Fibromyalgia – Its Many Possible Symptoms, Diagnosis via Palpation of the Musculoskeletal Tissues (Mapping), and the Guaifenesin Protocol

Fibromyalgia is a symptomatically progressive illness that affects millions of people. It is manifested by many complaints that early in the disease come and go, but later are unrelenting. Recurrent flares eventually involve multiple body areas and systems until patients simply cycle from bad to worse.

They are typically referred from doctor to doctor based on individual complaints. The specialist may fail to grasp the extent of the problem and divide the disease into categories that lead to medical dead ends or incomplete treatments. Some of these symptom clusters are:

  • Chronic fatigue,
  • Systemic candidiasis,
  • Myofascial pain,
  • Irritable bowel, or
  • Vulvar pain syndrome.

There are no diagnostic x-ray or laboratory tests to diagnose Fibromyalgia.

The American College of Rheumatology recommends eliciting pain from at least 11 out of 18 predetermined “tender points” to confirm the diagnosis after a medical history is taken. Unfortunately, individual pain perception and tenderness vary greatly. Chronic fatigue patients have high pain thresholds and are not particularly sensitive to finger-poking. They may feel stiff, but complain mainly of exhaustion, muscle stiffness and cognitive impairment. The confirmation of affected tissue is more reliably obtained by using our method of palpation that we call mapping. 

The original description of fibromyalgia as “rheumatism with hard and tender places” has been forgotten. The tender-point exam seeks subjective patient pain sensations and so lacks the accuracy of objective, sequential body examinations (mapping).

We examine the musculoskeletal tissues using the pads of our fingers to feel muscles, tendons, and ligaments.

With practice, multiple swollen places become obvious. We sketch their location, size and degree of hardness on a caricature that becomes our baseline for future comparisons. Hands should move as if to iron out wrinkles in the underlying tissues. Expressions of tenderness do not influence findings. The most important site for confirming the diagnosis and establishing the efficacy of treatment is the left thigh. The outside of the quadriceps muscle (Vastus lateralis) and the front part (Rectus femoris) are involved in 100% of adults; they clear within the first month of proper treatment.

Fibromyalgia has no set symptoms.

Various combinations from the following list can be anticipated. (But importantly: Do not assume fibromyalgia is the cause of all symptoms. When in doubt or confronted with new problems, please consult your personal physician or appropriate specialist.)

Central Nervous System: Fatigue, irritability, nervousness, depression, apathy, listlessness, impaired memory and concentration, anxieties and even suicidal thoughts. Insomnia and frequent awakening due to pain result in non restorative sleep. 

Musculoskeletal: Swollen structures press on nerves to produce all types of pains including stiffness. Any muscle, tendon, ligament or fascia in the face, neck, shoulders, back, hips, knees, ankles, feet, arms, legs and chest may be involved. Calf/foot cramps, numbness and tingling of the face or extremities is common. Old injured or operative sites are commonly affected. Fibromyalgia is erroneously considered non-arthritic even though joint pain, swelling, heat and redness occur in a large percentage of patients. 

Irritable Bowel: Symptoms include nausea (usually transient, repetitive waves), indigestion, gas, bloating, deep pain, cramps, alternating constipation and diarrhea sometimes with mucous stools. 

Genitourinary: Mostly affecting women are pungent urine, frequent urination, bladder spasms, burning urination (dysuria) with or without repeated bladder infections and interstitial cystitis. Vulvodynia (vulvar pain syndrome) includes vaginal spasm, irritation of the labia (vulvitis) or deeper (vestibulitis) that induce painful intercourse (dyspareunia) all without the typical cottage-cheese discharge that accompanies yeast infections. Fibromyalgia is worse premenstrually. 

Dermatological: Various rashes may appear with or without itching: Hives, red blotches, itchy bumps or blisters, eczema, seborrheic or neurodermatitis, and rosacea. Skin is dry and nails are brittle or easily peel; hair is of poor quality and often falls out prematurely. Strange sensations (paresthesias) are common such as cold, burning (especially palms, soles and thighs), crawling, electric vibrations, prickling, super-sensitivity to touch, and flushing often with sweating. 

Head, Eye, Ear, Nose, and Throat: Headaches (migraines), dizziness, vertigo (spinning) or imbalance; itchy, burning and dry eyes or lids sometimes produce morning sticky or sandy discharges; blurred vision; hay fever or nasal congestion and post-nasal drip; painful, burning or cut-tongue sensation, scalded mouth and abnormal tastes (bad, metallic); intermittent low-pitched sounds or transient ringing in the ears (tinnitus); ear and eyeball pain; sensitivity to light, sounds and odors (perfumes or chemicals). 

Miscellaneous Symptoms: Weight gain; mild fever; reduced immunity to infection; fluid retention with morning eyelid and hand swelling that gravitates to the legs by evening, stretches tiny tissue nerves to produce restless leg syndrome; adult-onset asthma. 

Hypoglycemia Syndrome: This is a separate entity that may affect thirty percent of female and fifteen percent of male fibromyalgics. Sugar craving, tremors, clamminess, anxiety, panic attacks, heart pounding, headaches and faintness induced by hunger or by eating sugar and starches (carbohydrates) are solid clues for diagnosis. 

Though Fibromyalgia is almost always inherited, injury, infection, surgery, and stress may prod susceptible individuals into overt attacks. Family histories often span three and four generations from young children to those in their seventies. Boys and girls are equally affected before puberty, but in adults, females heavily predominate (85%). 

