Fibromyalgia and Ayurveda

Transcription

1 Fibromyalgia and Ayurveda Ayurvedic Nutritional Therapy, Pancha Karma Detoxification Programs and Ayurvedic Life Style Suggestions As an Alternative Treatment for Fibromyalgia Claudia Brachtl, L.Ac., Dipl. Ac., Dipl. C.H.

2 Fibromyalgia is the name for persistent, diffuse, aching pain affecting the muscles and connective tissues of the body (tendons and ligaments). It is a condition that has been described in the medical writings for hundreds of years and has been called a number of different names: fibrositis, myalgia, myositis, myofascial pain syndrome. Fibromyalgia is difficult to diagnose on objective physical findings. There are no consistent lab abnormalities such as objective measures of inflammation or actual damage to the muscles. Patients do not have a specific, easily identifiable lesion of the body. For all of these reasons, fibromyalgia is a particularly frustrating condition, both for patients who suffer with it, and doctors who want to offer their patients help and relief (1). According to the American Academy of Rheumatology, criteria require pain distributions across the four quadrants of the body and for tender points to be 11 or greater of 18 points. Tender points are located in the neck, spine, shoulders, hips and knees and are painful when pressure is applied to them. Accompanying symptoms are the following: Symptoms relating to the central nervous system: Fatigue, irritability, nervousness, depression, apathy, anxiety, insomnia, suicidal thoughts, frequent awakening, impaired memory. Symptoms relating to the musculoskeletal system: Shoulder joint pain, neck pain, upper and lower back pain, knee pain, elbow pain, wrist pain, hip joint pain, chest pain, TMJ pain. Symptoms related to the gastrointestinal system: Nausea, indigestion, gas, bloating, cramping, constipation, diarrhea, mucus in the stools, and irritable bowels. Symptoms relating to the genitourinary system: Frequent urination, bladder spasm, dysuria, vaginal spasm, vulvitis, vestibulitis, dyspareunia, yeast infection, interstitial cystitis. Symptoms relating to the dermatological system: Skin rashes, itching, increased skin sensitivity, prickling sensation. Miscellaneous symptoms include: Headache, dizziness, vertigo, imbalance, blurred vision, dry eyes, numbness and tingling of hands, feet or face, postnasal drip, abnormal taste, tongue irritation, leg or foot cramp, weight gain, brittle nails, hair loss, low grade fever, sensitivity to sound, lights, odors, or chemicals, swelling of eyelids in the morning, hypoglycemia and sugar cravings (2). How common is fibromyalgia? Who is mainly affected by it? The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) estimates that the number of adults in the United States with FM is about 3.7 million. Other organizations estimate that the number may be as high as 8 million. It mainly occurs in women of childbearing age, but children, the elderly, and men are sometimes 2

3 diagnosed with FM. What causes fibromyalgia? Although the cause of FM is unknown, researchers have several theories about causes or triggers of the disorder. Some scientists believe that an injury or trauma may sometimes cause the syndrome. This injury may affect the central nervous system. FM may be linked to muscle changes that cause fatigue and decreased strength. Others believe that an infection caused by a virus or other agent may trigger FM in susceptible people.other possible factors in FM include psychological stress, hormonal changes, or other changes in body chemicals such as serotonin and Substance P. The hormones produced by the hypothalamus-pituitary-adrenal (HPA) axis may be important in FM. Sleep problems, so common in people with FM, may be a cause as well as a symptom of FM. Increased sensitivity to the perception of pain seems to be involved. There is some controversy about the criteria for diagnosing FM. Some experts believe that it is not necessary to have at least 11 tender points for diagnosis, or pain that affects all segments of the body at the same time.dr. Lee Vliet believes that fibromyalgia is caused by a hormonal imbalance. She states that eighty percent of all fibromyalgia patients are women between the ages of thirty and fifty. According to her research, stress will cause a drop in estradiol, which has an effect on nerve transmission and decreases the pain threshold. This will lower serotonin and endorphin levels in the brain which leads to more pain, causing more anxiety, irritability and muscle tension. Sleep as well as nighttime muscle repair and healing are disrupted, which leads to more pain and another drop in ovarian hormones such as estradiol. Hence, a vicious cycle is created. Synthetic HRT is not the answer according to Dr. Lee Vliet. Synthetic hormones seem to make fibromyalgia worse, but she has seen improvement with natural hormone compounds. How is fibromyalgia treated? FM patients may benefit from a combination of exercise, medicine, physical therapy, and relaxation. There are medicines that may help elevate mood, improve quality of sleep, reduce pain, and relax muscles.drug therapies used in fibromyalgia include: Drugs for pain. These include aspirin, ibuprofen, and other pain relievers. Antidepressants. These drugs can help relieve depression and may also help with sleep. Low doses of certain tricyclic antidepressants and the newer serotonin boosters (SSRIs) are often used. Drugs for anxiety (anxiolytics). These medicines can help with anxiety and with sleep. Muscle relaxants such as cyclobenzaprine. Alternative treatment approaches: Fibromyalgia is best treated with a combined treatment approach, including physical therapy, myofascial release, craniosacral therapy, posture and movement training and chiropractic treatments. Gentle exercise to ease sore muscles by increasing blood circulation and range of motion. Biofeedback, yoga, tai chi, pilates, stress management nutritional counseling and acupuncture. Swimming in a heated pool to allow for greater mobility than can be obtained from other activities. Hot soaking baths with a half pound 3

