A Case of Fibromyalgia

KEYWORDS: Fibromyalgia (FM), case report, homeopathic therapy

BACKGROUND

Fibromyalgia (FM) is a complex pain syndrome characterized by chronic musculoskeletal pain with distinct points of hyperalgesia termed as tender points, coupled with psychosomatic symptoms like disturbed sleep patterns, fatigue, gastrointestinal disorders, anxiety, depression etc.

Despite being frequently encountered, the pathophysiology of FM is still under question and is related to combined factors like epigenetics and gene polymorphism^1,2, neuroinflammation which is evidenced to be often triggered by HPV vaccination³, autoimmunity (with overlapping disorders like thyroid dysfunctions, rheumatoid arthritis, SLE etc.), persistent inflammation involving the pro-inflammatory factors or cytokines, cognitive dysfunction and life-style changes.^4,5

Due to its complexity in identifying the etiology and pathogenesis, there are no reliable biomarkers or gold standard diagnostic criteria for FM and a comprehensive clinical assessment is being put into practice.⁶

However, generalized pain index, symptom severity score and American College of Rheumatology (ACR) classification criteria⁷ are employed in assessing FM which defines the condition to have widespread pain and psychiatric conditions for more than three months, but again this lacks specificity in tracking down the disease course.^6,8 Routine blood tests are also often advised for screening any underlying inflammatory cause.⁹

FM globally affects 1-7% of the population, with an increased incidence in females compared to males, with the ratio of 2:1. The majority of cases reported fall under the age group between 30-50 and above.^10,11

The management protocol of FM advocates non-pharmacological approaches like cognitive behavioral therapy, physical exercises involving resistance and flexibility exercises, massage therapy and other alternative therapies.

This strategy is recommended over pharmacological treatment due to the heterogeneity of the condition and lack of studies to provide evidence on the effectiveness of drugs in FM cases.^9,12,13

The syndrome being multidimensional, renders itself well to alternative therapies for effective management. We present a case of a female aged 36 years, diagnosed with FM through a detailed clinical assessment and treated with individualized classical homeopathic therapy.

The patient was on conventional prescriptions for FM without any satisfactory results and simultaneously suffered from thyroid dysfunction which was managed by her general physician.

CASE REPORT

Female, 36 years old

Initial Consultation – 23.01.2020

Main complaint – diagnosed with fibromyalgia. Pain all over the body.  Poor digestion. Heartburn.

Background information:

At 11 years old – diagnosed with thyroid problems, put on thyroid medication.  Was too small for her age, children made fun of her small size.  Poor concentration, constipation.  Didn’t like to be in crowds.

At 13 years old – father passed away at the age of 49 (possible heart attack).  Was very close to her father.

At 21 years old – diagnosed with iron deficiency, poor appetite, moved away from home – was very sad.

In early 2018 began to experience tightness of muscles and pains all over her body (extremities, joints, back).  The pains became more severe with time. Was put on allopathic medication.

In Oct 2018 – Suspected gluten intolerance. Stopped eating gluten. No improvement in overall condition.

Urinary tract infection a year ago, no fever, antibiotics taken.

Last fever 4 years ago.

Currently:

Weakness in limbs, shoulders, hips. Severe muscle pain, tightness, stiffness.

Fear of heights; fear of being alone, when dark.

Low energy level. Can’t stand too long. Feels as if will lose balance.

Food – desires vegetables

Thirsty – all the time, dryness, drinks in small sips, cold water.

Needs movement, feels restless and stiff if stays in one place for a while.

Wakes up very stiff. Sleeps covered, prefers to sleep on sides, wakes up twice at night from busy dreams. Sometimes will take a long time to get back to sleep.

No perspiration.

Occasional constipation – will skip a day.

Fastidious – gets irritated when things are out of order.

Irritable, but will not show. Irritated by noise. When sick, she needs quiet, but it doesn’t make her feel better.

Avoids conflict. She gets easily offended but will not speak up and object.

Likes shopping, but because of pains and vertigo she can’t go, which is very upsetting for her.

Needs someone with her all the time.

Smell, sight of food makes her nauseous.

