salt, processed foods are removed.
It has been suggested a gluten free diet may help treat some cases of fibromyalgia (Isasi et al., 2014). Gluten sensitivity, which is a non-celiac reaction to gluten by the immune system, may be related to the development and severity of fibromyalgia. There is evidence a mostly raw vegan diet may reduce fibromyalgia symptoms (Kaartinen et al., 2000). This is a particularly good option for vegetarians, however, it contains very little B12, therefore supplementation with B12 would be sensible. There is some degree of overlap between the Paleo diet and the raw vegan diet described in this paper, as both favour a plant based diet and reject refined sugars and processed foods. This kind of approach will increase the overall health of the body through greater intake of fruits, vegetables, and fibre.
Vitamin D and magnesium
It has been suggested vitamin D deficiency may contribute to disease severity and fatigue in patients with fibromyalgia (Solmaz et al., 2015). In one study, the authors observed a negative correlation between fatigue and vitamin D level in fibromyalgia patients. They also found a similar relationship between pain scores and vitamin D level. While these data are not fully conclusive, it is certainly worth considering supplementation of vitamin D and magnesium if you are suffering with fibromyalgia. In another study, the authors found statistical improvement of tender joints and depression with magnesium treatment, but the effects were not as strong when the drug amitriptyline was used instead (Bagis et al., 2013). Both applied together were found to work better than either applied alone.
Traditional herbal medicines
Whilst conventional drugs like lyrica, amitriptyline, and cymbalta may prove helpful for fibromyalgia patients, they may result in unwanted side effects leading to discontinuation or they may not work for some aspects of the disease. Herbs tend to be gentler on the body and by combining multiple herbs with different actions it is possible to create a more complex formula that may approach treating fibromyalgia from a few different angles.
For instance, herbs like St. John’s wort and black cohosh have anti-depressant properties and may relieve some of the emotional burden associated with fibromyalgia, whilst they also have an analgesic effect and so target the nerve pain. Black cohosh and ashwagandha have an anti-spasmodic property and should help painful tight muscles, while skullcap and milky oat seed have a nervine tonic action that tend to help restore normal sleep patterns. When combined in this way, herbs may be more powerful than a single herb acting alone.
Ashwagandha or withania somnifera has been used in Ayurveda for at least 3000 years (Castleman, 2001). It is mentioned in the ancient text, the Charaka Samhita, that recommends the root as a whole-body tonic, particularly for emancipation, reproductive powers, and longevity. It is classified as a rasayana in Ayurveda, or restorative herb for the body, also known as an adaptogen (Winston, 2007). Adaptogens are thought to work on the adrenal glands and modulate cortisol levels, amongst other mechanisms, to the effect of buffering the body against non-specific stress (Singh et al., 2011). Since fibromyalgia can be seen as a ‘bodily distress syndrome’, reducing the impact of stress in the body could have a significant positive impact.
Ashwagandha is known to have a profound anti-anxiety effect observed in human double-blind placebo controlled studies (Chandrasekhar et al., 2012). It also has an antispasmodic effect (Mishra et al., 2000), and may help relax painful tight muscles which are found in some fibromyalgia patients. Furthermore, ashwagandha is classified as a nervine tonic and so is thought by herbalists to have a restorative effect on the nervous system. There is data that suggests it helps nerves regenerate (Nakayama et al., 2007), supporting this theory to some degree. It’s gentle stimulating effect that occurs over time may help to treat the fatigue often associated with diseases. Overall, ashwagandha is an important herb for a worn out, stressed nervous system.
Black cohosh or cimicifuga racemose was originally used by the Native Americans as a medicine as they boiled its roots in water and drank the decoction for fatigue and arthritis (Castleman, 2001). It subsequently became known as an herb for all kinds of rheumatism including those types involving muscular pains (Hoffman, 1988). Similar to St. John’s wort, black cohosh also has quite a strong anti-depressant action so can help lift some of the psychological burden associated with fibromyalgia (Gladstar, 2000). It also acts as a nervine sedative so may help related sleep troubles (Jiang et al., 2015). While, similar to ashwagandha, it has an antispasmodic action, capable of relieving the painful tight muscles that may be associated with the disease. Black cohosh is often combined with ashwagandha in various formula to target fibromyalgia by herbalists (Winston and Kuhn, 2000).
