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October 4, 2002
Mark J. Pellegrino, M.D., is Board Certified in Physical Medicine and Rehabilitation and Electrodiagnostic Medicine, and is one of the nation’s leading experts on fibromyalgia. Dr. Pellegrino is the author of numerous books and articles on FM, and despite having FM himself, he maintains an active medical practice with over 10,000 patients cared for.
ImmuneSupport.com: When did you first become aware of fibromyalgia (FM) as a valid illness with real symptoms?
Dr. Pellegrino: I first became aware of fibromyalgia as a valid illness in the mid-1980s during my residency in physical medicine and rehabilitation at The Ohio State University. I learned about this disorder as a common problem for which patients present to a physiatrist (specialist in physical medicine and rehabilitation). Also, during my third year of residency, I was diagnosed with fibromyalgia after developing chronic pains all over, especially in the right shoulder and back areas.
ImmuneSupport.com: What are the most common factors for FM?
Dr. Pellegrino: The two most common factors for fibromyalgia are hereditary factors and trauma factors. Individuals can inherit fibromyalgia, or they can inherit a vulnerability that makes them more predisposed to getting fibromyalgia following a specific trigger. In my experience the most common cause or trigger of fibromyalgia is trauma, especially neck trauma that can be seen with a whiplash type injury. Other factors involved in developing fibromyalgia include infections, underlying rheumatic diseases, hormonal imbalances, and chemical exposures.
ImmuneSupport.com: Do you have a standardized treatment protocol for your FM patients? What are your treatment goals?
Dr. Pellegrino: Decreasing pain, as much as possible. It would be great if everyone could go into remission and be pain-free, but this rarely happens. What usually happens, however, is the pain decreases, sometimes decreasing considerably from a higher level to a much lower and more stable level. Some people achieve remissions where they hardly feel any pain.
Improving function. Even if a person is unable to do activities done prior to developing fibromyalgia, one can still improve and learn to focus on their abilities. That is why I like the word “habile,” because it focuses on making able again, or abilities, focusing on the positive. Too often, we tend to focus on the negative, or inabilities, or things that we used to do. Remember habile!
Teaching a successful program to self-manage fibromyalgia. We live with this condition every day so we should try to find out what works and learn to do it ourselves. We can’t sling our doctors and therapists over our backs, carry them with us throughout the day, and pull them out when needed to treat our increased pain. We must manage our pain as best we can by ourselves on a daily basis. I use a combination treatment approach that is individualized for each patient.
Education. This is half the battle. People with fibromyalgia must understand that this condition is not life threatening, deforming or paralyzing, and it is a valid medical condition. The more one learns about fibromyalgia, the more it is understood and the less frightening it becomes.
Medicines. There is no magical medicine to eliminate all the symptoms of fibromyalgia, but many medicines can be helpful in controlling various symptoms. I use sleep modifiers (i.e., Ambien, Restoril), antidepressant medicines (i.e., tricyclics and serotonin reuptake inhibitors), pain medicines and various other prescribed medicines. Often, different medicines need to be tried to find the best combination, and even when a good combination is found, the medicines can “stop working” after a while. Rotating different medicines over time can help.
Nutritional supplements. Magnesium with malic acid, 5-HTP, Colostrum and others can be beneficial. In my experience, many people who are too sensitive to prescribed medicines may better tolerate nutritional supplements.
Pain management. I like to prescribe a program that may include moist heat, bioelectric therapy, trigger point injections, ultrasound and more with the goal of decreasing pain to a lower level. Once the pain has decreased, one can try to progress to an exercise program.
Exercises. It is important to increase the flexibility and tone of the muscles. This can be done by instructing a person on a combination of postural stretches, light aerobic conditioning and strengthening and toning exercises. Elastic bands such as Therabands can be used.
Manual therapy. This includes therapeutic massage, myofascial release, soft tissue mobilization and adjustments.
Relaxation. Sometimes one of the best treatments to prescribe is relaxation! Deep breathing exercises, guided imagery, biofeedback, yoga, tai chi, and prayer are a few examples of relaxation techniques that can be very helpful and effective.
Home program. Each individual needs to find whatever works best and must follow through with a home program on a regular basis.
