Managing Fibromyalgia with Yoga and Ayurveda

by Renee Downing E-RYT 500

A research paper I wrote as part of my 500 hour teacher training

Managing Fibromyalgia with Yoga and Ayurveda by Renee Downing, E-RYT 500

Fibromyalgia syndrome (FM) is a condition that stems from a dysfunction of the central nervous system, causing, as stated in Fibromyalgia and Chronic Myofascial Pain Syndrome, A Survival Manual[1], "delayed, inappropriate and exaggerated autonomic nervous system responses to external or internal stimuli that has long passed."

A combination of overactive and blocked nerves causes a broad range of symptoms. One of the most prevalent symptoms is widespread, chronic pain often described as allodynia, the perception of pain resulting from a stimulus that would not normally be painful. Many patients compare the pain to body aches of the flu.

Another of the most compromising symptoms is chronic fatigue that can be so severe that patients find it difficult or impossible to perform the simplest of tasks, like get out of bed or chew food. Cognitive problems, such as slurred speech, disorientation and delayed reaction, complete the trifecta of the most frequent fibromyalgia symptoms. Common coexisting conditions include anxiety, depression, sleep disturbances, headache, dizziness, light-headedness, restless leg syndrome (RLS), temporomandibular joint dysfunction (TMJ), irritable bowel syndrome (IBS), itchy skin and many others.

Many people with fibromyalgia are highly sensitive to touch, smell, sound (the buzzing of fluorescent lights, for example, can cause headache and irritability), light, and many even have electromagnetic sensitivity, becoming tense, edgy, unable to sleep during electrical storms or a full moon, even sensing the feelings of others.

Most of these symptoms are present at all times to varying degrees, but patients often call an increase in average daily symptoms a "flare." Symptoms may get worse with activity, cold or damp weather, anxiety, and stress[2].

Some Statistics

Fibromyalgia is most common among women aged 20 to 50. It is estimated that 2-4% of the American population are affected by it[3]. Twenty to fifty percent work few or no days despite being in their peak wage-earning years. Disability payments are received by 26%–55% of FM patients compared with the national average of 2% of patients who receive disability payments from other causes. FM patients account for the largest disability group of newly disabled women in Norway. Health care costs are three times higher among FM patients compared with matched controls. Recent studies report that the average 40-year-old with FM has fitness findings expected for a healthy 70- to 80-year-old[4].

Many fibromyalgia patients describe themselves as having a "Type A personality," always wanting to be the best and prove to themselves and others that they can take on the world and save it at the same time. They tend to put the needs of others ahead of their own and use the little bit of energy they have on juggling all the responsibilities and commitments they take on.

Some Science

The cause of fibromyalgia is unknown although the current theory is that a major trauma, physical or emotional, may be the trigger for the initial onset of symptoms. After the initial onset, stress continues to be the ultimate trigger for future flares. As of May 2010, patients receive a diagnosis if they experience pain in 7 or more areas in combination with fatigue, cognitive impairments and poor sleep for at least 3 months in the absence of any other disorder that could account for such symptoms or functional disturbances. However, many rheumatologists still use what is known as the 18 tender points test. Blood and urine tests come back normal. Fibromyalgia is not an autoimmune condition. Brain scans have shown heightened sense of pain with less pressure or heat in fibromyalgia patients in comparison to control subjects. Studies have shown that fibromyalgia patients have higher than normal levels of certain neurotransmitters involved in pain awareness, such as substance P (SP), nerve-growth factor (as SP facilitator) and glutamate. Studies have also shown a lack of neurochemicals that inhibit pain, such as serotonin, norepinephrine, and dopamine. Substance P has also been shown to disrupt sleep when present in abnormally high amounts.

