Fibromyalgia
5 Hours Continuing Education
Carolyn McMakin, M.A.,D.C.
Private Practice
Portland, Oregon
Therapeutics
Non-prescription programs that work:
- Magnesium and Malic Acid
- - reduces muscle pain - 15 pts, 8 weeks, 1200-2400 mg Malate, 300-600 mg
magnesium. Tender point index went from 19.6 to 6.5(p <. 001).
Subjective improvement in myalgia occurred within 48 hours of supplementation. 6 patients mean TPI =6.8 after Malic acid/Mg after two weeks on placebo TPI increased to 21.5(p<. 001). Worsening occurs within 48 hours of placebo administration. Abraham MD, Flechas, MD, MPH, Journal
of Nutritional Medicine (1992) 3, 49-59 (We use Metagenics product Fibroplex.)
- Detoxification:
- Metagenics/ Jeff Bland Ph.D. program.
- Theory is that the problem is one of toxicity, dysfunctional oxidative
phosphorylation, intestinal dysbiosis, increased gut permeability causing
problem with amino acid transport and utilization - i.e. if the liver is
using amino acids for detoxification systems there are reduced amounts
available for neurotransmitter synthesis. Sustain, Ultra-Clear, Ultra-Clear
Plus, Hypoallergenic diet, Hypoallergenic diet, supplemental digestive
enzymes, gut flora replacement, candida treatment. (4R- remove, replace,
re-inoculate, repair. Metagenics/Jeff Bland, Ph.D.) In some of our
patients the diet alone has reduced symptoms dramatically.
- Tyler Protocol:
- same theory as Metagenics - gut permeability, de-tox, enzymes, flora -
capsules instead of powder.
- 5-Hydroxytryptophan
- 90 day trial, 50 patients - number of tender points, anxiety, quality of
sleep, fatigue all showed significant improvement (p=<. 001) good/fair
=50%, no one removed from treatment due to side effects. Puttini
PS, Caruso, I; Primary Fibromyalgia syndrome and 5-hydroxytryptophan-90
day open study, Journal of International Medical research 20(2): 182-9,
1992 April. (5-HTP is available in USA)
- Electro-acupuncture
- - Deluze, C; Bosia, L; Zirbs, A
- - 7/8 outcome parameters showed significant improvement in active treatment group; none improved in sham group. 50% had satisfactory improvement, 25% had dramatic improvement - almost complete disappearance of symptoms. Points included: Stomach 36, Large intestine 4 (bilaterally) and six other points not described but chosen "depending on the patient's pain pattern
and according to the empirical efficacy of the sites in the treatment of
pain." (See Melzack, Still, Fox; "Trigger points and acupuncture points
for pain: correlation and implications." Pain 1977; 3:2-23)
- In-office trials, my office,
- we have similar results, excellent response. We have stimulated different points on the stomach and bladder meridian. Refer to an acupuncturist you trust. Deluze, C; Bosia; Zirbs; Electro-acupuncture in Fibromyalgia, British Medical Journal, Nov., 1992, 305(6864) 1249-52
- Waylonis MD, Ohio State Medical Journal
- - 46% of patients treated said the best most long lasting relief was obtained from electro-acupuncture.
- Simms, Controlled trials of therapy in Fibromyalgia Syndrome,
- Baillieres Clinical Rheumatology 8(4): 917-34, 1994 Nov.
- Aerobic exercise
- - results are inconclusive - it helps some patients, but makes the seriously
impaired patients worse - they are so close to the anaerobic threshold that exercise puts them over the edge. (Patients scored lower on five of the seven measures used, higher on the physical disability profile on the Sickness Impact Profile, (N=19).
- Mild physical activity seems beneficial
- - warm water swimming
- Gentle low impact aerobic exercise
- seems to help. Patients need to get above the aerobic threshold by
exercising parts that don't hurt.
Nichols DS, Glenn, "Effects of aerobic exercise on pain perception, affect, and level of disability in individuals with Fibromyalgia", Physical Therapy
74(4): 327-32 1994 April.
- Improving physical fitness
- can result in decrease symptoms and improved function. (McCain)
- NSAID's
- useful for simple analgesia, but not otherwise effective; this is not primarily
an inflammatory condition. Can cause bladder irritation.
- Niacin
- - time release Niacin 250 mg/day increases peripheral circulation
- Guaifenesin
- - Available in tablets, it is an expectorant - reduces phosphate and uric
acid deposits. OTC - dose 300 - 600 mg bid/tid
Dr.St. Amand (UCLA) has been working with FMS for 20+ years. He found
that medications that cause the excretion of uric acid are effective in
reversing the symptoms of FMS. His working hypothesis is that people
with FMS have an inherited abnormality in phosphate excretion, which causes
deposits to form inside the mitochondria. He uses Guaifenesin 600mg
twice a day. Three weeks treatment reverses one year of deposits.
We have used it successfully on two patients whose Fibromyalgia symptoms
disappeared after four weeks use.
- Hypnosis
- works better than physical therapy - In refractory FMS patients N=40 12
week treatment period with follow-up at 24 weeks - "Compared with patients
in the physical therapy group, the patients in the hypnotherapy group showed
significantly better outcome with respect to their pain experience, fatigue
on awakening, sleep pattern and global assessment at 12 and 24 weeks."
Haanen et al, "Controlled trial of hypnotherapy in treatment of refractory
fibromyalgia." Journal of Rheumatology 18(1): 72-5, 1991 Jan.
- Imagery, progressive muscle relaxation
- Juvenile patients (N=7) 8.6-17.7 years old "In majority of patients such
techniques were effective in reducing pain and facilitating improved functioning." Walco, Ilowite "Cognitive-behavioral intervention for juvenile primary Fibromyalgia Syndrome", Journal of Rheumatology 19(10): 1617-9, 1992 October.
- Treat for Candida
- - muramyl dipeptides produced by healthy bowel flora help induce sleep,
candida may be a feature of IBS symptoms. Fluconazole (Diflucan),
and Garlic oil capsules are effective. Stool sample testing for candida
overgrowth will do sensitivity testing to determine effective agent.
© copyright
1997