Reishi or ganoderma lucidum is a mushroom has been used as a medicine in China for over 2000 years. It is traditionally used to replenish the Qi or vital energy, relax the mind, relieve asthma, and for many other conditions (Benzie, 2011). It was thought by ancient Chinese doctors to increase the duration of lifespan (Babu, 2008). Preliminary results indicate reishi has anti-convulsant, neuroprotective, and anti-inflammatory properties (Liu et al., 2003; Aguirre-Moreno et al., 2013). A double-blind placebo controlled clinical trial supports a medicinal effect of reishi against emotional disturbance (Tang et al., 2005). Reishi is classified as an adaptogen and nervine tonic by herbalists, similar to ashwagandha, and is thought to have wide ranging anti-stress and nerve restorative effects in the body.
Reishi also has an effect on the gut, as in mice reishi has been found to reduce obesity via the modulation of gut flora (Chang et al., 2015). Reishi acts as a prebiotic and may help balance the gut environment which is typically dysregulated in fibromyalgia. It also has a role in the treatment of fatigue associated with fibromyalgia because it gently stimulates an individual’s energy with time. Although, it also can also over stimulate some people, so a tincture can be used together with nervines, then the dose can easily be reduced if necessary. The traditionally used part of the mushroom is the fruiting body, that grows above the ground.
St. John’s wort
St. John’s wort or hypericum perforatum has a history of medicinal use that dates back to the ancient Greeks (Castleman, 2001). The Greek physician Dioscorides recommended flower extracts as a treatment for sciatica. It has been shown to have an anti-depressant action by many well controlled clinical studies (Ng et al., 2017), however, perhaps most of all, herbalists see it as a nervine tonic. It is thought St. John’s wort helps heal nerves and also has an analgesic effect, therefore has applications in treating many kinds of neuropathic pain (Winston, 2007). St. John’s wort is best in the form of a fresh tincture of the flowers, the colour of the tincture should be deep red to indicate its potency.
American skullcap or scutellaria lateriflora was used by the Native Americans in North America as a sedative and tonic (Barceloux, 2008). Fresh aerial parts of the plant made into a tincture are indicated for anxiety, insomnia, painful tight muscles, and nerve pain. A tincture made from dried leaf material has a lot less medicinal power, but is widely marketed and sold anyway. Skullcap is thought to have a renewing effect on the nervous system and may help direct it towards health and balance (Hoffman, 1988). A mood elevating effect has been shown for skullcap in a double-blind placebo controlled human study (Brock et al., 2014), but I have only noticed a calming effect personally. St. John’s wort and black cohosh have a stronger mood elevating property. The anti-anxiety effect of skullcap has been verified in a well-controlled human study (Wolfson et al., 2003)
Oats or avena sativa is a well known food, but for just one week of the growing cycle of oats, the oat seed is filled with fresh white milk. Herbalists have found if the undried seeds are harvested quickly and then made into tincture, they make an excellent nervine tonic (Winston, 2007). The action of milky oats on the nervous system is slow and may take longer than other herbs, but it can help restore a stressed out nervous system and a normal sleep pattern, which is disrupted in fibromyalgia. This is especially true when applied alongside a fresh American skullcap tincture. It also has a warming and moistening energetic effect in the body. This means it acts to balance drying herbs in a formula, and so avoid constitutional drying out (e.g. dry skin, constipation). It is thought to act as a nutritive tonic for the nervous system, and this may be related to the high b vitamin content of the fresh milky oat seed.