4 epsom salt added to the water. Candida control diet. Supplements: 5 HTP for sleep, anti depression, increase in serotonin mg 3 x day Melatonin 33 mcg - 3 mg at bedtime (time released) SAMe, to alleviate depression 400 to 1600 mg daily Malic acid to help with muscle aches, three 350 mg capsules daily Digestive enzymes(one to two capsules before each meal) DHEA 25 to 50 mg (blood testing recommended, also test for adrenal stress) Borage or fish oil (3 soft gels twice daily) MSM reduces pain and inflammation (1000 to 3000 mg daily) Olive leaf extract helps with depression and pain Ayurveda and Fibromyalgia The above mentioned treatment approaches have proven to be helpful especially when used in combination. Still in my practice I have seen patients so incapacitated by fibromyalgia, that none of these approaches seemed to alleviate any of the symptoms these patients were experiencing. This is why I am interested in finding out what Ayurveda might have to offer in terms of treating this complex condition. I think that Ayurvedic treatments seem very promising as you will see later on in the case study. But first let s take a look at what is written in the ancient text Astanga Samgraha about pain and the involvement of the three doshas (imbalances) - vata, pitta and kapha: If vata is predominant, there is too much pain, throbbing and pricking, roughness, black or blue color, increase or decrease of swelling, catching pain in the body parts, dislike for cold, stiffness (loss of movement), tremors (or rigors), and loss of sensation.if pitta is predominant, there is burning sensation in the hands, feet, shoulders, etc., delusion, perspiration, fainting, toxicity, thirst, tenderness, pain, redness, swelling, ulceration and severe local heat.if kapha is predominant, there is inactivity, feeling of heaviness, loss of tactile sensation, greasiness, cold, mild itching and pain.if there is a combination of any two doshas or of all three, the symptoms of both or all of them will be present. In the Madhava Nidana, a classical text on Ayurvedic pathology, translated by Gupta, it states that vata vayadi is caused by practices which derange air, filling vessels in one part, or all over the body...produce the symptoms of the disease. It goes on to say when air is deranged...the muscles of the small joints are contracted with rigidity and cannot be moved. These symptoms are accompanied by spasm of different parts with loss of sense and great fatigue. Ayurvedic Diagnosis of Fibromyalgia Fibromyalgia Starts with the Growth of Imbalance There are many factors that can be involved in the chronic pain and tenderness associated with the fibromyalgia condition. These factors are not always the same for each individual. However, in general, Ayurveda views the condition resulting from two major causes: 4

5 1) disturbance in nervous system function (called "Vata" in Ayurveda) and 2) an accumulation of toxins and blockages ("ama") throughout the physiology. As the nervous system becomes less stable and aggravating impurities accumulate the ground for fibromyalgia is created. Once these imbalances reach a critical level, often a further stressful experience or event in a person s life triggers the onset of fibromyalgia symptoms. When the individual becomes more balanced and rested the symptoms subside but when the individual has stressful events, poor sleep, poor diet etc. the symptoms flare up again. Following is an overview that shows 6 major areas of Ayurvedic assessment and how imbalance in each of these areas relates to the fibromyalgia condition. This explains how the two majors causes of fibromyalgia symptoms (Vata imbalance and accumulated impurities) can be created by a wide variety of imbalances. 1.Vata Nervous system, Elimination, Respiration, Circulation: Vata is the main imbalance in the fibromyalgia condition. Aggravated Vata destabilizes the nervous system and can create hypersensitivity leading to pain and tenderness. 2.Pitta Digestion. Metabolism: Poor digestion and metabolism can lead to the buildup of toxins and impurities that aggravate the nervous system creating pain and tenderness. 3.Kapha Overall Tissue development: Kapha imbalance creates blockage in circulation and disruption of normal nervous system function. 4.Ama Level of toxins and blockage in the body: Ama is the impurities, like free radicals, that are highly irritating to tissues including the nervous system. Ama also includes the toxic buildup that blocks channels of circulation and communication and prevent the body from cleansing and healing itself. 5.Dhatus Balance of specific tissues: "Majja" is nervous system tissue and fibromyalgia is mainly a destabilized, hypersensitive state of nervous system function and majja tissue. 6.Ojas Immunity: Fibromyalgia is often associated with low ojas that creates fatigue, lack of vitality and susceptibility to infection. Creating General Health to Remove Specific Symptoms of Fibromyalgia Ayurveda focuses on creating overall health and balance as the main path to remove the 5