Putting Band-Aids on Broken Arms

Fibromyalgia patients are commonly treated in the Western world with drugs that include pain relievers, antidepressants, sleeping medications, muscle relaxers and anti-anxiety medications. Currently, three drugs are approved by the FDA for treatment of fibromyalgia. Two of these drugs affect the levels of serotonin and norepinephrine in the brain. The other works for FM by blocking the excess activity of nerve cells involved in pain transmission[5]. With medication, patients may find relief for a time, but these treatments pose a number of problems. Most carry a long list of short-term side effects, and the long-term side effects, in many cases, have not yet been studied because a drug has either not been on the market for very long and/or the formula used to produce the drug changes frequently. Often, the drugs are ineffective or lose their effectiveness. The use of these medications is usually meant to be short term and, most importantly, the medications do not treat the cause of fibromyalgia. Fibromyalgia patients also sometimes turn to chiropractic and, in some extreme circumstances, often before a fibromyalgia diagnosis, patients have undergone surgery in hopes of alleviating pain symptoms. A surgeon may misinterpret back pain as compression in the spine, heel pain as a bone spur, or shoulder pain as a rotator cuff issue, as examples. The patient agrees to surgery only to find that not only did the pain not go away, but new pain surfaces, often from the physical and emotional stress of surgery.

Ayurveda

Ayurveda translates to "life-science" or "knowledge of life." It is one of the oldest medical systems to exist, originating in India over 5,000 years ago. Vasant Lad, Indian author, Ayurvedic physician, professor and director of the Ayurvedic Institute in Albuquerque, New Mexico calls it "both systematized knowledge and practical wisdom[6]” It examines each individual's natural constitution at birth, along with current imbalances due to lifestyle, environment and other factors. According to Ayurveda philosophy, doshas make up one's natural constitution or Prakriti. Dosha means "anything that can go out of whack[7]." Everyone is born with a very individualized ratio of three doshas: vata, pitta and kapha. The ratio is constantly fluctuating throughout life, but the ratio one is born with is one’s Prakriti. When Prakriti is in balance, the body, mind, and spirit can function without dis-ease. Ayurveda focuses on maintaining Prakriti to eliminate suffering of the body, mind and spirit. Disease and disorder result from disharmony in the way the internal body reacts to the external environment. One should always be decreasing doshas that are imbalanced, rather than increasing what may appear as a dosha that is "too low." Increasing doshas, even though they may appear low, can cause a new imbalance that one will eventually have to treat. A person could spend an entire lifetime studying Ayurveda, but for the purpose of this paper, information on Ayurveda will be limited to how it relates to fibromyalgia. Consult a trained Ayurveda practitioner for a better understanding of your own particular constitution and needs.

Ojas

Ojas is the essential energy of the body, or "that which invigorates[8].” Also known as the "fluid of life," it is the essence of all bodily tissues and contains within itself the power of rejuvenation. After digestion and assimilation, ojas is what is left. It nourishes all the tissues of the body. When ojas is abundant, immunity is high. When ojas is deficient, weakness, fatigue and, eventually, disease materialize. People with fibromyalgia need to build ojas to increase health. Special herbs like ashwagandha contain high amounts of ojas. Mantra and meditation are also an important part of building ojas.

Pitta

Pitta is the principle of fire. It is highly intelligent and driven to succeed. It governs digestion. It is strong willed, naturally competitive and strives for perfection. Maya Tiwari says, "Pittas invite as many stimuli into their lives as they can cram in, and demand perfect functioning from their bodies at all times[9].” The type A personality is a great example of pitta. When the strive for perfection becomes an obsession, pitta easily loses sleep. Regular, quality sleep is extremely important for fibromyalgia patients. When pitta is out of balance, it is irritable, judgmental, impatient and easily angered. Pitta is the dosha involved in inflammation, so when pitta increases, so does inflammation.

Vata

Vata is the principle of air and space. It is loving and spiritual. It governs the nervous system. It promotes creativity and flexibility, happiness and joy. It is very mobile with a heightened sense of touch and rapid fluctuations of energy. It has a delicate, sensitive and aware nature. Vata is prone to insomnia, diarrhea and constipation, loss of sensory acuity, incoherency of speech, and often has poor circulation. When the vata mind is out of balance, it is easily distracted, difficult to focus, and can crash due to exhaustion. It is prone to worry, fear, anxiety and insecurities. When vata is tired, rather than resting, it prefers to use stimulants in order to keep going (Tiwari). Stimulants further deplete vata's energy, causing vata to reach for even more stimulants. Tremors and spasms are often caused by vata being out of balance, which could account for symptoms of RLS. Chronic pain is a sign of vata out of balance. Muscle tightness, low backache and sciatica are also due to aggravated vata - conditions that many fibromyalgia patients often report.

