Exploring the Research on Homeopathic Treatment for Fibromyalgia

Fibromyalgia is a chronic ailment without a known cause and without a safe, effective conventional medical treatment. However, the three to six million Americans who suffer with fibromyalgia will be pleased know that several studies published in leading medical journals have found outstanding results from homeopathic treatment.Well-designed high quality scientific studies published in the British Medical Journal and inRheumatology (the journal of the British Society for Rheumatology) have confirmed the real benefits of homeopathic medicines as distinct from a placebo.Fibromyalgia is not considered to be a "disease" by the conventional medical standards but is recognized and referred to as a "syndrome." Although there are no specific blood tests, x-rays or any other type of technology that is presently accepted by conventional medicine for diagnosis of this condition, the diagnosis is based on clinical findings from the history and physical exam (pain in tender points).Fibromyalgia was previously called "fibrositis," but this name was changed when it became evident that inflammation was not a part of this condition. In 1990 the American College of Rheumatology (ACR) established criteria for the classification of fibromyalgia as a product of a well-designed, multi-center study of the condition (Wolfe F et al, 1990). As defined by ACR, fibromyalgia must include:

1. A history of widespread pain for at least three months. Widespread pain must have all of the following: pain in the left side of the body, pain in the right side of the body, pain above the waist and pain below the waist. In addition, axial skeletal pain (cervical spine or anterior chest or thoracic spine or low back) must be present.
2. The patient must report feeling pain in 11 of 18 tender sites on digital palpation (with 4 kg of force) which are located bilaterally on the body.
3. Lastly, the presence of a second clinical disorder does not exclude the diagnosis of fibromyalgia.

The syndrome of fibromyalgia can cause stiffness, fatigue, myalgias (muscle pain), subjective numbness, headaches (often migraine), dizziness, paraesthesias, IBS-like gastrointestinal disturbances, memory and concentration problems, sleep disorders and various states of anxiety and depression (Chakrabarty and Zoorob, 2007).A recent meta-analysis of the efficacy of fibromyalgia pharmacological and non-pharmacological treatments found that there was no clear indicator that specialized care provided more than the same moderate efficacy obtained in primary care settings with routine treatments (Garcia-Campayo J et al, 2008). Recommendations for the conventional medical management of fibromyalgia typically are based on a program that emphasized education, use of antidepressants and/or muscle relaxants, exercise and cognitive therapy best accomplished when the patient and healthcare providers work as a team (Goldenberg, et al, 2004).In 2004, Goldenberg et al published results from an extensive literature search of fibromyalgia treatment trials and found no evidence for efficacy of opioids, corticosteroids, NSAIDs, benzodiazepines and nonbenzodiazepine hypnotics, melatonin, calcitonin, thyroid hormone, guaifenesin, dehydroepiandrosterone or magnesium. Since this article's publication, duloxetine (Cymbalta), milnacipran (Savella) and pregabalin (Lyrica) have attained FDA approval for treatment of fibromyalgia, although as is typical, each of these drugs is known to cause a variety of side effects, including significant fatigue, dizziness, nausea, headache, insomnia, sexual problems (that can even last for years after stopping drug treatment), weight gain, excessive sweating and constipation. The most serious adverse effects cases, admittedly rare, are uncontrolled hypertension, hepatotoxicity (liver toxicity) or suicide. Even more problematic is the fact that each of these drugs is known to create a wide variety of minor and serious symptoms if or when the patient tries to stop taking the drug.In 2010, a systematic review of the most recently used conventional drugs for fibromyalgia was published in a leading scientific journal (Clauw, 2010). Although some drugs had beneficial effects, the author acknowledged the significant limitations of these benefits and the need to utilize other treatment options. He wrote, "Because of the modest overall analgesic efficacy seen with any class of analgesic drug in any chronic pain state, we should be particularly aggressive about using more non-pharmacological therapies in treating patients with chronic pain."

Conventional physicians are usually forced to use combinations of drugs to control the numerous and varied symptoms expressed by fibromyalgia patients, though the use of multiple drugs concurrently generates additional pathology and further challenges when the patient wishes to slow down or end the medication. Further, little research has been conducted to date evaluating the use of polypharmacy methods for these patients (thus, whatever research has been conducted on individual drugs becomes questionably relevant to those patients taking multiple drugs).Fibromyalgia affects women 10 times more often than men, and is most common in women 20-50 years old (Chakrabarty and Zoorob, 2007). This condition also has been observed in children and adolescence and is more common in relatives of patients with fibromyalgia, suggesting the contribution of both genetic and environmental factors, which naturopathic and homeopathic practitioners are especially trained to address and manage effectively.

