Scientific studies, logical analyses, and years of related clinical experience have led me to several conclusions about the cause of fibromyalgia syndrome and its proper treatment.

Other Underlying Mechanisms

Other metabolism-impairing factors may also induce and sustain symptoms that lead to a diagnosis of fibromyalgia. All that is necessary is that these other factors impede the metabolism of the tissues from which fibromyalgia symptoms and signs arise. Such factors include a diet that contributes to impaired carbohydrate metabolism, B complex vitamin deficiencies, the use of beta-blocking drugs, and physical deconditioning. One such factor may not be enough to induce fibromyalgia symptoms. However, combinations of the factors may be sufficient. The fibromyalgia symptoms of most patients who come under our care are caused by a combination of such factors combined with inadequate thyroid hormone regulation of their tissues.

Basic Requirement for Effective Treatment

The metabolism-impeding factors responsible for fibromyalgia must be controlled or eliminated before a patient can significantly improve. When fibromyalgia results from inadequate thyroid hormone regulation, the proper form of thyroid hormone is indispensable if the patient is to improve or recover. The use of T4 alone (such as Synthroid) is seldom effective. Most patients require treatment with desiccated thyroid (such as Armour Thyroid), a synthetic T4/T3 combination (with 4 parts T4 to one part T3, such as Thyrolar), or T3 alone. Treatment is seldom effective when the clinician adjusts the patient's dosage according to blood TSH levels. Treatment results are likely to be no better when the patient's dosage is adjusted according to the free T3 level. Most patients improve or recover only when their thyroid hormone dosage is adjusted according to the responses of their tissues to thyroid hormone.

Nutritional Supplements

For most patients, nutritional supplements are also essential. The nutrients synergistically interact with thyroid hormone to cause a sustained increase in metabolism. As thyroid hormone accelerates metabolism, the body’s requirement for nutrients—especially B complex vitamins—increases. Not taking nutritional supplements may result in nutritional deficiencies and an abnormality of heart muscle (cardiomyopathy). Taking nutritional supplements can avert such adverse effects and can aid thyroid hormone in normalizing metabolism.

Exercise to Tolerance

For all patients, exercise to tolerance is essential. Exercise enables patients to capitalize on the increased metabolic capacity provided by the combination of thyroid hormone and nutritional supplements. Resistance exercises contribute to the increase in metabolism by increasing muscle mass. Muscle has a higher metabolic rate than fat, so increasing muscle mass by resistance exercises increases the metabolic rate. Aerobic exercise also contributes to the increased the metabolic rate.

Physical Treatment

For most patients, some physical treatment is necessary during metabolic rehabilitation. For most patients, the most important forms of physical treatment are trigger point therapy and spinal manipulation. Physical treatment is essential for some patients' pain scores to continue to decline. With effective physical treatment, most patients eventually no longer meet the pain criteria for fibromyalgia.

"But that's only a theory!" some physicians object.
Dr. John C. Lowe replies