Vata's fatigue-induced lack of concentration often leads to an increase in pitta when the determined, truth-seeking pitta mind cannot collect its thoughts to make a point. Frustration increases, leading to further imbalance of vata as the vata mind easily fills with self-doubt. The increase in vata causes the already compromised and depleted nervous system to work overtime, making the nerves even more vulnerable to attack. The new imbalance of pitta increases inflammation, and since the nervous system is already compromised with fibromyalgia, the nerves are often the first tissue to become inflamed, causing even more disruption of the flow of signals throughout the nervousness system, eventually manifesting as a fibromyalgia flare. 

Kapha

Kapha is the principle of earth. It is heavy and stubborn. Kapha can increase as a side effect of fibromyalgia’s vata/pitta aggravation, manifesting as depression, complacency and weight gain.

This is the perfect storm of imbalanced doshas for the fibromyalgia patient.

Where Ayurveda is concerned, one can see how fibromyalgia's physical manifestation can likely be caused by a vata imbalance driven by a pitta mind. A dysfunction of the nervous system is perpetuated by too much vata, which is made worse by the intensity of pitta. Fibromyalgia patients should consider decreasing vata to lessen physical symptoms, while learning ways to calm pitta imbalances in the mind in order to prevent triggering the cycle that can cause future flares.

Typical Western treatments for pain include over-the-counter and prescription pain relievers, muscle relaxants and sometimes even surgery. Ayurveda sees pain as an imbalance of vata, sometimes aggravated by an imbalance of pitta when inflammation is involved. Below are listed some Ayurvedic remedies for relieving pain and managing symptoms of fibromyalgia based on pitta-vata individuals with an imbalance of one or both of these doshas. Please remember that each person has a very individualized constitution that needs to be taken into consideration when applying Ayurvedic principles.

Massage

Many studies have shown massage to be effective in managing fibromyalgia pain, anxiety and depression[10]. Abhyanga is a type of Ayurvedic massage that uses warm oil and very specific pressure and strokes. It is often performed by two people on one. If Abhyanga is not available to you, regular oil massage is just as beneficial. According to Ayurveda, oil massage gives tone and vigor to the dhatus (tissues) of the body. Massage in the direction of muscle fibers relieves muscle spasms, tightness and soreness.

Oils and Herbs

Coconut oil is suitable for internal and external use by both pitta and vata. Sesame oil is good for vata but not for pitta. Sunflower oil is good for pitta. Topical oils massaged onto the skin can lower pain's intensity. Hot oils, in temperature as well as flavor, are often used to relax muscles. However, use caution where hot oils are concerned. Heat will increase pitta. It is best for pittas and pitta-vatas to avoid oils with warm or hot attributes like cinnamon, clove, and cayenne. Pitta-vatas may tolerate warm oils in cooler environments and cool oils in warmer climates and seasons. Cool oils like peppermint and eucalyptus will not only cool pitta, but will help to soothe the racing mind of vata. 

Sandalwood has nervine qualities, meaning it calms the nerves. It calms and cools the entire body and mind. Sandalwood oil can be purchased or made at home. Steep 4 ounces sandalwood powder in one pint of cold water overnight, add to one pint coconut oil and simmer at low heat until all the water is evaporated8. Lad suggests using sandalwood oil to relieve imbalanced pitta symptoms of anger and hostility. Place a drop on the "third eye" area between the eyebrows, as well as on the throat, breastbone, navel, temples and wrists. Massage with sandalwood oil is also helpful.

Fennel is tridoshic, meaning it is suitable for all doshas. It relieves flatulence, is calming to nerves and the seeds improve digestion without increasing pitta. 

Sarsaparilla is antispasmodic. Its purifying action extends to the nervous system to help cleanse the mind of negative emotions.

Amalaki works on all tissues and increases ojas.

Tea made with Fo-ti and Gotu Kola may revitalize the mind. Both of these herbs are nervine in quality. Fo-ti rebuilds tissues and Gotu Kola is a tonic for pitta and inhibits vata. Add 1/2 ounce equal parts Fo-ti and Gotu Kola to 1 pint water and simmer for 30 minutes. Fennel seeds may be added for better absorption. Caution: Fo-ti used in excess increases ama (toxins).