Table 1: Repertorisation of symptoms 23.01.2020

Symptoms
Mental/emotional	Physical	Generalities
MIND ­ TIMIDITY +++ MIND ­ COMPANY ­ desire for +++ MIND – FEAR – alone, of being – night ++ MIND ­ RESTLESSNESS, nervousness ++ MIND ­ FASTIDIOUS +++ MIND ­ RESTLESSNESS, nervousness ­ motion ­ constantly, must move ++ MIND ­ SENSITIVE, oversensitive ­ noise, to ++ MIND ­ FEAR ­ high places, of +++ MIND ­ IRRITABILITY +++ MIND – QUARRELING – aversion to ++	STOMACH ­ THIRST ­ small quantities, for (in sips) ­ often ++ EXTREMITIES ­ PAIN ­ Hip +++ STOMACH – HEARTBURN ++ SKIN- DRY- inability to perspire ++ SLEEP – DREAMS – busy + PAIN ­ muscles +++	HYPOTHYROIDISM +++ CHILL ­ COLDNESS in general +++ AIR ­ open ­ amel. ++ FOOD and DRINKS ­ smell of ­ agg. ++ FOOD and DRINKS – vegetables – desire +

Figure 1: Results based on repetorisation of symptoms in Table 1

Level of health: 7-8 (the patient hasn’t had high fevers for a few years, with an ongoing chronic inflammatory disease, which indicates lower level of health)

Prescription – Arsenicum Alb 6C, twice a day (the patient is taking allopathic drugs, hence repeated doses of the remedy are required). Arsenicum covers 13 out of 14 symptoms and most importantly mental/emotional symptoms.

Table 2: Follow ups

Date	Follow up	Prescription
25.01.2020	Appetite increased, vaginal discharge increased, first day there was no muscular pain, the pain came back the next day (was quite severe). Feeling weak, but not as weak.  Constipation < (as bad as it was when she was a child).	Dose is decreased to once a day.
21.02.2020	While there were days when the patient experienced no or little pain, for most of the time the pain was quite intense. She experienced vertigo with nausea on regular basis, which prevented her from going to work and doing basic tasks. Felt a bit depressed. Cried during follow up. In the recent weeks she felt a lot of anger and kept remembering situations when she was criticised by her mother-in-law (few years back). She recalled that after ongoing criticism, she once had an outburst and said very mean things to her mother-in-law. She felt guilty for showing her anger, but said that sometimes she can’t hold it back. The patient, who appears very polite and obedient, explained that she usually tries her best not to show when someone upsets her.  But in the past few weeks she’s become more aware of how angry she was and didn’t know what to do about it. She was not as fastidious as she was before, but still preferred order. She was still restless. Her sexual desire was excessive. (See Table 3)	Staphysagria 200C – one dose (the patient was no longer taking allopathic drugs, except her thyroid medication)
24.02.2020	high fever at night	Nil
25.02.2020	headache – heavy, can’t put it down Nausea, vomiting, appetite is good.	Nil
26.02.2020	nausea, headache cleared, had a good night sleep
08.04.2020	After taking the remedy, the patient noticed significant improvement in her ability to speak up when something upset her or if her opinion was different from others.  She felt calmer, not as restless. She had a dream with someone from her past.  A lot of guilty feelings emerged because she felt that she has hurt that person many years ago.  After having the dream, she contacted that person and apologised for the pain she caused.  Felt more at peace afterwards. Her pains and vertigo were coming and going. About 10 days before the follow up someone recommended for her to use essential oils to ease her pains. Straight away she began to relapse. At the time the patient was asked to stop using the oils. However, she continued to deteriorate.	Staph. 1M
29.09.2020	The patient came back complaining of overall weakness, some pain and tension all over her body. She feels a lot better emotionally. She is no longer bothered by things being slightly out of order.  She feels free to object to suggestions which do not agree with her. Can express her opinion and is not so bothered by what others think of her. She now has a very good relationship with her mother-in-law. She looks well, but complains of low energy level, vertigo and pain.	Ferrum 12C once a day (recently started herbal treatment daily)
10.10.2020	The patient reported significant improvement in her energy level. Despite the pains she sounded happy and more reassured. She was informed by her GP that her blood test showed abnormal liver readings and was recommended (by GP) to stop herbal treatment.	Continue
20.02.2021	The patient is very happy with how far she’s come.  She is no longer in pain. No vertigo. No nausea, good appetite. She is able to enjoy life and can’t compare it to the way it was a year ago. She feels she has better relationships with people around her.	Continue