Kava or piper methysticum is consumed traditionally by the Polynesians from New Guinea to Tahiti who have an ancient tradition of consuming the herb in ‘kava circles’ (Castleman, 2001). In the South Pacific, kava has been used as a treatment for headache, colds, arthritis, and as a sedative and aphrodisiac. The Eclectic physicians used kava for urinary tract pain, renal colic, chronic urethritis, neuralgia, mouth and throat pain, and dyspepsia (Kuhn and Winston, 2000). Kava is a strong sedative or hypnotic and can help both sleep and pain in fibromyalgia. It can be addictive, so high doses should be avoided. Best not combined with alcohol, it may stress out the liver. Do not use in individuals with a history of liver disease, with hepatotoxic drugs, or in pregnant or breast-feeding women.
The below formula is an example of a compound of different nervines discussed that should help address the disease pattern of fibromyalgia. However, there are many different kinds of fibromyalgia, therefore personalisation may well be necessary for a better result. There may be underlying digestive problems or poor diet that may be necessary to improve upon. Also, different types of constitution may respond better to certain herbs, for example, ashwagandha is a little more suited to vata type people (cold and dry).
An elevation in mood, improvement in sleep, reduction in fatigue, and decrease in pain may be observed with this formula. It is best to allow 2 months to evaluate a formula’s efficiency.
Nervine tonic and adaptogen compound
Ashwagandha (1 part) (warming, drying)
Black cohosh (1 part) (cooling, drying)
Kava kava (1 part) (warming, drying)
Contraindications: Not for use during pregnancy and when breast feeding. If on sedative medication be highly cautious regarding dose. Not for use in people with history of liver problems. Be very cautious if combining with drugs or alcohol, it is best not to do this because of the kava. Black cohosh may be toxic in higher doses, so 5-15 drop doses of this herb are best.
Nature has provided many different solutions to help treat fibromyalgia and related conditions such as CFS. Perhaps the most important part of treating such a condition is the restoration of a normal sleep pattern, for this, the gentle sedative tonics American skullcap and milky oats may help, or kava kava if a stronger nervine is required. Mild adaptogens such as ashwagandha and reishi also have a central role with their gentle calming yet activating action upon the nervous system. This article has given some nervine and adaptogenic herbs that could be used in the construction of a herbal formula for fibromyalgia.
Note: If you are not fully comfortable with a DIY approach for your condition for any reason, please do not hesitate to contact a local professional herbalist for more tailored assistance.
Aguirre-Moreno, Alma, et al. “Anticonvulsant and neuroprotective effects of oligosaccharides from Lingzhi or Reishi medicinal mushroom, Ganoderma lucidum (Higher Basidiomycetes).” International journal of medicinal mushrooms 15.6 (2013).
Babu, P.D. and Subhasree, R.S., 2008. The sacred mushroom “Reishi”-a review. The American-Eurasian Journal of Botany, 1(3), pp.107-110.
Barceloux, Donald G. Medical toxicology of natural substances: foods, fungi, medicinal herbs, plants, and venomous animals. John Wiley & Sons, 2008.
Benzie, Iris FF, and Sissi Wachtel-Galor, eds. Herbal medicine: biomolecular and clinical aspects. CRC Press, 2011.
Bagis, Selda, et al. “Free radicals and antioxidants in primary fibromyalgia: an oxidative stress disorder?.” Rheumatology international 25.3 (2005): 188-190.
Bagis, Selda, et al. “Is magnesium citrate treatment effective on pain, clinical parameters and functional status in patients with fibromyalgia?.” Rheumatology international 33.1 (2013): 167-172.
Brock, C., Whitehouse, J., Tewfik, I., & Towell, T. (2014). American Skullcap (Scutellaria lateriflora): A Randomised, Double‐Blind Placebo‐Controlled Crossover Study of its Effects on Mood in Healthy Volunteers. Phytotherapy Research, 28(5), 692-698.
Castleman, Michael. “The new healing herbs.” Bantam Book, New York (2001): 465-471.