Other herbs with nervine qualities: oat straw, bala, lotus 

Be in nature

Nature is calming to the nervous system and decreases vata. Cool, damp environments are ideal for vata-pitta types. Go for a walk in a park, at the beach or near a lake. Start your own garden or tend to one of your neighbors' or a community garden. Keep fresh flowers in your living space. 

Move

Practice yoga, go for a swim, take a walk. As little as 5-10 minutes of gentle, structured, vinyasa-style yoga stretches can alleviate pain. The gentleness cools pitta and calms vata. The focus on structure gives the pitta mind a goal to work toward while the continuous movement of vinyasa style gives the easily distracted vata mind something to stay focused on.

Decrease Inflammation

When pitta is high, add anti-inflammatory herbs and foods to your cooking. Turmeric is a great anti-inflammatory spice. Aloe vera also relieves inflammation in the digestive tract and its effects are anti-pitta. The tea of the castor root is an anti-inflammatory substance and is used to treat many vata disorders11.

Stay hydrated. Dehydration increases inflammation.

Avoid ice cold

Avoid ice and ice-cold drinks. It seems logical that ice and cold would cool the intense fire of pitta, however, the important digestion that pitta controls needs some fire. Too much cold or wet will put out a fire and actually slow down digestion, causing the natural flow of energy in the body to slow down and even stop at times. 

Decrease stimulation

Turn off the TV, phone, computer and any other electronic devices. The stimulation of electronics, including their buzzing sounds and the frequencies they emit, increases vata.

Color therapy

Red creates heat in the body and stimulates circulation. It also gives energy to the nerve tissue. Green soothes the emotions and brings happiness to the heart. Red, orange and yellow and green help to relieve aggravated vata and kapha but overexposure can aggravate pitta. Blue has a calming, cooling effect on the body and mind. Purple brings awakening of awareness. Blue and purple relieve aggravated pitta and kapha but overuse may aggravate vata[11].

Gem therapy

Amethyst helps control emotional temperament and is good for vata and pitta imbalances. Moonstone calms the mind and its cooling energy helps relieve disturbed vata and pitta. Pearls are used for healing as well as protection against anger. Violet or purple sapphire has a neutralizing effect on vata. It helps in diseases like sciatica, neurological pain and all vata disorders.

Get out of your head

Helping others or volunteering decreases pitta. 

Routine

It is important that fibromyalgia patients establish a routine. Vata-pitta types most need stability. To help reduce vata-pitta whenever possible, wake up between 5:30 and 6 a.m. Eat breakfast between 7:30 and 8 am, lunch 11-12 and dinner between 6 and 7 p.m. Go to bed between 10 and 11p.m. A regular bedtime is vital to establishing quality sleep patterns.

Seasons

Autumn and winter, when temperatures are cold and the air is dry and windy, are the times when vata is easily aggravated. Dress warmly and eat warm, moist, slightly oily foods. Avoid dry fruits and high-protein foods. In the summer, avoid hot, spicy and pungent foods that aggravate pitta. Stay out of direct sunlight midday when it is hottest.

Panchakarma

A 6-month follow-up study at the Maharishi Ayurveda Health Centre in Norway using an Ayurvedic purification process known as Panchakarma found statistically significant improvements in working ability (limited by symptoms of FM), pain, tiredness, stiffness, tiredness on rising in the morning and anxiety. 18% of the patients had almost no symptoms at the end point[12].

Exercise

One of the most studied and proven ways to manage fibromyalgia symptoms is with exercise. More than 75 studies exist supporting the importance of exercise for fibromyalgia[13]. Many studies show that regular, low- to moderate-intensity exercise over time decreases pain, improves mood, has a positive effect on quality of sleep, and increases energy and overall well-being in fibromyalgia patients. Mixed modality exercise proved more effective than stretching alone. However, when a patient is in pain, often the last thing he or she wants to attempt is physical movement. Delayed onset, exercise-induced pain in fibromyalgia patients is common, and with many fibromyalgia patients possessing a perfectionist, type-A personality, it can be tempting for patients to over-exert themselves in the beginning stages of exercise in an all-or-nothing effort. The body heals more slowly with fibromyalgia because of a lack of deep, restorative sleep. Patients who are just starting out with exercise should start very slowly, keep the duration short and intensity light, and ensure enough rest and recovery time between sessions[14]. Once the patient starts to feel stronger, more intensity and/or duration can be added gradually. "Optimizing the balance between exercise and recovery is of crucial merit in order to avoid stress-related detrimental effects and achieve optimal functioning in patients with chronic pain[15].”

