• Medications for Fibromyalgia



• Understanding and Treating Chronic Fatigue Syndrome and Fibromyalgia



• Robert Bennett, M.D., is a Professor of Medicine at Oregon Health and Science University. He is a leading fibromyalgia researcher and has served on the editorial board of the Journal of Musculoskeletal Pain among other publications.
  
  
  • Robert Bennett, M.D., on Treatment of Fibromyalgia in Detail
  
  
  
• In exclusive interviews with Pro Health’s editor, the following respected physicians discussed their approaches to treating Chronic Fatigue Syndrome and Fibromyalgia with both traditional and alternative methods, including expert advice from their standard protocols and other recommendations for important issues patients deal with including pain, fatigue, sleep, depression, brain fog, diet, exercise, and nutritional supplementation.
  
  
  • Charles Lapp, M.D.
  • Kent Holtorf, M.D.
  • Derek Enlander, M.D.
  • Michael E. Rosenbaum, M.D.
  
  
  
• David Moskowitz, M.D., is a Harvard educated medical researcher who is investigating the possibility that Chronic Fatigue Syndrome and Fibromyalgia are autoimmune diseases or syndromes.
  
  
  • Interview with David Moskowitz, M.D.
  
  
  
• Treating Headaches & Muscle Spasms in Fibromyalgia

Understanding and Treating Chronic Fatigue Syndrome and Fibromyalgia

This article provides an overview of Fibromyalgia and Chronic Fatigue Syndrome, including information about symptoms and homeostasis (self-healing).

"The most commonly accepted definition (devised by the American College of Rheumatology in 1990) is that the person affected needs to show a history of widespread pain (pain is considered widespread when all of the following are present: pain in the left side of the body, pain in the right side of the body, pain above the waist and pain below the waist. In addition there should be pain in the spine or the neck or front of the chest, or thoracic spine or lower back) and pain in 11 of 18 tender point sites on finger pressure."

"Both Chronic Fatigue Syndrome and Fibromyalgia often seem to begin after an infection or a severe shock (physical or emotional), and the symptoms are very similar. The only obvious difference seems to be that for some people the fatigue element is the most dominant while for others the muscular pain symptoms are greatest. In other words for many people the diagnosis Chronic Fatigue Syndrome and Fibromyalgia are interchangeable terms, although there are certain symptoms (fever, swollen glands for example) which are found in a higher percentage of Chronic Fatigue Syndrome patients than those with Fibromyalgia, which sometimes make such a comparison less precise."

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Robert Bennett, M.D., on Treatment of Fibromyalgia in Detail

Robert Bennett, M.D., is a Professor of Medicine at Oregon Health and Science University. He is a leading fibromyalgia researcher and has served on the editorial board of the Journal of Musculoskeletal Pain among other publications.

Article includes treatments for pain associated with Fibromyalgia and a list of common Fibromyalgia syndromes and their treatments.

"The use of NSAIDs (e.g., ibuprofen, aspirin, etc.) is usually disappointing; it is unusual for Fibromyalgia patients to experience more than a 20% relief of their pain, but many consider this to be worthwhile. Narcotics (propoxyphene, codeine, and oxycodone) often provide a worthwhile relief of pain. In most patients, concerns about addiction, dependency and tolerance are ill founded. Ultram (Tramadol) and Ultracet (tramadol + Tylenol), are the most useful pain medications in many patients. They both have the advantages of having a low abuse potential and is not a prostaglandin inhibitor; tramadol reduces the epileptogenic threshold and it should not be used in patients with seizure disorders."