6 specific symptoms of fibromyalgia or any chronic disorder. The foundation of the Ayurveda approach is to enliven the healing response, the body s overall capacity for balance and self-repair. Ayurveda recommendations attempt to create the ideal mental, physical and behavioral environment for healing. The resulting enlivened inner intelligence of the body and strengthened self-repair mechanisms then naturally repair the imbalances at the basis of the fibromyalgia condition. Remember the fibromyalgia condition is just a symptom created by imbalances in basic bodily activities. Just as when you add light the darkness disappears, often fibromyalgia symptoms resolve when basic physiological balance is restored.this is the foundation of the Ayurvedic approach to all chronic disorders. First, by restoring healthy lifestyle we stop the mistakes that create the root imbalances at the basis of the fibromyalgia condition. Secondly, by assessing where imbalances are in the biological intelligence that controls the basic functions of the body (digestion, metabolism, elimination, circulation, nervous system and immunity), and using natural approaches to remove those imbalances, often symptoms of fibromyalgia begin to lessen and disappear (3). Ayurvedic Approach of Fibromyalgia Treatment The aggravation of Vata dosha and accumulation of Ama (toxins) are the primary causes and should be treated mainly. Associated weak digestion, constipation, insomnia and effects of chronic stress should also be tackled. Pancha Karma Therapy Pre-purification measures namely 'snehan' and 'swedan' are very useful to balance 'Vata' and to loosen the toxins. Snehan is the herbalized oil massage. This oil is applied to the entire body with a particular type of massage. Swedan is sudation or sweating and is given immediately following the snehan. An herbal concoction may be added to the steam to the further enhancement of effect. Daily herbalized oil massage also provides a deeply soothing and balancing effect to the entire nervous system. The motion of massage creates heat and friction which enhances circulation and helps cleanse the areas of chemical impurities that could be aggravating and hyper-sensitizing nerve tissues. Pancha Karma is indicated in the strong patient who has ama (toxins). Weaker patients with low ojas should not do Pancha Karma, but should do the palliation therapy called Shamana (mild purification therapy). Diet and Nutrition Following is the diet suggested for the patients suffering form fibromyalgia: Vegetable juices and soups Coconut water and coconut milk Juice of carrot, cucumber, beet root Cooked vegetables like squash, zucchini and pumpkin Spices like cumin, coriander, ginger, asafetida, garlic, fennel and turmeric. Green salad with a dressing of lemon juice and a little salt Khichadi (recipe made by cooking rice and mung dal, 1:1 or 1:2 proportion) The fibromyalgia patient should avoid the following: 6

