Why does fibromyalgia go into remission

I trust the judgment of my rheumatologist, however, who has heard that remission is indeed possible. Naturally, I enjoyed my time in remission, and readily look forward to the possibility of it happening again. We want to hear your story. Become a Mighty contributor.

The Mighty Asks We want to hear your story. Want the best Mighty stories emailed to you? No, thank you. There was a problem with the address entered. Please try again. Please enter a valid email address. Even if pain is the core symptom in FMS, non-painful symptoms may also impact the quality of life of patients.

Recognizing those symptoms may be difficult in the absence of other apparent organic diseases. This makes FMS a real challenge for physicians and healthcare professionals. We report the first case of controlled remission of symptoms in FMS, following a novel metabolic approach. The therapeutic protocol is a strict diet, focused on the withdrawal of food components that may interfere with the absorption of l -tryptophan Trp , 5-HT precursor The patient is a year-old woman, body mass index 18, Caucasian, high level instruction.

The onset of lower back pain, restless legs, and morning stiffness occurred few months after a surgery. The symptoms were first described as mild in severity, particularly concerning pain, and erratic.

One-year later, lower back pain and hip pain forced the patient to bed rest. Non-steroidal anti-inflammatory drugs i. Magnetic resonance imaging and X-ray investigations revealed a lumbar disk hernia and no lesions or abnormalities at hips. Previous treatment had no effectiveness and corticosteroid drug i. Pain was in part relieved by gabapentin, but only with slow dynamics and with collateral effects of suicidal thoughts and mental confusion. Further magnetic resonance and X-ray investigations confirmed the previous diagnosis with no new data to explain relapse worsening.

These episodes recurred three to four times a year, affecting life quality and mobility, and forcing patient to bed. Intriguingly, the worst episodes appeared to correlate to decreasing temperatures of the autumn.

The symptoms increased slightly, but progressively with unpredictable and fluctuating nature. Fatigue unrelieved by rest, low back pain, migrant aches in the joints, musculoskeletal widespread pain, short-term memory loss, concentration difficulties, and forgetfulness were the major symptoms.

The evaluation of her thyroid function did not reveal any abnormality [i. A modest improvement was observed during summer and hot weather conditions, but the unpredictable character of the symptoms made the patient feeling insecure and anxious. These had considerable impact on the everyday life, affecting social interaction and professional performance. The concomitant onset of such a pain to both hips and to the right shoulder led to investigate for rheumatic diseases and to the hypothesis of FMS.

Blood testing was then performed: rheumatoid factor, anti-nuclear antibodies, anti-nDNA antibodies research, anti-ENA antibodies, and anti-cyclic citrullinated peptide antibodies were all negative. Complete blood count was in the normal range. On a visit by a second specialist in rheumatology, tender points were accessed again, and the differential diagnosis of FMS was made.

The patient refused the proposed muscle relaxant drug i. The patient generally feared collateral effects of the drug treatments, and she was rather interested in the novel metabolic approach for the symptomatic remission in FMS The therapeutic protocol is a strict diet. It was devised to facilitate Trp absorption, and thus guarantee its bioavailability as a substrate for 5-HT synthesis.

In order to sustain 5-HT synthesis, it is mandatory to remove molecules that could negatively affect the fate of Trp in the gastrointestinal tract. The core of this approach is the exclusion of some carbohydrates from the diet and the proper intake of Trp with food Because of fructose is a high reactive sugar 14 , limiting the intake of fructose as much as possible is the essential point, including fructose chains, such as fructans and inulins, and some other molecules that do not have specific transport systems e.

Glutamate and aspartame should also be excluded Any food, beverage, or herb not in the previous list and not according to treatment guidelines is excluded from the diet protocol. Particularly, processed food containing artificial sweeteners, high fructose corn syrup, sorbitol, glutamate, and aspartame must be excluded: among others soft drinks, fruit juices and the majority of confectionery Most legumes, wheat and most cereals, and many vegetables that contain fructans and inulins 15 must also be removed Attention must also be paid to the excipients in pharmacological preparations, pills, syrups, and solutions The previous diet was mainly a Mediterranean diet.

It was rich in vegetables, fresh fruits, dried fruit, cereals, and legumes. It contained a moderate amount of fish, meat, dairy products, eggs, nuts, and sweets. In order to assess her dietary intake, the patient was asked to keep a food diary. This method requires the subject to list the consumed food and the state of health, reporting the presence of symptoms: widespread pain, fatigue, morning stiffness, bowel function, headaches, sleep quality, cramps, prickling sensation at fingers and toes, mood changes, anxiety, and depressive mood among others.

This method allows to evaluate compliance with the diet guidelines and the impact of diet modifications based on symptoms. It makes the patient an active subject to fight against the disease. The growing severity of symptoms highly motivated the patient to strictly follow the diet guidelines. Symptoms of depression disappeared. Fatigue unrelieved when rest disappeared and she regained restorative sleep.

Chronic musculoskeletal widespread pain and morning stiffness had a marked improvement up to no longer present. She recovered her energy and vitality. She got completely independent in all the activities of her daily life as before the onset of the disease by solving the occupational and social disabilities. The patient broke the dietary protocol: not admitted foods were arbitrarily, deliberately, and voluntarily assumed for instance, among others: eating a pear, or a fig, or an onion, or asparagus.

It plays as negative control. It is significant for three different reasons: to exclude a major placebo component in the remission of symptoms, to evaluate the short-term effectiveness of the treatment, and to validate the protocol as a final cure or a remission protocol. The recurrence of symptoms is correlated with diet faults.

