Fibromyalgia, also called fibrositis, is more prevalent in adults, with a higher incidence in women.
Decreased levels of ATP and changes in energy metabolism have also been found in the red blood
cells of fibromyalgia patients, suggesting that fibromyalgia may be a more general and systemic
problem than originally thought, possibly impinging on other organ systems.

 Ache all over: waxes & wanes, similar to arthritis
 Fatigue: feels like muscles are pulling: pain in ligaments and tendons
 Muscles twitch & burn
 More women affected
 Lack of energy (severity of symptoms fluctuate)
 Resembles post viral state
 Possible relation to CFS
 Sleep disorders (REM level of
3-4 interrupted) creates alpha
EEG anomaly in deep sleep
 Alpha wave intrusion
 Chronic headaches
 TMJ dysfunction syndrome
 PMS, chest pain, morning
stiffness, memory impairment,
numbness & tingling sensation,
muscle twitching
 Skin sensitivities, swollen
extremities, dry eyes & mouth,
dizziness, impaired
 Vision problems
 The chemistry of the brain is imbalanced because the chemistry of the brain is a mess
(chemical pain)
 Liberalism (see bullet point above)

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Diagnosis of fibromyalgia:
 Can be very difficult, must rule out other diseases, as it mimics other disease states
 Acupressure points
 Must have pain in all 4 quadrants of the body for a minimum of 3 months
 Muscular-skeletal pain & fatigue
 Up to 18 sites clustered around the neck, shoulders, chest, hip knee & elbow
 Usually bilateral, usually 11 out of 18 sites
 No real definitive laboratory testing except, O2 Utilization & VO2max.
 Not considered an inflammatory disease
 A Cortisol inverted ratio
 LOW TESTOSTERONE LEVELS (this modulates pain & endorphin levels)
 Substance P, FM produces 4x’s as much here as in response to normal noxious stimuli
 GH deficiency, due to non-REM sleep
 Due to interruption of slow waves

Aggravating factors:
 Deep level of sleep is interrupted, (stage 4-rem, you get an altered alpha; EEG
 Changes in weather
 Hormonal imbalances & fluctuations
 Stress, depression and over-exertion
 Physical exertion, even mild exertion
 The aerobic capacity decreases as you age

The Inflammatory Cascade Precipitating events that trigger onset:
 Infections, viral or bacterial
 Traumatic accidents
 Most FM patients consume enormous amounts of CARBOHYDRATE-rich foods, which may greatly contribute to their symptoms!
 Heavy metal toxicity
 Rheumatoid arthritis
 Lupus Erythematosis
 If resting oxygen is low, the thyroid is problematic
 Hypothyroidism:
 Poor Dietary habits esp., HIGH FRUCTOSE CORN SYRUP, as this is toxic to the body’s
metabolic process and affects fibromyalgic’s to a greater degree!

All the above events may awaken underlying physiological abnormalities
that are already present.

TESTING and LABORATORY SCREENING for Chronic Myofascial Syndrome
(Hematological Profile, Blood Chemistry & Vitamin testing)
~ Janet G Travell, MD; The Trigger Point Manual, 1983, p 155.


1. ESR (Erythrocyte Sedimentation Rate). If normal, no chronic bacterial infection.
If elevated, it is non-specific and may indicate other conditions such as, RA or cancer.
2. ESR, if decreased, or low hemoglobin, indicates anemia which tends to make muscles
hypoxic and increases TP (trigger point) irritability. Anemia can be caused by a folate or
cobalamin deficiency.
3. MCV, if increased above 92 (95-100), a folate or cobalamin deficiency is likely increased.
4. Eosinophilia, if elevated, may be due in part to an active allergy or an intestinal parasite like
E.histolytica or tapeworm.
5. Monocytes, may be due to low thyroid function or an acute viral infection
(if elevated, more than 50%)


1. URIC ACID LEVEL: if increased:
indicates gout (hyperuricemia)
2. POTASSIUM: if low can cause
muscle cramps and increase
myofascial TP’s
could mean calcium deficiency.
increased could indicate low
thyroid function: if low could
mean low folate


1. B1, B6, B12, FOLIC ACID & VITAMIN C: abnormally low levels of any of these
vitamins perpetuate TP’s
2. esp., if in of lower quartile of normal
T4- T3 And Basal Body Temperature
~Janet G Travelle, MD; The Trigger Point Manual, 1983, p. 156


Theories explaining fibromyalgia:
 Hormonal system imbalances (PMS, ERT, HRT, etc.)
 Viral symptom imbalance
 Alterations in sleep physiology
 Low levels of IGF-1 are present in most FM patients
 Sleep apnea
 Mitochondrial derangement in small muscle fibers
 Sleep deprivation
 Alterations in immune system function
 Alterations in brain chemistry & function, esp., neurotransmitters (esp., serotonin)
 Toxin exposure can result in prolonged firing of the body’s pain receptors, increasing
sensitization and exaggerating the central nervous system response. Exposure to
heavy metal mercury may contribute to altered inflammatory and immune responses
and have neurotoxic effects.