Chandrasekhar, K., Jyoti Kapoor, and Sridhar Anishetty. “A prospective, randomized double-blind, placebo-controlled study of safety and efficacy of a high-concentration full-spectrum extract of ashwagandha root in reducing stress and anxiety in adults.” Indian Journal of Psychological Medicine 34.3 (2012): 255.
Chang, Chih-Jung, et al. “Ganoderma lucidum reduces obesity in mice by modulating the composition of the gut microbiota.” Nature communications 6 (2015).
Clauw, Daniel J. “Fibromyalgia: a clinical review.” Jama 311.15 (2014): 1547-1555.
Cordain, Loren. AARP The Paleo Diet Revised: Lose Weight and Get Healthy by Eating the Foods You Were Designed to Eat. John Wiley & Sons, 2012.
Hoffman, David. Holistic herbal. Element Books, 1988.
Kuhn, Merrily A., and David Winston. Herbal therapy and supplements: a scientific and traditional approach. Lippincott Williams & Wilkins, 2000.
Jiang, K., et al. “Black cohosh improves objective sleep in postmenopausal women with sleep disturbance.” Climacteric 18.4 (2015): 559-567.
Gladstar, Rosemary, and Pamela Hirsch, eds. Planting the future: saving our medicinal herbs. Inner Traditions/Bear & Co, 2000.
Isasi, Carlos, et al. “Fibromyalgia and non-celiac gluten sensitivity: a description with remission of fibromyalgia.” Rheumatology international 34.11 (2014): 1607-1612.
Kaartinen, K., et al. “Vegan diet alleviates fibromyalgia symptoms.” Scandinavian journal of rheumatology 29.5 (2000): 308-313.
Mishra, Lakshmi-Chandra, Betsy B. Singh, and Simon Dagenais. “Scientific basis for the therapeutic use of Withania somnifera (ashwagandha): a review.” Alternative medicine review 5.4 (2000): 334-346.
Ng, Qin Xiang, Nandini Venkatanarayanan, and Collin Yih Xian Ho. “Clinical use of Hypericum perforatum (St John’s wort) in depression: A meta-analysis.” Journal of Affective Disorders 210 (2017): 211-221.
Liu, Y. H., et al. “Effectiveness of Dp2 nasal therapy for Dp2-induced airway inflammation in mice: using oral Ganoderma lucidum as an immunomodulator.” Journal of microbiology, immunology, and infection= Wei mian yu gan ran za zhi 36.4 (2003): 236-242.
Nakayama, Natsuki, and Chihiro Tohda. “Withanoside IV improves hindlimb function by facilitating axonal growth and increase in peripheral nervous system myelin level after spinal cord injury.” Neuroscience research 58.2 (2007): 176-182.
Singh, Narendra, et al. “An overview on ashwagandha: a Rasayana (rejuvenator) of Ayurveda.” African Journal of Traditional, Complementary and Alternative Medicines 8.5S (2011).
Solmaz, D., et al. “AB0944 Vitamin D Deficiency Might Contribute Fatigue and Disease Activity in Patients with Fibromyalgia.” (2015): 1215-1215.
Tang, Wenbo, et al. “A randomized, double-blind and placebo-controlled study of a Ganoderma lucidum polysaccharide extract in neurasthenia.” Journal of medicinal food 8.1 (2005): 53-58.
Winston, David, and Steven Maimes. Adaptogens: herbs for strength, stamina, and stress relief. Inner Traditions/Bear & Co, 2007.
Wolfe, Frederick, Brian T. Walitt, and Winfried Häuser. “What is fibromyalgia, how is it diagnosed, and what does it really mean?.” Arthritis care & research 66.7 (2014): 969-971.
Wolfson, P., and D. L. Hoffmann. “An investigation into the efficacy of Scutellaria lateriflora in healthy volunteers.” Alternative therapies in health and medicine 9.2 (2003): 74.