7 Too much tea, coffee, alcohol, white sugar, yogurt, chocolate, cocoa. Sleeping during the day and staying up late at night. Mental tensions like worry, anxiety, fear, stress and grief.irregular meals, too many raw foods. Many people suffering from chronic pain turn to readily available drugs for relief: alcohol, nicotine, caffeine, pain killers, and the like. Each of these substances has many adverse effects on the brain chemical messengers, which collectively result in intensified pain. Cold and iced drinks, especially during or after meals. Instead of drinking ice cold water, drink warm water (preferably herbal tea ) during the meal. Yoga for Stress Management and Improved Mental and Emotional Function It is well documented that fibromyalgia is often worsened by heightened 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. The sleep disturbance that is often created by fibromyalgia symptoms increases fatigue which in turn increases one's susceptibility to stress which in turn aggravates the fibromyalgia condition.meditation, Yoga, Pranayama and studying of spiritual philosophy are all recommended for supporting personal healing and relaxation of the mind. Efforts should be made to increase the sattvic quality of mind. Yogasana : Various stretching exercises are known to have a positive effect on fibromyalgia. Regular practicing of sets of different postures are helpful in creating a healthy flexibility throughout the body. Yogic breathing practices will also create a state of restful alertness in mind and body. Progressive deep relaxation, i.e., shavasana (Corpse posture) brings about a relaxed state of mind which prepares the individual for meditation. Lifestyle and Daily Routine One of the most important factors for balancing Vata and maintaining stability in the nervous system is to have a lifestyle that does not disturb natural bodily rhythms. When we eat, sleep and exercise in constantly fluctuating and disturbing patterns, the body loses its natural balancing cycles. Therefore regularity in our daily routine can be extremely effective in reducing Vata imbalances. Ayurvedic Herbs Decoction of the roots of ten herbs (Dashamularishtam) should be given in the dose of 30 ml, twice daily. Daily use of the Ayurvedic compound 'Triphala choorna' is recommended to cleanse the colon. Half a teaspoon of turmeric powder with warm water helps to reduce pain and inflammation in fibromyalgia. Dosage: twice a day Garlic is useful for detoxification and to enhance immune system function. Guggul is a very helpful herb for the relief of pain. Kaishore guggulu is good for pitta aggravated fibromyalgia patients, yogaraj guggulu is better for vata imbalances. Licorice root supports the glandular system and acts in the body like cortisone, but without the harmful side-effects. Caution: If overused, licorice can elevate 7

8 blood pressure. Do not use this herb on a daily basis for more than seven days in a row. Avoid it if you have high blood pressure. Ginger Tea. Ginger is a good alternative to aspirin to relieve minor aches and pains. Steep 1 teaspoon of the grated root in 8 ounces of hot water for 10 minutes. Strain. Add honey for taste, if you like. Alternatively, take 1 to 2 grams of powdered ginger a day with food. It is recommended to see an Ayurvedic specialist for evaluation and dietary and herb suggestions. Vaidya R.K. Mishra s Fibromyalgia Protocol Vaidya Mishra noted that the 18 fibromyalgia diagnostic points correspond with some of the major marma points. Marma points are vital points, they are receptors for vibrational healing from the universe. Pain at these points is an alarm signal and means that nature is telling you that it is time to heal body, mind and spirit. Vaidya Mishra states If you ride a bicycle a lot, you become very good at it, if you swim a lot, you will be an excellent swimmer. The more you feel pain, the better you will become at feeing pain, anything will trigger pain, the nervous system learns to feel anything in terms of pain. It is important to retrain the nervous system into a new pattern. Chiropractic work, acupuncture, etc. will teach the system not to feel pain, but will not be strong enough to eliminate it. Combined with Ayurvedic principles and the removal of toxins from the body, those treatments will be successful. Vaidya Mishra emphasizes the importance of drinking good water. Filtered water is not a good choice, it needs to be spring water. Check the salivary PH of the patient, many fibromyalgia patients are too acidic. Trinity or Volvic are high alkaline waters, which will balance the body. Deep breathing is important. So many people pay a lot for pills and supplements, but forget the most important thing which does not cost any money: breathing! Being in nature to get all of nature s vibrations. Vaidya Mishra designs herbal waters for his fibromyalgia patients, he advises them to take a few sips, then take deep breaths, throughout the day. He designed transdermals which are applied to the major marma points, these transdermals are effective, because they are absorbed by the skin, and bypass the digestive system, which might be having problems. You need to work with doctors to slowly get the patient off medications, it is important to titrate them.vaidya Mishra had designed his herbal waters because he thinks it is dangerous to detoxify too quickly: Over the years, after having practiced Ayurveda here on the American continent, I realized that the Indian diet and Ayurvedic protocols were not applicable to western physiology. For example, Indian children start eating turmeric from very early on as infants. Turmeric is a great spice for combating almost any disease. For Indians, who grow up eating turmeric their liver acquires an internal immunity such that it is less prone to accumulating any toxic ama. In contrast, the western liver is not ready to detoxify as readily even during regular detour season in the spring or the fall - because the liver is overloaded with acidic toxins that can rupture the circulatory channels when being evacuated. So after my first year of practice, I realized I needed to modify my formulations and recommendations. When acidic toxicity is already sitting in the liver, even if one eats good organic food, does yoga as well as adopts any other possible health-inducing protocol, if the detoxification 8