Forty-seven years ago, a patient of mine, taking a uricosuric gout medication [to increase excretion of uric acid] noticed he could peel calculus – a calcium phosphate compound – off his teeth with his fingernail. This mundane observation raised the possibility that tartar was a reflection of an unrecognized systemic problem expressed in saliva. After working with many patients, some with elevated uric acid and others with muscle pain and fatigue, but normal uric acid levels, I postulated a genetically defective enzyme prominent in the kidney that would cause a backup of phosphate throughout the system. Excesses of this ion in certain cell structures (mitochondria) would seriously impede the formation of energy (ATP). The resulting cellular fatigue would cause wide-spread malfunctions that would easily explain all the symptoms of what we now call fibromyalgia. 

We treat fibromyalgia using [a substance called] guaifenesin.

It increases urinary excretion of phosphate, gradually extracts abnormal body-wide accumulations, and thus reverses the illness. Guaifenesin is devoid of significant side effects and totally safe for children. It has been marketed for over 70 years for loosening and increasing the flow of mucus. Manufacturing processes seem to determine its potency, effectiveness and duration of action. Excessively short-acting tablets lack 24-hour action and most patients cannot use this as a stand-alone compound.

We determine what works for individuals by sequential physical examinations. Treatment is begun using reliable products at 300 mg twice daily for the first week. Worsening symptoms suggests that is the correct dosage for reversal, an amount that works for only 20% of patients. If there are no significant changes that first week, we raise the dosage to 600 mg. twice daily and hold there until the next examination a month later.

The response rate at this amount is 80%. Obviously, 20% of patients will need further adjustments. We repeat the muscle examination monthly until sufficient areas disappear to confirm the adequacy of dosage. Better hours eventually cluster into days and finally weeks. During this process, lesions objectively soften upon examination, sometimes split, and gradually vanish. The earliest lesions are the last to clear. 

To ignore the following guarantees failure.

Aspirin and other sources of salicylate block the action of guaifenesin at the same kidney level as they do other uricosuric medications. Salicylates are present in pain medications (aspirin) and those for some forms of colitis. Salicylate is absorbed through intact skin as well as the thin membranes of the mouth and intestine. Products used topically or as medications should be inspected for ingredients including all synthetic forms such as octisalate in sunscreens and wintergreen in gum. Almost all plant species have substantial levels of the natural chemical. Quantities vary from crop to crop and are stored to fend off infections and to help heal injuries. For this reason herbal medications block guaifenesin as do topical plant extracts and oils including camphor. 

The following is an incomplete guide to common sources of natural and synthetic salicylates.


1. Pain relievers containing salicylate or salicylic acid, for example, aspirin, Salflex, Excedrin, Disalcid.

2. Herbal medications such as St. John’s Wort, gingko biloba, saw palmetto, evening primrose oil, Echinacea. Vitamins with rose hips or bioflavonoids (quercetin, hesperiden or rutin) or plant extracts such as alfalfa.

3. Some wart or callus removers, acne products and dandruff shampoos contain salicylic acid. 

4. Topical pain creams such as Tiger BalmR, Ben GayR, ZostrixR, and Capsaicin.

5. Medications such as Pepto BismolR, AsacolR, Alka SeltzerR and UrisedR

Cosmetic and Topical Products:

1. Skin cleansers (exfoliants) that use salicylic acid or witch hazel.

2. Hair products with plant extracts such as balsam or bisabol.

3. Bubble baths with essential oils such as lavender.

4. Watch for the letters ‘SAL’ in sunscreens: octisalate, homosalate, or the name meradimate 

5. Lip balms containing camphor or menthol.

6. Lipsticks, glosses and deodorants should be checked for castor oil.

7. Avoid tissue or wipes containing aloe, razors with an aloe strip.

8. Moisturizers with oils such as almond, extracts such as green tea, or gels such as arnica. 

Oral Agents:

1. Mouth washes with mint, wintergreen or salicylate (Listerine).

2. Toothpastes with salicylates, including fresh or synthetic mint, often unlisted as part of the flavor; 

3. Avoid cough drops, floss, breath fresheners or chewing gum with mint flavor (including menthol, wintergreen, peppermint or spearmint).  You Must Take Responsibility for the Protocol. Physicians are Not Trained to Recognize Salicylate-Containing Ingredients Get the full list of contents when you phone manufacturers because customer service employees will not know that plants make salicylates. Our website ( offers updated lists of safe products and connects you with a knowledgeable support group that will help you with questions. 

No diet is required for fibromyalgia because the liver has a certain but limited capacity to counter salicylates in foods. It cannot override excesses from the high concentration in herbal medications. Tea is high in salicylate and should be used sparingly. 

Our protocol demands a patient’s skill and determination with or without professional supervision. Remember, reversal of the disease reproduces past symptoms and can induce new ones. We repeat these are not side effects. Though the intensity of the early reversal may cause concern it is similar to a rollercoaster ride that gets progressively tamer. Meticulously done, this is a highly-effective protocol. 

R. Paul St. Amand, MD
Associate Clinical Professor Medicine
Endocrinology – Harbor-UCLA

Claudia Craig Marek 
Medical Assistant 

August 2007

As indicated above: Do not assume fibromyalgia is the cause of all symptoms. When in doubt or confronted with new problems, please consult your personal physician or appropriate specialist.


Note: This information has not been evaluated by the FDA. It is general information and is not intended to prevent, diagnose, treat, or cure any condition, illness, or disease. It is very important that you make no change in your personal healthcare plan or health support regimen without researching and discussing it in collaboration with your professional healthcare team.

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