Osteopaths can diagnose fibromyalgia by testing and detecting designated sensitive points on the body (see Figure 22 below). For reasons that are not yet understood, it appears to affect five times as many women as men. When considering a diagnosis of fibromyalgia it is very important to distinguish it from fibrositis, which is characterised by the inflammation of muscles or connective tissue. Figure 22 The cause of fibromyalgia does not stem from inflammation. Rather, research indicates that the painful muscles are due to decreased energy production and the reduced ability of muscles to relax . This has been linked to a deficiency in the energy molecule ATP which is normally produced in each cell of the body to provide the fuel for its functions . Without ATP, the cells (and consequently the muscle, organ or whatever tissue they are part of) cannot function optimally. In the case of fibromyalgia, the muscles fail to relax properly once they have contracted.
One factor contributing to ATP deficiency is a poor oxygen supply to cells. Insufficient oxygen (called hypoxia) results in low energy production and compromised cellular function in general. The disrupted sleep patterns experienced by many fibromyalgia sufferers can contribute further to exhaustion and anxiety. Studies done in France found that people diagnosed with fibromyalgia have low levels of serotonin in the brain . Serotonin is a neurotransmitter that is partly responsible for bringing about restful sleep. It is made from the amino acid tryptophan. Supplements of 5-hydroxytryptophan (5-HTP), in doses of 200mg one hour before bed, can help restore restful sleep.
In studies 5-HTP has very successfully reduced muscular symptoms as well. ,  According to Professor Federigo Sicuteri from the University of Florence, an expert in this area of research, ‘In our experience, as well as in that of other pain specialists, 5-HTP can largely improve the painful picture of primary fibromyalgia’.  Like many disorders, it’s best to treat fibromyalgia on several levels – mechanical, chemical and emotional.
So-called ‘mechanical’ methods of treatment (such as massage and exercise) do help to increase the supply of oxygen to tissues by stimulating the blood flow. These do not, however, address the underlying cause of the energy deficiency and pain. Indeed, some people feel worse after massage, and many feel unable to take any exercise while they are exhausted and in pain.
Some of the most successful results have come from treating fibromyalgia on a more chemical level. Research has shown that a deficiency in magnesium can lead to an increased perception of pain.  This in turn increases stress which stimulates the release of stress hormones. One effect of these is to push magnesium out of cells, further depleting stores of this vital mineral , worsening muscular pain and also putting sufferers at risk of other magnesium deficiency symptoms such as cardiovascular problems. In this way, a vicious circle of action and reaction can be set in motion. The good news is that the cycle can be broken – researchers in the US suggest that it is possible to reverse ATP deficiency due to insufficient oxygen by taking magnesium and malic acid. 
They report that some FM sufferers have a significant reduction in pain after as little as 48 hours. Other nutrients that are particularly necessary for the efficient production of ATP are B vitamins, manganese and co-enzyme Q10. Indeed, symptoms of a deficiency in B vitamins, particularly B1, do resemble those of fibromyalgia. Some people with vitamin D deficiency get wrongly diagnosed with fibromyalgia.  Manganese is also needed for various hormonal processes that lead to thyroxine output. Thyroxine is responsible for determining metabolic rate, so any reduction in it could lead to an overall decline in metabolism and energy production.
Fibromyalgia, chronic fatigue and homocysteine
A team of researchers headed by Dr Bjorn Regland at the Institute of Clinical Neuroscience at Sweden’s Goteborg University ran a battery of tests on fibromyalgia sufferers, including homocysteine.
By far the most significant finding was that every single patient with fibromyalgia had high homocysteine. They also found a direct correlation between their B12 status and the severity of their reported symptoms.  Fibromyalgia sufferers should be routinely tested for homocysteine, and if high, immediately started on a homocysteine-lowering programme. For more information on homocysteine and related conditions, read my book The Homocysteine Solution, co-written with Dr. James Braly.
In summary, the following advice may provide relief from the symptoms of fibromyalgia:
• Eat a healthy diet, with plenty of magnesium-rich foods such as green vegetables, nuts and seeds.
• Supplement key vitamins and minerals – magnesium and malic acid (magnesium malate), vitamin B complex, co-enzyme Q10 and a multivitamin/mineral that contains manganese.
• Supplement 5-HTP, particularly if your symptoms include sleep problems and/or depression. The ideal dose is 100mg, three times a day, or all three tablets one hour before sleep for sleep problems. Some practitioners recommend taking 5-HTP in combination with St John’s Wort (300 mg three times per day, 0.3 per cent hypericin content) and magnesium (200–250mg), also three times a day.
• Reduce your stress levels and learn how to relax. Stress management skills can help teach relaxation. Other relaxation methods, such as yoga, T’ai Chi and breathing exercises, can also be useful. Consider supplementing the herb Kava Kava as a muscle relaxant.
• Increase exercise slowly. Exercise should be gradually increased as the FM sufferer’s capacity for it increases. Posture and overall body structure need to be optimised, perhaps with the help of an osteopath or Alexander Technique teacher. Gentle massage, heat treatment and gentle stretching also help to improve muscle function and reduce pain.
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