Muscle hypoxia and prolonged energy deficiency, may be causes of fibromyalgic pain.

Biochemical studies have confirmed that energy metabolism is abnormal in fibromyalgia, thus
requiring appropriate metabolic therapy. ~Olson NJ, JH Park 2

Most current theory is that oxygen deprivation may be the culprit!

Blood flow to the tissue in fibromyalgia patients is lower than normal thus leading to:


Reduced blood flow, changes in capillary wall thickness and structural changes to the
mitochondria contribute to hypoxia, decreased oxidative phosphorylation, lower ATP
synthesis and reduced levels of Adenine Nucleotides in fibromyalgic muscle.

Recent research has shown that those with fibromyalgia have capillary walls (capillaries are the
smallest of blood vessels that bring blood and oxygen to affected muscles) that become thickened
and are unable to deliver enough oxygen to fully meet the need in the tissue. This lack of oxygen
creates localized ischemia, draining energy from muscles.

Energy depletion then unleashes a cascade of physiological events that cause mild to severe pain;
muscle stiffness and soreness; and overwhelming fatigue. One of the major impacts of the cellular
energy deprivation associated with fibromyalgia is the muscles’ inability to manage their own
calcium load.

The subsequent lack of cellular energy inhibits the activity of the cellular calcium pump, so that
calcium cannot be adequately discharged from the cell following a muscle contraction. YOU MUST

This buildup of calcium in the cell sustains the muscle’s contraction, keeping it tense. The increase
in intracellular calcium also causes potassium ions to rush out of the cell, activating pain receptors
on the cell membrane called nociceptors. Most of us experiencing muscle pain do the same thing:
tense and tighten that painful area even more.

All this contraction contributes to more muscle stiffness and exacerbates the drain on energy
reserves. We all know how exhausting pain is, both physically and emotionally. And so, the
downward spiral continues.

Some patients, having been in an automobile accident, for example, go on to develop symptoms.
Others, exposed to environmental toxins like heavy metals, insecticides, and pesticides, become so
poisoned that they develop these symptoms. These factors, and others, are causing the incidence of
FM and CFS to increase.

Additionally, the poor bioenergetic status of muscles in the fibromyalgia syndrome may be due to
reduced blood flow in the affected tissue, which in turn would limit production of ATP. Just as a
heart in failure is energy-starved, so is a fibromyalgic muscle. Since decreased levels of ATP and
changes in energy metabolism have been found in red blood cells of fibromyalgic patients, and that
blood is circulated throughout the body, some researchers now believe that fibromyalgia may be
more of a systemic problem than a localized one.

