First, it is important to understand the meaning of the word ‘syndrome’. A syndrome is a group or set of symptoms that cluster together. A syndrome (e.g., pneumonia) can look the same clinically (with pneumonia, you cough, have a fever, produce sputum, have shortness of breath, fatigue and perhaps chest pain), but have different causes (pneumonia can be caused by tuberculosis, pneumococcal pneumonia, mycoplasma, fungal infections, toxic exposures, etc.) and therefore different treatments, depending on the cause. Additionally, there are predisposing antecedents (vulnerability factors) for pneumonia, such as alcoholism, cystic fibrosis, or hypothyroidism. This means that people with these antecedents are at higher risk than the average person. Finally, there are chemical mediators of the pneumonia (the substances or factors that act as the medium of illness) such as white blood cells, hormones (e.g. adrenal steroids), and cytokines (the hormones of the immune system).
When one looks at a syndrome with this ‘Whole’ perspective, things are both more complicated, and more understandable and treatable. Thus, with fibromyalgia, we assume that there are a variety of antecedents, mediators, and triggers, which in combination can produce a syndrome we call ‘fibromyalgia’.
The Whole Psychiatry understanding of fibromyalgia assumes that while there may be psychological antecedents, triggers, or mediators of fibromyalgia, and its closely associated CFS, is NOT primarily a psychological condition. While psychological treatments may be helpful (e.g., cognitive behavioral therapy), and medication may be useful in some circumstances, these approaches do not get to the roots of the problem. So, while they are usually a secondary part of the picture and the treatment, the main focus of evaluation and recovery-treatment is geared toward identifying the physiological antecedents, triggers, and mediators, which are modifiable. Using this approach most people with fibromyalgia can recover fully or significantly.
The Whole Psychiatry evaluation of fibromyalgia will involve a careful history, physical, and a wide variety of tests, (determined by the history and physical exam), ranging from genetic tests (to determine for example susceptibility to biotoxins, methylation pathways, detoxification pathways), tests of immune function and infection (e.g., NK cell activity, cytokines, CBC, tick borne diseases, viruses), tests of the environment (e.g., mold, chemical exposure), tests of digestive, liver, nutritional and hormonal status, tests of mitochondrial function, neurological tests (e.g., MRI, SPECT, sleep studies, EEG). Based on these test results a treatment plan is initiated.
Often, nutritional repletion (e.g., adding magnesium), correction of blockages in the Kreb’s Cycle (e.g., removal of heavy metals, increasing malic acid), supporting detoxification, hormonal adjustment (adrenals, thyroid, melatonin, parathyroid, vitamin D etc.), and correction of immune system problems (inflammation, infection) will alleviate the syndrome completely.
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