"There are several points that need to be stressed about exercise in Fibromyalgia patients: (i) Exercise is health training, not sport’s training. (ii) Exercise should be non-impact loading. (iii) Aerobic exercise should be done for 30 minutes each day. This may be broken down into three 10 minute periods or other combinations, such as two 15 minute periods, to give a cumulative total of 30 minutes. This should be the aim -- it may take 6-12 months to achieve this level. (vi) Strength training should emphasize on concentric work and avoid eccentric muscle contractions. (vii) Regular exercise needs to become part of the usual lifestyle; it is not merely a 3-6 month program to restore them to health. Suitable aerobic exercise includes: regular walking, the use of a stationery exercycle or Nordic track (initially not using the arm component). Patients who are very deconditioned or incapacitated should be started with water therapy using a buoyancy belt (Aqua-jogger)."

"The common treatable cause of chronic fatigue in fibromyalgia patients are: (1) inappropriate dosing of medications (TCAs, drugs with antihistamine actions, benzodiazepines etc.), (2) depression, (3) aerobic deconditioning, (3) a primary sleep disorder (e.g. sleep apnea), (4) non-restorative sleep and (5) neurally mediated hypotension. A new drug called Provigil is of some help when used intermittently for management of fatigue."

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Charles Lapp, M.D., on the Effective Treatment of Chronic Fatigue Syndrome and Fibromyalgia"

Charles Lapp, M.D., is nationally recognized and sought after as a medical consultant regarding Chronic Fatigue Syndrome and Fibromyalgia. He is Co-Chairman of the Clinical Affairs Committee for the American Association for CFS, medical advisor to the CFIDS Association of America, and a board member of the American FM Syndrome Association. Dr. Lapp is currently Director of the Hunter-Hopkins Center, P.A., Medical Consultations, in Charlotte, North Carolina, where he is a practicing physician, and is also Assistant Consulting Professor at Duke University Medical Center in Durham, North Carolina.

Here you will find Dr. Lapp's definition of Fibromyalgia and Chronic Fatigue Syndrome, as well as his recommendations for treatment of sleep disorders, pain, low energy, depression, and brain fog associated with Fibromyalgia. Also includes information on his standardized treatment protocol, the "Stepwise Approach."

"Most doctors who study both Chronic Fatigue Syndrome and Fibromyalgia find the two disorders so similar that we consider them “identical” for all intents and purposes. There are some subtle differences, however. Chronic Fatigue Syndrome is most likely triggered by an infectious or flu-like illness, whereas a number of Fibromyalgia cases are triggered by minor injury or trauma. Chronic Fatigue Syndrome is characterized biochemically by elevated levels of RNaseL (an anti-viral enzyme), whereas Fibromyalgia is unique in having excess Substance P (which triggers pain in nerves) in the bodily fluids. Profound exertional fatigue, post-exertional malaise, deep myalgias, sleep disruption, cognitive dysfunction, and autonomic abnormalities are common to both. Fibromyalgia tends to be a more persistent ailment, whereas studies have shown more spontaneous improvement in PWCs (Persons with Chronic Fatigue Syndrome). Persons with “pure Fibromyalgia” (that is, minimal cognitive dysfunction) tend to improve with low level, slowly progressive exercise, whereas persons with Chronic Fatigue Syndrome are more likely to flare or relapse with even minimal activity."

"Low energy (combating fatigue): Start with high dose (injectible) B12 and NADH. Next step, consider Wellbutrin (a dopamine agonist) or a non-sedating Selective Serotonin Reuptake Inhibitor (SSRI, like Prozac, Zoloft, Celexa, Effexor). But the best therapy is to use low doses of CNS stimulants like methylphenidate (Ritalin), dexamphetamine (Dexedrine or Adderall), and modafinil (Provigil). The latter has an excellent safety profile, minimal effect on the cardiovascular system, and little abuse or habituation potential. Provigil not only improves fatigue (alertness), but also somnolence, mental clarity, attention deficits, and depression."

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Kent Holtorf, M.D., on Effective Treatment of Chronic Fatigue Syndrome and Fibromyalgia

Kent Holtorf, M.D., established the Hormone and Longevity Center in Torrance, California to concentrate of the treatment of hormone deficiencies. Eighty percent of Dr. Holtorf’s practice involves patients complaining of fatigue, with Chronic Fatigue Syndrome and Fibromyalgia comprising the largest area of his practice. His medical practice focuses on these conditions as well as hypothyroidism, natural hormone replacement and optimization. He was recently selected to be the medical director of the Fibromyalgia and Fatigue Centers, and is currently writing a book on the topic.