Homeopathic Treatment:Homeopathic medicine is a 200+-year-old system of medicine that utilizes specially prepared doses of medicines made from various substances of the plant, mineral or animal kingdom. Each medicine is prescribed for its capacity to cause, if given in overdose to healthy people, symptoms similar to those that the sick person is experiencing. Because basic physiology recognizes that symptoms represent defenses of the body (and mind) in its efforts to fight infection and/or adapt to stress, a homeopathic medicine is selected for its capacity to mimic a person's own symptoms, thereby augmenting their own defensive response.Just as vaccines and allergy treatments are in part based on this same premise -- whatever a substance causes in overdose, it will elicit an immune response when taken in small doses -- homeopathic medicines are a system of helping the "wisdom of the body" defend and heal itself.In homeopathy, ALL ailments are considered "syndromes," that is, all disease is a constellation of physical and psychological symptoms, and each patient has his or her own subtly different syndrome of a disease. The fact that people with fibromyalgia tend to have sometimes slightly or overtly differing symptoms from each other is no significant problem for homeopathic treatment. In fact, homeopathic treatment tends to be easier when patients have idiosyncratic or unusual symptoms.The good news for fibromyalgia patients who receive homeopathic medicines is that these remedies are not known to cause direct drug interactions with any conventional drugs the patient may be taking. The pharmaceutical lobby decries homeopathy for its lack of effect: the problem for them is that if one unfathomable homeopathic treatment works, their argument is in tatters. Patients are also spared some of the conventional drug artillery used to limit symptoms. Further, because people with fibromyalgia tend to have distinct and unusual symptoms, this situation actually makes it easier for homeopaths to treat them successfully.Other advantages homeopathy has over conventional drug therapies are lower cost and the avoidance of the usual GI, headache and CNS side effects as well as reactions that can be life threatening.However, newspapers, magazines and even books on fibromyalgia, typically ignore studies showing the efficacy of a homeopathic medicine in its treatment. This omission occurs despite evidence of its significant efficacy as verified in several studies published in major medical journals. In addition to the scientific evidence for homeopathic treatment, surveys of people with fibromyalgia tend to show that homeopathic medicines is one of the more popular alternative treatments used by people suffering from this ailment. For instance, Dietlind et al (2005) found that 10 percent of patients answering a survey on their use of Complementary and Alternative Medicine for fibromyalgia symptoms reported using homeopathy.