9 organ of the body is itself in crisis, the blood will not be infused with prana vibrations, and this will affect all aspects of health. So I figured I needed to develop some alternative strategies for delivering herbal products that would bypass an already overworked liver. Having a background in dermatology, I formulated transdermal products, capturing the essence of the herbs and placing them in a natural base so that they would be applied on the skin. In this way, the herbal essences would be made to travel through the skin, leaving the liver alone. But then I was faced with another challenge: transdermal reception had to be optimal, because no matter how great the product, the body needs to have an intact intelligence of reception in order to be able to make use of the herbal essences. So I was led to the idea of applying these transdermals on the body s marma points. It is at this point that one of my chiropractor students called from Washington DC saying he was trying to develop a protocol for his fibromyalgia patients, and I got involved working with him on this project. I was not familiar with this chronic disease beforehand, so I started doing some research. So I bought a fibromyalgia book. I noticed that there were 20 recurrent fibromyalgia points that had been isolated by physicians. I was intrigued because I noticed that they all corresponded to marma points! We used marma therapy in my family as an additional tool to relieve disease. After researching these points further, I developed 2 transdermal creams specific for two fibromyalgia points and gave them over to my student chiropractor. He used them with his patients in addition t the herbal water and diet changes that I generally recommend, and he obtained tremendous results in only 24 hours. That encouraged me to formulate some more products. We perfected a fibromyalgia protocol, complete with Ayurvedic recommendations, and enhanced by the Transdermal Marma System I developed. As a practitioner, you should be able to provide some relief to an overtaxed brain and body so that the individual can see some concrete results. You should be able to make the patient feel better than when he walked into the room, so that people can understand how safe and effective Ayurveda can be when used properly. Vaidya Mishra has designed specific herbal waters, based on the patients PH levels: Two quarts of water are boiled for 5 minutes and poured into a thermos containing the herbs. The water is sipped throughout the day. For a PH below 6.5: 2 pinches DGL 2 pinches marshmallow root 1/2 teaspoon fennel 1/4 teaspoon coriander 2 leaves mint 1 Tablet Total Tulsi For a PH between 6.5 and 7.4 1/4 teasp fennel One pinch DGL 1 pinch marshmallow root 1 tablet Total Tulsi For a PH above 7.4 (more Kapha) 1/2 teasp fennel One pinch DGL one black peppercorn 9

10 1 clove 1/4 teasp Coriander For Fibromyalgia add: 2 pinches manjistha, 2 pinches guduchi 1 tablet of amla berry after lunch and dinner DGL on palms, soles and liver Transdermals: joint relief, pro -pain, emotional- release DGL, muscle-maintain Probiotics Ayurvedic Coral Calcium 1-2 tablets per day A spice mixture that can be added to vegetables or rice can be designed for the fibromyalgia patient. Ingredients vary according to PH level. Turmeric is an excellent liver cleanser and good for immune system problems, but you have to be careful and just use it in small amounts. Spices are sautéed in ghee and then vegetables are added, thus ensuring the benefit of the water and fat soluble fractions. For PH under 6.5: 1 part turmeric, 1 part cumin, 6 parts coriander, 6 parts fennel For PH between 6.5 and 7.4: 2 parts turmeric, 3 parts cumin, 6 parts coriander, 6 parts fennel For PH higher than 7.4: 3 parts turmeric, 4 parts cumin, 6 parts coriander, 6 parts fennel, 1 part black pepper, 1 part ginger Always check the salivary ph first thing in the morning. Conclusion Fibromyalgia has proven to be a difficult condition to manage due to its complexity. Finding an appropriate treatment has created difficulty for the practitioner. Pain medications and antidepressants may be beneficial to some patients and of little help to others. In addition, side effects often outweigh benefits and create complications of their own. Ayurveda seems to be a viable alternative since it not only aims at healing the body but on a subtler level the mind and the spirit. Even in western medicine it is now acknowledged, that chronic pain can lead to a deconditioned nervous system that can cause greater pain sensitivity. Ayurveda has great success in treating the nervous system. In Ayurvedic terms a Vata disorder, it can be balanced with a number of treatments, therapies, diet, breathing techniques, life style changes and spiritual practices. Just implementing diet, herbs and other Ayurvedic recommendations will be beneficial for fibromyalgia. Patients will start feeling better right away, but since fibromyalgia is a condition that takes a while to develop, they should not expect any over night miracles. However, I believe that exploring Ayurveda might truly change their lives and lead them on an amazing healing journey. 10

11 References (1) Elisabeth Lee Vliet, M.D. Screaming to be Heard :231 (2) Dr. Sam Liang AAOM Conference 2002 Nov (3)Dr. Nancy Lonsdorf - Online Newsletter on the Maharishi Approach to Fibromyalgia (4)Dr. Shashikant Patwardhan, July