Current treatment regimens forfibromyalgia:
 Physical therapy & aerobic therapies
 Acupuncture & acupressure
 Stress & relaxation therapies
or DKN Vibration Plate technology (3x’s QW.)
 OXYGEN UTILIZATION: a 45-minute test utilizing a
pulmonary gas analyzer & an exercise ergometer
 Mitochondrial energy optimizer by Life Extension,
(for energy & fatigue)
 Body-Bio the P-K Protocol for membrane
 IAG & Amino Sport : Biotics research Inc.(arabinogalactins & amino acid formula for muscle strength)
 Cognitive Reframing
 Txt in a hyperbaric oxygen chamber
 SAM-e, a methylator
 Ambien gives steady sleep pattern BUT is addictive
 Tramadol (Ultram) decreases the use of opioids to decrease tolerance and addiction
 NEO-40, increases NO Levels
 PQQ, boosts mitochondrial biogenesis
 PEMF bio-magnetic mats, BEMER or INRF brands
 NAD+, from Life Extension
 Magnesium Orotate, 600 mg qd. to bowel tolerance
 NT-Factor, Trace minerals, and OZONE THERAPY!
 D-RIBOSE, D-RIBOSE, D-RIBOSE, (15 mg per day, dispense TID.) D-Ribose supplementation accelerates the metabolic pathways responsible for making the ATP molecule itself, rebuilding energy pools and promoting normal heart and skeletal function.
 Balance all HORMONES, esp. thyroid & testosterone
 Balance all NEUROTRANSMITTERS, esp. Serotonin and Dopamine
 Control insomnia, OSA, esp., stage 4 REM-sleep
 Trigger point injections
 Address ADRENALS
 Myotherapy
 Humira, a TNF-alpha blocker (for severe arthritis) (polyarticular arthritis and CROHN’s), suppresses the immune system and can cause SERIOUS SFX.
 Testing for V-max and O2 utilization potential
 Move around and move often, aerobic exercise is hugely important
 CFS & FM: have a higher Inflammatory Cytokine Index and this inhibits IGF-1
 Remove all heavy metal toxins, see next step:
 The key botanicals in Ultra Clear Renew may modify upstream signaling pathways. Such as:
 Phase II enymes in the liver (GST,NQO-1,and activators such as:
 Nrf-2, HO-1, associated with the antioxidant response element (ARE) and metal response element (MRE)- Transcriptional elements that induce toxic element metabolism and liver detoxification
 Proper exercise techniques
 ULTRA CLEAR RENEW (Metagenics) helps patients manage pain and stiffness as well as
helping with urinary output of heavy metals.

Txt with: Ultra Renew & Ultra Clear Renew for 4 weeks caused a reduction in:
1. FIQ total score, (fibromyalgia impact quotient or Questionnaire)
2. Decrease in fibro-quest score
3. An increased mRNA expression of METALLOTHIONEIN, a cellular protein that plays
a role in the metabolism of heavy metal elimination.
4. An increase in Creatinine-adjusted excretion of Hg++


Biopsy studies investigating the metabolism of ATP, creatine phosphate (PCr), ADP, AMP,
pyruvate and glycogen have shown that levels of PCr and ATP are significantly lower (21% and
17%, respectively) in fibromyalgic muscle and the synthesis of PCr, the most important store of
high energy phosphate in the cell, is defective.

P-31 MRS looks directly into the muscle to determine the absolute values of energy compounds,
muscle pH and changes in metabolism as they occur at rest and during exercise. In addition, during
exercise there is an increase in metabolic breakdown products of ATP energy metabolism and
disruption of cell membranes, both associated with muscle disease.

The energy reserve, or phosphorylation potential (PP), and the ability to utilize oxygen (total
oxidative capacity or Vmax) have been determined using P-31 MRS. The mean PP is significantly
lowered in FM patients and V-max is also significantly reduced. These findings are consistent with
reduced oxidative phosphorylation and ATP synthesis in the muscles of fibromyalgia patients and
may translate into the clinical symptom of fatigue.

Poor bio-energetic status of muscles in fibromyalgia may be due to reduced blood flow to affected
tissue and thickening of capillary walls, leading directly to reduced levels of ATP, lower energy
reserves and oxidative capacity (V-max) and abnormal levels of phosphor-diesters in the muscle.

The additional complication of impaired oxidative phosphorylation in the mitochondria and
diminished glucose metabolism, both lowering ATP turnover, suggests that fibromyalgic muscle is
energy starved. Decreased numbers of capillaries that reduce oxidative capacity may increase pain,
while thickened capillary walls lowering oxygen delivery and abnormal mitochondria lead to
fatigue and weakness. All are associated with reduced levels of ATP and energy metabolism that, in
turn, leads to disruptions in calcium stasis, muscle soreness and stiffness.

Ribose in Maintaining Tissue Energy Stasis

Tissue hypoxia leads to a progressive depression of the cellular purine nucleotide pool creating an
energy deficit. The adenine nucleotide ATP is the primary energy source of all living cells.
Exogenous ribose administration provides the metabolic support required to bypass the rate
limiting enzymes of the PPP, form PRPP and restore energy stasis in metabolically stressed muscle.
The effect of ribose treatment in myoadenylate deaminase deficiency (AMP deaminase deficiency)
and adenylosuccinase deficiency has been well documented. Like fibromyalgia, these conditions
lead to progressive depletion of cellular energy pools, leading to muscle pain, soreness and
stiffness. The beneficial role in energy recovery in these disease conditions with ribose treatment is
suggestive of its potential role in energy recovery in fibromyalgia.