This article outlines possible causes, diagnosis, and treatment of Chronic Fatigue Syndrome and Fibromyalgia.

"Current research suggests that many triggers can initiate a cascade of events, causing the hypothalamic, pituitary, immune and coagulation dysfunction. The most common initiating cause is a viral infection, which is very commonly Epstein-Barr Virus, Cytomegalovirus or HHV6. These are found in 80% of Chronic Fatigue Syndrome and Fibromyalgia patients. Many people with these syndromes can pinpoint the onset of the disease(s) to a viral infection that never got better. Also, stress seems to be a contributing factor. Effective treatment, with 80 to 90 percent of individuals achieving significant clinical benefits, can be achieved by simultaneously treating the above problems that an individual is found to have."

"The mix of treatments needed varies from patient to patient. There are some abnormalities that are common. For instance, close to 100% of individuals with these syndromes have low thyroid. This is, however, usually not picked up on the standard blood tests because the TSH is not elevated in these individuals due to pituitary dysfunction. Many of these individuals will also have high levels of the anti-thyroid reverse T3, which is usually not measured on standard blood tests. In addition, the majority of individuals can also have a thyroid receptor resistance that is not detected on the blood tests. Consequently, thyroid treatment, especially with timed release T3, is effective for many patients. T4 preparations (inactive thyroid) such as Synthroid and Levoxyl do not work well for these conditions."

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Derek Enlander, M.D., on the Treatment of Chronic Fatigue Syndrome and Fibromyalgia

Derek Enlander, M.D., is originally from Belfast, Ireland, and is Physician-in-Waiting to the British Royal Family and to several members of the British government during their visits to New York. He is presently in private practice in New York where he sees Chronic Fatigue Syndrome and Fibromyalgia patients, is on the faculty of Mt. Sinai Medical Center in New York City and serves as President of the Israel Medical Research Foundation.

Included in this article is Dr. Enlander's advice on treating common Fibromyalgia related syndromes such as fatigue, pain, and brain fog, as well as information about a formula he has developed to help treat Fibromyalgia symptoms.

"After a full examination, I treat according to each patient’s health needs. However, yes, there is a common thread of treatment. Over 10 years approximately, I developed a formula given by injection weekly to help alleviate symptoms over time. This formula method is NOT a cure, but it does help significantly over time. Many of my patients have been able to resume a significant portion of their lives, including returning to work."

"The formula works very slowly, often taking 8-12 weeks before the first signs of improvement begin. Other physicians use some of the ingredients I use to help treat Chronic Fatigue Syndrome/Fibromyalgia, but I have found that combining these ingredients into a single injection and consistently using this protocol has given tremendous improvement for most patients. My studies over the years have found a 70-80% improvement rate with use of the formula compared to only about 30% using individual items from the formula list."

"Low energy (combating fatigue): One of the ingredients in the formula that I use for patients is glutathione. Many patients find this helpful for increasing energy levels. Other drugs I use may also have side benefits of increasing energy. Neurontin is such a drug. This is an anti-seizure medication that currently has uses in sleep issues, pain issues, as well as helping with energy levels. Antidepressants are used for many reasons besides depression, and these may often help elevate energy levels. If a patient does suffer from depression issues, certain antidepressants may help alleviate any fatigue issues related to the depression. Elavil is one older antidepressant drug that is often helpful for low energy, as well as sleeplessness."

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Michael E. Rosenbaum, M.D., on Treating Chronic Fatigue Syndrome and Fibromyalgia

Michael E. Rosenbaum, M.D., is a pioneer in Nutritional Medicine with 25 years experience in alternative healthcare, specializing in the treatment of Chronic Fatigue Syndrome, fibromyalgia, Myofascial Pain, endocrine and metabolic disorders, and allergies. He is currently in private medical practice in Corte Madera, California.