ImmuneSupport.com: What are your recommendations for the following important issues for FM patients (as applicable):
Dr. Pellegrino:
Sleep: For sleep problems, I frequently recommend sleep modifiers such as Sonata, Ambien, 5-HTP, or medicines in the tricyclic antidepressant families such as Amitriptyline or Trazodone. I emphasize developing a sleep routine to optimize restful sleep.
Pain: I prescribe different medications for pain including pain medicines, non-steroidal anti-inflammatory drugs, muscle relaxers, anti-seizure medicines, and other medicines.
Fatigue: For fatigue, I often recommend supplements that include magnesium/malic acid, colostrum, NADH, and others. I recommend specific dietary strategies for fatigue, namely a diet higher in protein and lower in carbohydrates.
Depression: For depression I prescribe different medicines in the tricyclic antidepressant family and selective serotonin re-uptake inhibitor family. Often I will use a combination such as a selective serotonin inhibitor in the morning and a tricyclic antidepressant in the evening. I also recommend counseling whenever depression issues are present.
Brain fog: For brain fog, I focus on optimizing sleep and optimizing dietary and supplement strategies. I have found magnesium/malic acid supplements and colostrum are helpful supplements. Medicines that increase serotonin levels or norepinephrine level can be prescribed. Achieving a regular exercise program is also helpful to combat brain fog.
Diet: I often recommend a diet that is higher in protein and lower in carbohydrates to help fibromyalgia.
Nutritional Supplementation: The research supports that those with fibromyalgia have low or below normal levels of magnesium, thyroid, growth hormone, B-12 levels and serotonin, among others. If low or below normal deficiencies are identified, I recommend specific supplementation.
I also address other issues when treating fibromyalgia including immune dysfunction, chronic yeast infection, cognitive difficulties, work issues, stress management and more.
ImmuneSupport.com: What is your recommendation regarding exercise for FM patients?
Dr. Pellegrino: I instruct my fibromyalgia patients to try to achieve a regular exercise program that includes stretching and a form of light conditioning. Stretching can be done as many times during the day as desired. The light conditioning program can include warm water aquatics, walking, bicycling or any other form of light aerobic activity, and should be attempted at least three times a week for 20-30 minutes at a time.
ImmuneSupport.com: In your experience, what have been the most effective treatments for your FM patients?
Dr. Pellegrino: The most effective treatments I have found include education, improving sleep disorders, finding a successful therapy program that usually includes some form of manual work combined with stretching and a light conditioning program, nutritional supplement strategies including magnesium/malic acid along with dietary approaches, and a successful home program.
ImmuneSupport.com: Are you currently involved in any research studies?
Dr. Pellegrino: Currently I am performing a couple research studies involving prescription pain gel and the management of fibromyalgia pain. The most promising research developments in fibromyalgia research involve the attempt to better understand and characterize the dysfunctional neurobiology involved, particularly with the brain, spinal cord and autonomic nerves. I am fascinated with the cognitive retraining research as well.
ImmuneSupport.com: What do you think the future looks like for FM patients? Are we moving forward in dealing with this debilitating disease – as patients, practitioners, and as a society?
I believe we are moving forward in a positive and hopeful direction in dealing with the debilitating fibromyalgia condition. The medical society has increased its understanding of this disorder and enhanced its knowledge and treatment strategies, which I believe will continue to progress into the future. I look forward to better understanding the causes and mechanisms of fibromyalgia and attempting to prevent it from occurring in vulnerable individuals. I look for further research to understanding trauma and how it can lead to fibromyalgia, and I am hopeful that cognitive retraining and prolotherapy, among other treatments, will be found to be effective in treating fibromyalgia. HW
Dr. Pellegrino’s latest book, "From Whiplash to Fibromyalgia" describes the whiplash injury in detail and sets forth how fibromyalgia evolves from this type of traumatic injury. All monies raised from the sale of this book are given back to FM support groups, research, and advocacy efforts. The book is 130 pages (ORC Publishing, 2002) for $15.00 plus $3.00 S&H (within the US). A copy can be obtained by sending a check or money order payable to: ORC Publishing, 6651 Frank Ave. NW, N. Canton, Ohio 44720, or by calling 1-888-508-6604 to order and pay by credit card.
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