Yoga

Yoga is an ancient Indian system of science, art and philosophy. It goes far beyond the physical movement most known in the modern western world. As B. K.S. Iyengar says, "It means a poise of the soul which enables one to look at life in all its aspects evenly."[16] Yoga utilizes an eight-limbed path to unite body, mind and spirit. Included among these eight limbs are practices of observance, postures (asanas), breath control, concentration and meditation. Asana literally means "comfortable position." Completely explaining all of what yoga is goes far beyond this article, because, as one author puts it, "People can study and practice yoga for a lifetime yet still remain in the infancy stages of understanding yoga."[17] Gentle stretching, like many yoga asanas, is recommended to fibromyalgia patients who are just starting out with an exercise program. According to The American College of Rheumatology, "Research shows that gentle body-based therapies, including Tai Chi and yoga, can ease fibromyalgia symptoms." Meditative movement therapies like yoga are strongly recommended alternative therapies for fibromyalgia[18]. An 8-week study on the effects of yoga on fibromyalgia symptoms in the 10 participants that met the study requirements showed improvement in pain, fatigue, sleep, anxiety and depression3. Another study using 11 participants with fibromyalgia found significant improvement in the overall health status of the participants and in symptoms of stiffness, anxiety and depression. Significant improvements were also seen in the reported number of days "felt good" and number of days "missed work" because of fibromyalgia[19]. The results of another study of 22 fibromyalgia patients suggest that a yoga intervention may reduce pain and catastrophizing and increase acceptance of pain and mindfulness[20]. 

There are also many studies showing the effectiveness of yoga on managing depression and anxiety. A study on women ages 30-40 found that two months of twice-weekly 90-minute classes significantly reduced depression and anxiety. The researchers credited the scores to yoga's ability to increase overall body awareness and confidence[21]. Another study comparing short sessions of yoga postures followed by supine rest (savasana) to just supine rest alone found that movement followed by rest significantly improved memory and was almost four times more effective in decreasing anxiety than the same amount of time in supine rest[22]. Seventeen men and women diagnosed with unipolar major depression in partial remission showed significant reductions in depression, anger, anxiety and neurotic symptoms after 20 classes taught by senior Iyengar yoga teachers17. 

There is no question that a regular yoga practice can significantly improve fibromyalgia symptoms. As the patient gets stronger with consistent practice and better awareness of their own physical state, he or she can gradually begin to increase the intensity of his or her yoga practice to keep the body and mind challenged without becoming overwhelmed. However, as Janet Hennard, RYT-500, suggests based on her research in her informative article "Yoga Therapy in Practice, A Protocol and Pilot Study for Managing Fibromyalgia with Yoga and Meditation," patients should be reminded more frequently than in a general population class to rest when they need it18.