Outlines Dr. Rosenbaum's treatment protocol for Chronic Fatigue Syndrome and Fibromyalgia.

"I have found that a cocktail of calcium 600 to 800 mg and magnesium 300 to 500 mg taken before bedtime has a relaxant effect that is very useful for sound sleep and to prevent restless legs. Melatonin and serotonin inducers like tryptophan and 5 HTP are also very useful. Too much tryptophan can cause bizarre and unpleasant dreams. GABA which occupies GABA receptors helps allay anxiety and induces sleep. Usual dose are 500 to 1500 mg."

"A menu of medications, nutrients and herbs help the treatment in each step [in the my treatment protocol]. The following nutrients and alternative approaches have worked best in my practice:

Energy: B Complex vitamins, especially vitamins B1 and B12; NADH – a stabilized form of vitamin B3, Coenzyme Q10. The above vitamins all participate in the formation of ATP energy packets. For muscle energy, creatine, carnitine and branched chain amino acids are often very useful.

Cognition: Raising brain acetyl choline with tyrosine, N-acetyl carnitine and DMAE; stabilizing brain cell membrane functions with phosphatidyl serine."

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Treating Chronic Fatigue Syndrome and Fibromyalgia: Interview with David Moskowitz, M.D.

David Moskowitz, M.D., graduated from Harvard Medical School in 1980 and trained at Barnes Hospital and Washington University Medical School in St. Louis from 1980 to 1987. From 1987 until 1998, Moskowitz was an assistant professor at St. Louis University Medical School, with a lab and practice at the St. Louis VA Medical Center. In 1998, he started his first biotechnology company. Genomed, his second company, is the disease management company with which he is currently affiliated.

This article discusses Fibromyalgia and Chronic Fatigue Syndrome as autoimmune diseases.

"We have encountered two patients with Fibromyalgia initially diagnosed as having Autoimmune Fatigue Syndrome (AIFS). To investigate the relationship between AIFS and Fibromyalgia, the distribution of the tender points in patients with AIFS was assessed according to the ACR criteria for Fibromyalgia. It was revealed that AIFS patients had 5.6 tender points on average. Patients with headaches, digestive problems, or difficulty going to school had more tender points than patients without. Patients with ana titers < 1:160 had more tender points than patients with ana > or = 1:160. Anti-sa negative patients had more tender points than positive patients."

"These results suggest a relationship between AIFS and Fibromyalgia in terms of the pathophysiologic mechanisms of the numerous tender points. In other words, ana-positive Fibromyalgia patients could be one form of AIFS, as well as ana-positive Chronic Fatigue Syndrome patients. Thus, autoimmunity could explain the controversial disease entities of Fibromyalgia and/or Chronic Fatigue Syndrome."

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Treating Headaches & Muscle Spasms in Fibromyalgia

In this article you will find helpful information on treating headaches and muscle spasms. Suggestions include stretching, keeping good posture, and using heating pads.

"What causes muscle spasms? Spasms are triggered by physical and emotional stress. Physical stress can be doing too much and becoming fatigued or having "painful" posture. Painful posture is sitting or standing with your back looking like a C: your head falling forward, upper back curled over, shoulders elevated, being bent forward at the waist or tilting to one side (by the way, sitting at the computer may be the #1 cause of painful posture.) Emotional stress can be anything from the slings and arrows of living in the 21st century to the hard-driving, pressured, overachieving, work-till-you-drop Type A lifestyles that many Chronic Fatigue Syndrome/(Fibromyalgia) patients have."

"If spasms are causing pain you need to take the stress off yourself and your muscles. You need to slow down, pace activities and rest during the day, even lie down to take the load off your muscle for 15-minute rest breaks, one in the morning and one in the afternoon. You also need to balance your body -- front to back and side to side, while sitting, standing and walking -- so that muscles don't have to fight gravity to keep you upright."

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