Scientific Evidence for Homeopathy

The first controlled trial testing the homeopathic treatment of patients with fibromyalgia was an impressive and sophisticated double-blind "crossover" trial that was published in the prestigiousBritish Medical Journal (Fisher et al, 1989). A crossover trial is a sophisticated method to test the efficacy of a treatment because each patient's results with the "real treatment" are compared with that same patient's results with a placebo. While most double-blind studies compare one group of people who receive the "real treatment" with another (hopefully similar) group of people who receive a placebo, crossover trials compare the results of each person and his/her response to real treatment with his/her response to placebo.Because of the nature of a crossover trial, the researchers chose to accept into this study only patients that fitted the symptom-syndrome for needing just one homeopathic medicine that tends to be one of the most commonly indicated remedies for fibromyalgia patients. The researchers found a surprisingly high percentage of patients (42 percent) whose symptoms indicated a need for this medicine, Rhus toxicodendron (Rhus tox).After the researchers found 30 patients who seemed to fit the symptoms of Rhus tox, half of the subjects were given a placebo during the first half of the experiment, while the other half were given the homeopathic medicine. Then, halfway through the experiment, each subject's treatment was switched.The homeopathic dose of the medicine used was 6C. The researchers specifically chose to use a low potency dose of this medicine for this trial because these less potent doses provide short-term results. Over 200 years of homeopathic practice have found that homeopathic medicines that are of a higher potency -- that is, those that have undergone a greater number of dilutions, with vigorous shaking of the solution in between dilutions -- have a longer term effect [1]. Because halfway through this study each subject was given either a placebo or a homeopathic medicine, the researchers only wanted to use a medicine that provided a short-term result and this is precisely what their results confirmed.The researchers found that there was a substantially significant degree of improvement in the reduction of tender points and improved pain and sleep when the subjects were taking the homeopathic medicine, as compared to when these same subjects were taking a placebo. In other words, twice as many people experienced significantly less pain or significantly improved sleep when they were taking the homeopathic medicine as compared to when they were taking the placebo.Iris Bell, M.D., Ph.D. and her colleagues at the University of Arizona School of Medicine conducted a study funded by National Institutes of Health which resulted in four articles published in peer-review medical journals (Bell et al, 2004a; Bell et al, 2004b; Bell et al, 2004c; Bell et al, 2004d). The primary clinical results from this study were published in the highly respected journal,Rheumatology (published by the British Society for Rheumatology), and it found statistically significant results from homeopathic treatment. This randomized, double-blind, placebo-controlled trial with 62 fibromyalgia patients received an oral daily dose of an individually chosen homeopathic medicine (or a placebo) and were evaluated at baseline, two months and four months (Bell, et al, 2004a).The study found that 50 percent of patients given a homeopathic medicine experienced a 25 percent or greater improvement in tender point pain on examination, as compared to only 15 percent of those who were given a placebo experienced a similar degree of improvement. After four months, the homeopathic patients also rated the "helpfulness of the treatment" significantly greater than did those who were given a placebo. It is therefore not surprising that the study also showed that the average number of remedies recommended by the homeopaths was substantially higher to those in the placebo group as compared with the real treatment group.One special additional feature of this trial was that the first dose of medicine was given by smell and that both groups were monitored with EEG. The researchers found that there was a significant and identifiable difference in the EEG readings in patients who were given the real homeopathic medicine as compared to those given the placebo (Bell et al, 2004b; Bell et al, 2004c). Each patient had three laboratory sessions, including at baseline, at three months and at six months after initial treatment. The researchers found that the active treatment group experienced significant increases in the EEG relative alpha magnitude, while patients given a placebo experienced a decrease in this measurement.Another unique feature of this study was that it included an optional crossover design, allowing patients who had initially been prescribed one treatment (placebo or medication) to switch to the "other" treatment (Bell et al, 2004d). The researchers found that 31 percent of those patients who had been prescribed the real medication chose to switch, while 41 percent of those patients who had been prescribed the placebo chose to switch.The combined evidence of clinical improvement along with physiological response to the homeopathic medicine gives these results additional significance.The newest randomized controlled trial was conducted comparing "usual medical care" compared with usual medical care plus adjunctive care by a homeopath for patients with fibromyalgia syndrome (FMS)(Relton et al., 2009). Adjunctive care consisted of five in depth interviews and individualized homeopathic medicines. The primary outcome measure was the difference in Fibromyalgia Impact Questionnaire total score at 22 weeks. ("Usual care" refers to one or more of the following: physiotherapy, aerobic exercise, analgesics, non-steroidal anti-inflammatory drugs, antidepressants.)A total of 47 patients were recruited. Drop out rate in the usual care group was higher than the homeopath care group (8/24 vs 3/23). Adjusted for baseline, there was a significantly greater mean reduction in the FIQ total score (function) in the homeopathic care group than the usual care group (-7.62 vs 3.63). There were significantly greater reductions in the homeopath care group in the McGill pain score, FIQ fatigue, and 'tiredness upon waking' scores. The study also found a small effect on pain score (0.21, 95 percent CI -1.42 to 1.84) (despite what may be considered a relatively small effect on pain, this degree of benefit resembles the small to modest effect