These are general guidelines. Please take into consideration each student’s individual needs. A person with fibromyalgia who is just starting out with yoga should start slowly. According to Hennard's research, yoga for fibromyalgia should begin with five minutes of breath work to calm and center the mind. Reminding the patient to keep his or her focus on breath control teaches the patient to recognize when he or she is pushing or forcing the pose rather than relaxing into it. Since fibromyalgia patients tend to dwell in a constant fight-or-flight state, breath work and asanas should remain calm, fluid and centering. Nadi shodhana, or alternate-nostril breathing, is recommended because it balances the autonomic nervous system18. Forward folds are calming. Chest opening poses promote acceptance and courage that can be very beneficial in dealing with fibromyalgia symptoms, and back-bending poses to calm the nervous system may be helpful for reducing symptoms of depression and also for reducing pitta. Dr. Lad recommends back bends to relieve insomnia and mental disorders11. Many fibromyalgia patients struggle with balance[23]. Standing balance poses like vrksasana will help improve balance, strengthen the core, and create a sense of grounding. A yoga student with fibromyalgia may need to build up strength before standing poses can be performed comfortably. Use discretion when deciding whether or not to perform inversions such as salamba sarvangasana (shoulder stand), sirsasana (head stand), and even standing forward folds like Uttanasana. Inversions are calming to the nervous system, and Dr. Lad recommends Shalambhasana for anger and migraine headache. However, they are contraindicated for fibromyalgia according to Hennard's research. The increased blood flow to the brain can trigger a headache or migraine, dizziness and/or light-headedness if the patient is prone to those symptoms. Plus, inversions can be aggravating to pitta. Once the body and senses have been stilled by asanas and breath work, 5-10 minutes of guided meditation with the spine erect may be beneficial to give the feelings of relaxation and calmness of mind a more lasting effect, and to assist the patient with acceptance of pain. Props may come in very handy for savasana. It is important for the FM patient to be comfortable for the long duration of stillness. A bolster or blanket under the knees will relieve discomfort in the back and heels. A blanket or extra mat will provide extra cushioning if the firmness of the ground is aggravating to symptoms. An eye pillow may help calm the senses even more if any light is coming into the room from the outside.

The setting for exercise should be moderate intensity for pitta and quiet for vata7. Yoga can encompass both those characteristics. It cools pitta fire and aggression and sun salutations are vata reducing. The lights should be dimmer than a normal classroom setting for fibromyalgia. The temperature should be slightly warm, not hot. Too much heat can ignite pitta and cause the student to push too hard and become irritable. Pushing too hard can cause not only muscle soreness, but possibly trigger a fibromyalgia flare that lasts longer than the typical day or two of muscle soreness. The major seat of pitta is the solar plexus. Asanas that affect the solar plexus are matsyasana, navasana, ustrasana, shalabhasana, danurasana and moon salutations. Hennard suggests that pittas avoid inversions.

The major seat of vata is the pelvic cavity. Asanas that stretch the pelvic muscles help calm vata, such as forward bends, back bends, spinal twists, halasana, ustrasana, bhujangasana, shalabhasana, cat/cow. Note that ustrasana and shalabhasana are recommended to reduce both doshas. Exercising in water is also recommended for fibromyalgia patients within and beyond Ayurveda philosophy as it cools pitta and is easier on the muscles and joints. 

Meditation

One's ability to manage stress and keep a calm mind plays a huge role in being able to function with fibromyalgia. One way to calm the mind is with regular yoga and meditation practice. A regular yoga and meditation practice will help tremendously with the ability of someone with fibromyalgia to listen to his or her body and recognize when it is necessary to rest or back off from an activity. One study that used neuroimaging saw a decrease of 40-50% in the brain's reactivity to pain after five months of Transcendental Meditation[24]. 

Breath   

As the authors of Fibromyalgia and Chronic Myofascial Pain Syndrome, A Survival Manual state, "Proper breathing is the first requirement for optimum health."1 Deep breathing is an important and simple way to manage fibromyalgia symptoms. Pranayama, or breath control, is another of the eight limbs of yoga. It is derived from two words: prana and yama. Prana has several English meanings, including breath, life and energy[25]. Yama means "to control." So pranayama literally means breath control. Regular pranayama practice will create more consistent mind calming. Receiving proper nourishment, which includes breathing properly, will greatly improve one's quality of life. Pain and anxiety often cause shallow breathing. One of the first things that happens when one becomes stressed is a change in breath rhythm. It becomes shallow and irregular, causing the body to become more tense, thus increasing pain, sensitivity and fatigue. An easy and effective way to control the breath is by simply observing it as it goes in and out. Spending a few minutes before bed practicing this form of meditation can improve quality of sleep.

Vasant Lad, in his book The complete book of Ayurvedic Home Remedies, offers an easy breathing technique to let go of anger. He states, "At the moment the feeling comes up, look into it. Let's suppose it is a feeling of anger. Take a long, deep breath, let yourself feel the anger, and exhale it out. Give the feeling total freedom to express itself within you, so that you look at it honestly and feel it. Breathe into it, and breathe out. Soon it will dissolve by itself.” 

