Pharmaceutical treatment of fibromyalgia includes tricyclic antidepressants, SSRIs, norepinephrine reuptake inhibitors, anticonvulsants, and analgesics, and is often directed only at management of pain symptoms. As many as 98% of patients use some form of CAM therapy, to manage symptoms. Multidisciplinary treatment of fibromyalgia is recommended including aerobic exercise, relaxation exercise, massage, meditation, acupuncture, hypnotherapy, cognitive behavior therapy, transcutaneous electrical nerve stimulation and dietary supplementation in addition to pharmacotherapy.
Addressing thyroid function may be key to effectively treating patients with fibromyalgia. Clinical protocols with T3 may include T3 (up to 150 μg per day) or T3/T4 combinations (4:1 combo 40 μg T3/10 μg T4 (1–2 times per day)). Treatment with T3 should continue until the patient achieves a body temperature of approximately 98.6°F for 3 weeks. As a general guideline temperature should be based on acrophase temperature taken between 16:00–21:00, when body temperature is highest. Taking first morning temperature before rising, between 03:00–06:00, temperature values would be expected to be approximately 1.8°F lower. It is also important to consider the patient’s age, gender, and if female and ovulatory, the phase of her menstrual cycle. Once this is achieved, T3 should be cycled down in a manner which maintains body temperature, usually every 2–5 days; however, this is dependent on the individual. In any case, body temperature must be monitored to ensure temperature is stabilized. T3 therapy has been reported to provide relief of symptoms associated with fibromyalgia, including fatigue, muscle pain, depression, headache and insomnia and has also been reported to increase metabolism rates and mitochondrial function. In one study, follow up was continued after cessation of treatment, and improvements persisted for 1–5 years. T3 can increase cardiac oxygen requirements, cardiac output and cardiac rate; therefore, although T3 normally reduces blood pressure, monitoring pulse for tachycardia is advised.
Despite wide-spread use of T4 to treat thyroid-related disorders and other non-thyroidal conditions, the effects of T4 are less clear with respect to mitochondrial function. It has been shown that treatment with T4 alone is not sufficient to elevate T3 in all affected tissues.
In cases of long term hypothyroidism which can lead to hypoadrenalism and decreased cortisol levels, hydrocortisone (5 mg twice a day) or licorice (240 mg glycyrrhizin twice a day) may be efficacious. Both hydrocortisone and licorice should be given upon rising and around noon to mimic the natural circadian rhythm. As licorice can lead to blood pressure elevation in some users, blood pressure monitoring is recommended while following this protocol. Should it become elevated, dosage should be reduced to 120 mg per day. Other treatments indicated to increase metabolism and reduce symptoms associated with fibromyalgia include the use of botanicals and nutraceuticals such as iodine, diodotyrosine, blue iris and guggul, which stimulate and support normal thyroid function, promoting an increase in T3 levels, and black cohosh for pain relief, a debilitating symptom associated with fibromyalgia. Each of these natural ingredients provide activities that may aid in reducing inflammatory processes and/or symptoms associated with fibromyalgia, which may in turn increase quality of life in this demographic of patients.