Table 3: Repertorisation of symptoms 21.02.2020

Symptoms
Mental/emotional	Physical	Generalities
MIND ­ ANGER, irascibility ­ suppressed, ailments from +++ MIND – QUARRELING – aversion to ++ MIND ­ FEAR ­ high places, of +++ MIND ­ IRRITABILITY +++ MIND ­ FASTIDIOUS +++ MIND ­ SENSITIVE, oversensitive ­ noise, to +++ MIND ­ TIMIDITY ++ MIND ­ OFFENDED, easily +++ MIND – RESTLESSNESS ++	PAIN ­ tearing ­ Muscles +++ GENITALIA­FEMALE ­ SEXUAL desire ­ increased ++ STOMACH ­ THIRST ++ EXTREMITIES ­ PAIN ­ sore, bruised ­ Hip ++ VERTIGO ­ NAUSEA, with ++ SKIN- DRY- inability to perspire ++	HYPOTHYROIDISM +++ CHILL ­ COLDNESS in general +++ GENERALITIES ­ FOOD and DRINKS ­ soup ­ desire ++

Figure 2: Results based on repetorisation of symptoms in Table 3

Table 4: Repertorisation of symptoms 29.09.2020

Symptoms
Mental/emotional	Physical	Generalities
MIND ­ FASTIDIOUS + MIND ­ IRRITABILITY + MIND ­ TIMIDITY ++ MIND ­ PLEASING ­ desire to please others + MIND ­ DANCING ++ MIND ­ SENSITIVE, oversensitive + MIND ­ IRRITABILITY ­ pain, during +++	CHILL ­ COLDNESS in general ++ EXTREMITIES ­ PAIN ­ Hip ++ VERTIGO ­ WATER ­ looking at running water + GENITALIA­FEMALE ­ MENSES ­ early, too ++	HYPOTHYROIDISM +++ FOOD and DRINKS ­ warm food ­ desire ++ FOOD and DRINKS ­ eggs ­ aversion + WEAKNESS +++ MOTION ­ amel. + TENSION ­ externally +++ WEAKNESS ­ menses ­ before ++ WEAKNESS ­ walking ­ from +++ WEAKNESS ­ walking ­ slowly ­ amel. ++

Figure 3: Results based on repetorisation of symptoms in Table 4

Outcome:

The patient is free from her pains. Energy level is very good.  She is able to work (full-time) and take care of the family. In her own words, “I believe that homeopathy addressed the core of the issue.”

Once she was off herbal treatment, she only took Ferrum metallicum 12C (once a day) for a couple of weeks, before she could see that she had regained her health and didn’t need the remedy anymore.

She is still on thyroid medication, which is managed by her GP.

DISCUSSION

The homeopathic therapeutic system renders an integrated point of view for a case in order to understand the depths of the suffering in all three planes of a human being viz. physical, mental and emotional; and it is important for any therapeutic modality to yield this general state of well-being.

FM is such a syndrome where the pathology runs its course in all these three levels and thus crippling the life of patients. Therefore, it becomes important to address this intermingled complexity of the disease to perpetuate a general state of well-being as it is being exemplified in this case report.

The initial prescription being Arsenicum, produced an immediate aggravation and seemed to not improve any of her physical ailments, but this helped to open up the underlying layer of suppressed anger, with a history of being criticized and unable to express her anger and emotions.

At this point, the patient became more expressive, especially concerning her anger, which is encouraging. But the anger advanced in an unbalanced manner, where the patient could not control her emotions, and hence calls forth for the next prescription, which was based on the Essence¹⁴ of the case.

Staphysagria was able to unshackle her from the unexpressed anger, which also released her physical state to a better health level. The return of high fever within just two days is the evidence of that. According to the Theory of Levels of Health,¹⁵ the patient belonged to lower levels (seven to eight) of health because she had only few episodes of fevers and suffered from thyroid dysfunction and other disorders at an early age.

It was a breakthrough for such a health level to develop a high fever immediately after the remedy, which occurred only after the sequential prescription of the remedies through a precise knowledge of layers¹⁴ and direction of cure^14,16 in a case.

As her mental and emotional health improved, the defense mechanism localized her suffering to a much lower degree as being explained in the Three Levels of Human Being¹⁴, that is the physical level in this case. The physical picture of pains started becoming clear and was able to point to the remedy Ferrum Metallicum, which addressed the symptoms of FM, poor absorption (of iron) and ongoing weakness, thus restoring a general well-being of the patient. Since thyroid dysfunction was her oldest complaint, it is yet to be addressed, which we expect will be addressed as the cure progresses.

CONCLUSION

This case report is an example of cure proceeding through multiple layers of illness through individualized classical homeopathic treatment in complex syndromes like FM. Additional studies are necessary to establish the efficacy of homeopathy in such instances.

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