Another type of breath work, shitali pranayama, cools pitta. Lad says, "Make a tube of your tongue; breathe deeply through your mouth and into your belly; hold the breath for a few seconds; exhale through your nose. Do about 12 repetitions."

Sleep

Fibromyalgia patients often do not fall into the deep stages of sleep in which growth hormones are produced and released to heal and repair the body from the day's wear and tear. For this reason, people with fibromyalgia need to do everything they can to get deep, continuous, quality sleep. Chamomile and lavender teas can help induce relaxing sleep. A pinch of nutmeg can be added to help as well. Rubbing oil on the soles of feet before bed is soothing and promotes restful sleep. Coconut, peppermint and eucalyptus oil are cooling for pitta. Oil massage quiets the central nervous system, reducing nervous sensitivity, making it easier for one to fall into deeper sleep, and therefore alleviating pain. Oil massage in the evening is suggested for people with a vata constitution. “A person of pitta constitution may benefit from sleeping on the right side.”11 Sleeping on the left aggravates solar energy, which in turn aggravates pitta.

Food

There are many correlations between what medical texts suggest fibromyalgia patients should and should not eat, and what Ayurveda recommends for vata-pitta nutrition. Fibromyalgia patients are advised against consuming foods in the nightshade group: peppers, potatoes, tomatoes and eggplant. In Ayurveda, eggplant and tomatoes are considered regressive vegetables for vata-pitta, as are mushrooms, onions, Brussels sprouts and Swiss chard. In the Norway study on Ayurveda's effects on fibromyalgia, a number of food items were found to be incompatible with certain participants. Interestingly, these food items included wheat (in 97% of the subjects), pork (97%), and egg (94%) 12. Wheat incompatibility was reversed by using turmeric. Turmeric has anti-inflammatory properties, which hints to the potential for wheat sensitivity in fibromyalgia patients. More studies are needed on this subject. 

People with fibromyalgia, with its vata imbalance, should do their best to avoid anything that stimulates the nervous system. At the top of the list of stimulants to avoid are caffeine, alcohol, chemicals, preservatives and nicotine. As stated in Fibromyalgia and Chronic Myofascial Pain Syndrome, A Survival Manual, "When you light that cigarette, you also light up your autonomic nervous system."1

Eat slowly, in silence, with awareness. Vata should avoid raw and cold foods and instead opt for warm, cooked foods. Pittas should limit salt intake, avoid excess oil and eat non-spicy foods with cooling attributes, such as cucumber and watermelon, for example.

The following is a list of vata-pitta pacifying foods and foods that are regressive for vata-pitta. 

Meat

Avoid meat

Vegetables

V-P pacifying: Artichoke, asparagus, carrots, collards, cucumber, green beans, summer squash, sweet potatoes, winter squash

V-P regressive: Brussels sprouts, eggplant, mushroom, onions, Swiss chard, tomatoes, turnips

Fruits

V-P pacifying: Apricot, avocado, coconut, dates, fresh figs, grapes, lemons, limes, mango, oranges, pineapple, plums, tangerines

V-P regressive: cranberries, persimmons, sour fruits, in excess

Grains

V-P pacifying: barley, basmati rice, cooked oats.

V-P regressive: buckwheat, corn, oat bran, rye

Legumes, beans

V-P pacifying: adult beans, mung dhal, urad dhal

V-P regressive: black-eyed peas, Lima beans, navy beans, pinto beans, split peas, green or yellow, white beans

Nuts and seeds

V-P pacifying: coconut, pumpkin seeds, roasted, sesame seeds, white, sunflower seeds, roasted. 

V-P regressive: all nuts

Dairy

V-P pacifying: butter, cottage cheese, cow's milk, goat's milk, ghee, yogurt

V-P regressive: ice cream and processed dairy

Oils

V-P pacifying: canola, coconut, safflower, sesame, sunflower. 

V-P regressive: animal oils or lard, corn, vegetable 

Sweeteners

V-P pacifying: barley malt, brown rice syrup, brown sugar unrefined, dates, maple syrup, sugarcane juice. 

