Itchy and Scratchy: Wool and Fibromyalgia

Abstract & Commentary

By Russell H. Greenfield, MD, Editor

Synopsis:This brief pilot intervention trial grew out of data suggesting that symptoms of fibromyalgia are often worse during cold weather, and that the skin temperature associated directly with specific trigger points may be lower than in healthy subjects. Focusing specifically on the use of woolen undergarments and bedding, the results suggest that keeping warm during winter months may help ameliorate pain and enhance functionality in people with fibromyalgia.

Source: Kiyak EK. A new nonpharmacological method in fibromyalgia: The use of wool. J Altern Complement Med 2009;15:399-405.

In an extraordinary display of research tenacity, the author of this clinical intervention trial sought to determine whether the use of woolen undergarments and bedding during the winter months would have health implications for people in Turkey with fibromylagia (FMS). A total of 50 adult female volunteer subjects who met the American College of Rheumatology's criteria for FMS were selected for the study, and were equally divided between the treatment and the control group, the groups being statistically similar to one another. Members of the treatment group were to wear woolen underwear that covered the body from the shoulders to the thighs, thus covering most trigger points, and to use a woolen bed liner, woolen quilt, and woolen pillow during the six-week trial that occurred between January and March. The control group subjects received cotton undergarments and bedding made of synthetic material.

Participants underwent pre- and post-intervention assessments that included a measure of pain using a visual analog scale (VAS), tender points count as determined by a specialist blind to treatment, and results of the Fibromyalgia Impact Questionnaire (FIQ, used to assess daily activity and FMS symptoms). The day following a subject's initial evaluation, the author personally visited the person's home and provided the treatment materials. She also made the subject's bed. The author subsequently visited each subject on a weekly basis for six weeks to ensure adherence to study protocol. Subjects were instructed to wear their garments constantly and not to remove the specified bed linens. Study participants were also instructed to maintain a daily diary of treatment material use as well as medication use (analgesics and/or NSAIDs).

The mean duration of FMS was more than five years in this study population, the majority of whom were married, poorly educated, and unemployed. At the end of the trial, significant improvement was seen in members of the treatment group compared with the control group for degree of pain, tender point counts, and scores on the FIQ. Subjects in the treatment group also used less medication than those in the control group, and experienced more restorative sleep. The author concludes that the use of woolen clothing and bedding during cold weather reduces the symptoms of FMS.

Commentary

Give this author a prize of some sort. I know plenty of people not enrolled in research trials who would be pleased to have someone come by their home to make their beds, even once!

Getting serious, theories abound but there is no universally accepted theory regarding the cause of fibromyalgia, nor its treatment. Many have noted that patients' symptoms of FMS seem to be worse during cold weather and better with higher ambient temperatures. In fact, the authors refer to data suggesting people with FMS have lower skin temperature at the site of tender points than healthy people, perhaps indicating decreased blood flow. Perhaps a practitioner's gentle admonition to "stay warm" might go a long way toward ameliorating some symptoms of FMS.

The author notes that animal wool has a higher capacity for retaining heat than plant or synthetic fibers, forms isolated air pockets, and is highly absorbent, capable of absorbing 30-50% of its weight in dampness, thus pulling sweat away from the body. The study emphasizes the use of woolen products, but it seems likely that seasonally appropriate garb and bedding could offer similar therapeutic benefit.

Leaving aside the memorable dedication of the author, there are some shortcomings of this pilot study. How the subjects were chosen is not clearly described, but the process does not appear to have been random, and the unique study population could impact generalizability, though this hardly seems a significant point.

Greater attention to details of lifestyle habits and dietary factors is finally becoming the norm in health care. For the setting of FMS, this study highlights a simple yet apparently effective lifestyle intervention requiring no prescription pad and minimal medical jargon. Simply say, "Stay warm."