from conventional medications described above); but this trial found a surprisingly large effect on function (0.81, 95 percent CI -8.17 to 9.79). Of additional importance, there were no reported adverse events from homeopathic medicines.Ultimately, the homeopathic treatment of patients with fibromyalgia requires individualized care by clinicians who are adequately trained in homeopathy. This condition is too complex for 'self-care treatment' or for treatment by clinicians who have not received professional training.The body of scientific evidence showing efficacy of individualized homeopathic treatment in the care of patients with fibromyalgia suggests significant benefits. If you or someone near and dear to you has fibromyalgia, consider getting professional homeopathic care for both safe and effective treatment. Further, although fibromyalgia is not officially considered a type of arthritis, a review of homeopathic research found patients with this more common ailment also benefit from homeopathic treatment (Jonas, et al, 2000).A Note to and about Skeptics of Homeopathy:Skepticism of homeopathy, like skepticism of any subject, can be healthy, except when this skepticism is based on ignorance of the subject and except when one maintains a closed mind or denies good scientific evidence. Sadly, the vast majority of people who express skepticism about homeopathy do not maintain a "healthy skepticism" but tend to be uninformed, misinformed, and simply in denial about homeopathy and the body of evidence that confirms its benefits.It is more than a tad ironic that those people who hold themselves out as "defenders of medical science" tend to have such an unscientific attitude towards homeopathy. These people tend to show evidence of both ignorance about homeopathy and (worse) arrogance about their viewpoints. These people who are "medical fundamentalists" love to attack homeopathy saying that "there is no evidence that homeopathy works." In fact, they make this assertion so often that they have gotten some people to actually believe them. Needless to say, anyone who says that there is no scientific evidence that homeopathic medicines work is simply proving their ignorance of the subject (as this article on fibromyalgia validates) or verifying their propensity for misinformation.These fundamentalists also love to assert that "there is no plausible mechanism" for how homeopathic medicines work. Such statements display a serious ignorance of medical history because people who say this ignore the fact that it was only relatively recently did physicians understood how aspirin worked, and yet, no doctor (or patient) chose to not use this drug simply because the mechanism of action was not adequately understood.Whenever good scientists or physicians make reference to the many clinical and laboratory studies that verify the efficacy of homeopathic medicines, the "deniers" assert that the scientist is only "cherry-picking" the good studies and ignoring the others. In reference to fibromyalgia, there have been no studies that have shown that homeopathic medicines don't work. The only studies that have been conducted to date have shown efficacy of homeopathic treatment. Obviously, there is no cherry-picking here.Sadly, many people who claim to be skeptics are simply representatives of Big Pharma. In England, the leading anti-homeopathy organization, Sense about Science, is led by a former public relations expert who has a long history of representing Big Pharma companies (SourceWatch.org - see link in References).Some "deniers" are audacious enough to suggest that the "weight of evidence" evaluating homeopathy shows that these medicines do not have any benefit beyond that of a placebo. Was Thomas Edison's discovery of electricity false because 999 experiments failed to produce electricity and only one that was successful? Is the weight of evidence that he failed?Deniers will inevitably assert that Edison's discovery is proven every day, and yet, homeopaths likewise will say that homeopathy is proven every day by the hundreds of millions of its users worldwide, including many of the most respected scientists, physicians, corporate leaders, political leaders, clergy and spiritual leaders, literary greats, sports superstars, and every day average people.The bottom line about research on homeopathy is that the denialists tend to evaluate a study by determining whether it was "well-conducted" according to inappropriate scientific standards. They do not evaluate whether the homeopathic medicine tested was the RIGHT medicine for the patient or not. For instance, if a researcher gave every patient the SAME drug no matter what disease they had, this study would not be a good test of that drug, even if it was "well-designed" (ie, it was randomized, double-blind, and placebo controlled). And yet, it is common for these denialists to assume that just because a study testing homeopathy was well-controlled does NOT mean that it was a fair or adequate test of the homeopathic method.People still skeptical about homeopathy might benefit from reading of body of previous articles that I have written at this website. More specifically, there is a body of evidence showing efficacy of homeopathic treatment of respiratory allergies, influenza, and many other conditions. Of additional importance is the fact that homeopathic medicine today is the leading alternative therapy used by physicians in Europe and that dozens of surveys have confirmed that patients who use homeopathic medicines tend to be significantly more educated than those who do not .Perhaps the best evidence to verify the value of homeopathic medicines and the serious threat that homeopathy plays occurred in mid-2010 when the British Medical Association deemed homeopathy to be "witchcraft" (Donnelly, 2010). Because history confirms that "witches" were women healers, herbalists, and intuitives who were a threat to local doctors and the church, many of us who are involved in homeopathy are honored to be aligned with witches.Finally, it may be appropriate for the medical fundamentalists to heed to words of the founder of homeopathic medicine, Samuel Hahnemann, M.D. On his gravestone are the Latin words, "Aude sapere," which translates as "dare to taste, to experience." Indeed, despite whatever skepticism one has, the proof is in the pudding. Try it yourself and see for yourself.

Special appreciation to June Riedlinger, R.Ph, Pharm.D., ND, who contributed to an earlier version of this article ... and a blessed thank you to Hugh Paterson for his excellent editing feedback.

Source:The Huffington Post