V-P regressive: cooked honey, molasses, sugar substitutes (saccharin, sweet n low, NutraSweet), white sugar

Herbs, spices, and flavorings

V-P pacifying: basil, black cumin, black pepper, caraway, cardamom, coriander, cumin, duo, fennel, mint, orange peel, peppermint, saffron, spearmint, tamarind, turmeric, vanilla, wintergreen

V-P regressive: chili peppers, fenugreek, garlic, onions

Beverages and teas

V-P pacifying: apricot juice, coconut milk, date and fig shakes, lassi, chamomile tea. 

V-P regressive: alcohol, caffeinated drinks, carbonated drinks, tomato juice. 

Condiments

V-P regressive: ketchup, mayonnaise, miso, mustard, chemical preservatives and additives, iodized salt, vinegar

Videos of interest:

Joy's Wellness Trip 2/28/11 Ayurvedic Treatment Part 1

http://youtu.be/DVHW-awqqDs

[1] Fibromyalgia and Chronic Myofascial Pain Syndrome, A Survival Manual,

[2] Fibromyalgia

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001463/

[3] Gentle Hatha Yoga and Reduction of Fibromyalgia Related Symptoms: A Preliminary Report, Lisa Rudrud, EdD International Journal of Yoga Therapy no. 22 (2012)

[4] Complementary and alternative exercise for fibromyalgia: a meta-analysis

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616139/

[5] The American College of Rheumatology

http://www.rheumatology.org/Practice/Clinical/Patients/Diseases_And_Conditions/Fibromyalgia/

[6] The complete book of Ayurvedic home remedies by Vasant Lad

[7] Prakriti by Dr. Robert Svoboda

[8] Yoga of Herbs by Vasant Lad

[9] A Life of Balance, Maya Tiwari

[10] Massage therapy for fibromyalgia: a systematic review and meta-analysis of randomized controlled trials.

http://www.ncbi.nlm.nih.gov/pubmed/24586677

[11] Ayurveda, the Science of Self-Healing, Dr. Vasant Lad

[12] Treatment of fibromyalgia at the Maharishi Ayurveda Health Centre in Norway. A six-month follow-up study; L.B. Rasmussen, K. Mikkelsen, M. Haugen, A.H. Pripp, Ø.T. Førre

CLINICAL AND EXPERIMENTAL RHEUMATOLOGY 2009

[13] Exercise Interventions in Fibromyalgia: Clinical Applications from the Evidence

http://www.jain-resources.info/uploads/3/3/5/8/3358541/jones_article.pdf

[14] Figuring Out Fibromyalgia by Ginevra Liptan

[15] Exercise, not to Exercise or how to Exercise in Patients with Chronic Pain? Applying Science to Practice, Daenen L1, Varkey E, Kellmann M, Nijs J.

http://www.ncbi.nlm.nih.gov/pubmed/24662498

[16] Light On Yoga by B.K.S. Iyengar

[17] Yoga as a complementary treatment of depression: effects of traits and moods on treatment outcome.

http://www.ncbi.nlm.nih.gov/pubmed/18227917

[18] Complementary and Alternative Therapies for Fibromyalgia Syndrome. Systematic Review, Meta-Analysis and Guideline 

http://www.ncbi.nlm.nih.gov/pubmed/22760464

[19] Yoga Therapy in Practice, A Protocol and Pilot Study for Managing a fibromyalgia with Yoga and Meditation, Janet Hennard, MA, RYT-500, International Journal of Yoga Therapy no. 21 (2011)

[20] An eight-week yoga intervention is associated with improvements in pain, psychological functioning and mindfulness, and changes in cortisol levels in women with fibromyalgia

http://www.ncbi.nlm.nih.gov/pubmed/21887116

[21] Effects of yoga on depression and anxiety of women. Complementary Therapies in Clinical Practice

http://www.ncbi.nlm.nih.gov/pubmed/19341989

[22] Effect of two yoga-based relaxation techniques on memory scores and state anxiety.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2734564/

[23] Fibromyalgia is Associated with Impaired Balance and Falls

http://www.ncbi.nlm.nih.gov/pubmed/19125137

[24] Neuroimaging of meditation's effect on brain reactivity to pain http://www.ncbi.nlm.nih.gov/pubmed/16951585

[25] Yoga Sutras of Patanjali by Sri Swami Satchidananda