Complementary and Integrative Methods in Fibromyalgia

1. Ather Ali, ND, MPH, MHS* 2. Paul L. McCarthy, MD* 1. *Department of Pediatrics, Yale University School of Medicine, New Haven, CT. * Abbreviations: ACR: : American College of Rheumatology CAM: : complementary and alternative medicine 5-HTP: : 5-hydroxytryptophan SAM-e: : S-adenosylmethionine 1. Clinicians should recognize that chronic widespread musculoskeletal pain without laboratory or physical examination evidence of joint or muscle inflammation is a common problem in the pediatric population. 2. Pediatricians should be aware of safe and likely effective lifestyle and complementary and integrative therapies that can be used for children with chronic widespread pain and fibromyalgia. After completing this article, readers should be able to: 1. Understand the definition and epidemiology of fibromyalgia in pediatric populations. 2. Articulate a framework to assess the desirability of a complementary therapy based on safety and efficacy and assess the utility of the most common complementary therapies used for fibromyalgia. 3. Discuss the rationale for seeking complementary and alternative therapies in patients with fibromyalgia. Maria is an 11-year old girl brought to the pediatrician by her mother who is concerned about her daughter feeling fatigued and experiencing pain throughout her body for the previous 8 months. The pain involves multiple joints, waxes and wanes, and is not associated with joint swelling. The pain has no accentuation in the morning. Maria also says she has pain in her thighs and upper arms in the muscle groups. She has had no fevers, weight loss, rashes, or oral ulcers. Because of her symptoms, she has missed 14 days of school in the current school year. She says she has less energy, sleeps more than in the past, and has had to stop playing softball. On examination, her vital signs are normal. She …