A diagnosis of FM was previously established using the American College of Rheumatology (ACR) 1990 classification criteria, where a certain number of specific tender points were required on physical examination. This was recently shown to be an insensitive method for making the diagnosis and has been revised. Newer criteria include diagnostic variables such as the widespread pain index (WPI) associated with cognitive symptoms, unrefreshed sleep, fatigue, and a number of somatic symptoms. Unfortunately, these symptom criteria overlap other illnesses and are not specific. They don’t tell us why someone develops FM.
It is essential in medicine to get to the root cause of symptoms. In addition to an infection with Borrelia burgdorferi, the agent of Lyme disease, which can cause fibromyalgia, we find that patients often have multifactorial causes for their illness. I call this syndrome Lyme-MSIDS. MSIDS stands for Multiple Systemic Infectious Disease Syndrome, and represents sixteen potential overlapping medical problems contributing to persistent symptoms in my patients.
The first point on the MSIDS map is infections. Ticks are now containing multiple bacterial, viral and parasitic infections which can be transmitted simultaneously with Borrelia burgdorferi, the agent of Lyme disease. Patients infected with Lyme disease and associated co-infections are much sicker and resistant to standard therapies. An example of a viral infection causing FM symptoms is human herpes virus-6 (HHV-6). Nearly 100% of adults today have been exposed, and it can reactivate later in life secondary to immunological and environmental factors. HHV-6 has been linked in the scientific literature as a possible cofactor in ADD, autism spectrum disorder and MS, apart from its links to CFS and Fibromyalgia. It is therefore one of many infections that can cause chronic fatigue and musculoskeletal pain.
Medicine has long searched for a common etiologic mechanism to explain diseases that share many symptoms in common, such as Chronic Fatigue Syndrome (CFS), Fibromyalgia (FM), Post traumatic stress disorder (PTSD) and persistent Lyme disease. Professor of Biochemistry and Basic Medical Sciences at Washington State University, Dr. Martin Pall noticed that the above disease states share many symptoms in common. These symptoms include chronic fatigue, muscle and joint pains, memory and concentration problems, mood disorders including depression and anxiety, and an inability to sleep. Back in 2001, he postulated that these illnesses with similar symptoms can all be initiated by a variety of factors, such as viral infections, bacterial infections, physical or emotional trauma, or exposure to environmental toxins, such as volatile organic solvents (VOS), pesticides, etc. These diverse stressors can all increase nitric oxide. Although nitric oxide has been shown to have extremely beneficial effects in the body such as lowering blood pressure and vasodilating the coronary arteries, it also can also have deleterious effects under certain conditions. What are the negative effects of nitric oxide?
When we stimulate nitric oxide (NO) production, we subsequently increase the production of peroxynitrite, which is a byproduct of the NO pathway. This molecule acts as a free radical, and increases oxidative stress, which can damage DNA and proteins inside the cell. It also can stimulate the production of NF-кB, a switch inside our nucleus that turns on the production of inflammatory molecules, such as IL-1, IL-6, TNF-α, and IFNγ (Interferon gamma). These are proteins which may contribute to the symptoms seen in Fibromyalgia and Lyme disease. It is therefore logical that apart from needing to address the underlying factors driving FM symptoms (i.e. treating the viral, bacterial, parasitic, and/or fungal infections, as well as treating overlapping etiologies on the MSIDS map, such as food allergies/sensitivities and mineral deficiencies), our therapy should focus on decreasing the free radical/oxidant byproducts of the nitric oxide biochemical cycle leading to fatigue and chronic pain. This would include a regimen of antioxidants, CoQ10, B vitamins, alpha-lipoic acid (ALA), magnesium (Mag++), zinc (Zn++), omega 3 fatty acids, and glutathione precursors such as N-Acetyl cysteine (NAC), and glycine. When I treat the infections and use medicines and nutritional supplements that support detoxification, balance an overstimulated immune system (like LDN, low dose naltrexone), and decrease oxidative stress, the majority of my patients with FM improve.
How do you know if you have Lyme-MSIDS causing Fibromyalgia? Lyme disease is a multisystemic illness and there are certain hallmarks of the disease which differentiate it from other medical disorders. Symptoms tend to come and go with good and bad days. Musculoskeletal pain and neuropathy (tingling, numbness and burning sensations) tend to migrate around the body. Symptoms often improve or worsen with antibiotic therapy (a Jarish-Herxheimer reaction when the Lyme bacteria are being killed), and women often report that symptoms worsen right before, during, or after the menstrual cycle.
Fill out the associated Lyme-MSIDS questionnaire (click here) . If you score 46 or higher on the questionnaire, there is a high probability that you suffer from Lyme disease and associated infections causing your FM (based on studies done in our medical office). Although blood testing lacks sufficient sensitivity to conclusively eliminate Lyme disease as a cause of FM, a Western Blot showing exposure to the 23, 31, 34, 39 and 83-93 kda bands is definitive evidence of exposure to Borrelia burgdorferi, the agent of Lyme disease, and helps to confirm the clinical diagnosis.
There is a commonly held belief in medicine, called Pasteur’s postulate that there is “one cause for one illness”. This does not apply to patients with chronic Lyme symptoms, or those diagnosed with Fibromyalgia. Once we address infections like Lyme disease and all of the other underlying etiologies on the MSIDS 16 point map, resistant fibromyalgia symptoms often improve.
Dr Richard Horowitz is a board certified internist, and author of the recently released book “Why Can’t I Get Better? Solving the Mystery of Lyme and Chronic Disease”, available through St Martin’s press.
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