The treatment leads to a remission but it is not a final cure. Two months after the beginning of the diet the patient was vastly improved in every aspect. She regained her positive mental outlook.

She returned to full employment. She recovered her energy and vitality as she did not since years. Marked not keeping occurred few times, being she well aware of the consequent recurrence of symptoms: when isolated, little faults trigger little symptoms; nevertheless, repeated and continuing faults have the potential for leading to the previous chronic condition of pain, fatigue, and mood symptoms. Moreover, being pain-free, the patient started physical aerobic exercise which she was unable to perform before due to stiffness and widespread musculoskeletal pain.

Some comorbidities did not completely solve: sensitivity to cold, hypersensitivity to odors and noise, dysmenorrhea, and memory lapses are still present.

Fibromyalgia syndrome is really a challenging, insidious, and disabling disease that afflicts patients and their relatives as a real burden in everyday life Epidemiological data clearly demonstrate the socio-economical burden associated with FMS and the urgency of effective answers 4 , 10 , 17 — Despite the large number of pharmacological and non-pharmacological clinical trials and studies performed, since nineties, an effective cure still lacks 1.

It has been clearly observed in experimental studies, although still not fully understood in its pathophysiological mechanism. Besides Trp, low levels of other essential aminoacids 30 , 31 and altered aminoacid homeostasis 32 have been reported in patients with FMS as compared to the general population: anyway, these findings did not translate into an effective cure 1. In this scenario, where the challenge for physicians and healthcare systems to face FMS is clear and still open 1 , we report the first case of controlled remission in FMS following a novel metabolic approach This report shows the crucial role of diet in FMS, and food choice as a key strategy for its management.

Intrinsically, a withdrawal approach avoids the potential side-effects associated with pharmacological therapies [i. The effectiveness-to-cost ratio of this approach is evident. It is a low risk and accessible therapeutic approach with virtually no costs for the treatment itself, than those related to possible vitamin and mineral salt supplements, and blood testing to evaluate their levels.

The economic perspective could be relevant bearing in mind the significant number of patients. Dietary modifications in FMS are not a new approach: different diets were attempted in the past, variably focused on the elimination of certain food or chemical additives Nevertheless, the therapeutic approaches proposed till now often did not ground on a solid theory which is able to fully predict and explain the experimental outcomes.

As in any therapeutic approach implemented for chronic pain, a significant placebo response should be considered. The placebo effect is reported in FMS 38 , Breaking the diet protocol with not admitted food aims to exclude the remission of symptoms by a main placebo contribution.

Although the placebo component could not be excluded at all a priori , the occurrence of an ad hoc nocebo effect precisely correlated with diet faults i. It is already known that nonimmunologically mediated adverse reactions to food, which resolved following dietary elimination, are then reproduced by food challenge Clinical improvement was reported after dietary treatment for fructose malabsorption in irritable bowel syndrome IBS patients by different studies 41 , 42 ; particularly, a significant reduction of symptoms and improvements in the quality of life proportionate to the amount of eliminated fructose was reported by Choi et al.

The threshold can be very low: the patient reports that even very low amounts of free fructose are able to trigger the symptoms.

In severe conditions, a compromise could not be possible at all, and a complete fructose-free diet is the suggestion. A patient-to-patient tailored approach is the best implementation in the clinical practice. This report supports the protocol intrinsically effective for the remission of symptoms in FMS. It is a matter of fact that adherence to the protocol is correlated with symptomatic improvements and non-adherence with the recurrence of symptoms.

Because of the abundance of fructose in our food supply as it is present not only in the form of simple monosaccharide, but also in the form of fructose chains , a strict fructose-free and fructan-free diet is binding, and maybe not required once patients experience sufficient relief from their symptoms.

This way, partial compliance with protocol guidelines may be a personal compromise to control the symptoms to a satisfactory level, while minimizing the social limitations that dietary restrictions impose. Painful periods are common with fibromyalgia and can add a monthly worsening to the already present pain. Some people find that their fibromyalgia flares follow their hormonal cycle, beginning at ovulation and tapering off during periods.

Painful and erratic periods are also common. Treatments ranging from hormonal therapy to endometrial ablation may be used to control symptoms.

As difficult as it may seem at times, a final practice many people with chronic diseases find helpful is expressing gratitude. Some people keep a gratitude journal or try to write down two or three positive things that happen each day. Some days your list may only include brushing your teeth, or the fact that no bills came in the mail. While we have no specific studies looking at gratitude and fibromyalgia symptoms, we do know that gratitude can reduce stress, and stress is a common trigger for flares.

No single treatment works for everyone, and achieving remission from fibromyalgia usually requires a variety of methods and lifestyle measures. Fortunately, ongoing research may guide us in more promising directions in the near future. Learn about treatment and lifestyle changes to cope with fibromyalgia and chronic fatigue syndrome.

Centers for Disease Control and Prevention. Lattanzio SM, Imbesi F. Front Med Lausanne. Fibromyalgia and non-celiac gluten sensitivity: a description with remission of fibromyalgia. Rheumatol Int. J Clin Sleep Med. Combination pharmacotherapy for the treatment of fibromyalgia in adults. Cochrane Database Syst Rev.

Adams, E. Journal of Pain Research. Schaefer, C. The Open Rheumatology Journal. Your Privacy Rights. To change or withdraw your consent choices for VerywellHealth. At any time, you can update your settings through the "EU Privacy" link at the bottom of any page.

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S Schaefer, C.