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Dr. St. Amand
For 36 years Dr. Paul St. Amand has studied treatment options for fibromyalgia. During this time he found that uricosuric medications helped patients with this multifaceted illness. His research has shown two gout medications, probenecid and sulfinpyrazone proved effective. Dr. St. Amand and others tailored the dosages, raising them progressively until cyclic reversal of the illness began. In less responsive individuals, the researchers noted, titration took considerable time.
Dr. St. Amand and colleagues realized the expectorant, guaifenesin, was weakly uricosuric. While it is not sufficiently potent to treat gout, it has proven invaluable for fibromyalgia. Dr. St. Amand’s analysis of 264 consecutive patients showed beginning lesion reversal at varying guaifenesin dosages: 300 mg per day was sufficient for 20 percent of patients; at 600 mg another 50 percent demonstrated improvement, and at 1,800 mg per day, another 20 percent showed reduction of palpable lesions. Thus, 90 percent of St. Amand’s patients were shown to have attained a sufficient dosage at 1,800 mg a day or less. Ten percent required 2,400 mg or more.
According to Dr. St. Amand, Guaifenesin is distinctly more effective than previous medications and has no listed side effects, and only rarely did a patient exhibit nausea, hyperacidity or rash. Guaifenesin must be dispensed without other ingredients that do cause complaints. Though serum serotonin levels of patients on guaifenesin have not been investigated, guaifenesin increases the metabolite of serotonin, 5HIAA (5-hydroxyindoleacetic acid) in urine.
In 1995, a double blind, placebo controlled study of guaifenesin was conducted by Robert Bennett, M.D., and fellow researchers at the University of Oregon. Time released guaifenesin treatment (600mg twice daily) was administered to 20 female fibromyalgia patients for a period of one year. At the end of the study period, results showed guaifenesin was no more effective at relieving symptoms of fibromyalgia than placebo. However, Dr. St. Amand, strongly disputes these findings, stating the trial contained fundamental flaws that produced the poor results. He cites these key points in refuting the study:
- The study was conducted before anyone knew the signs of reversal are not apparent if the subject has uncontrolled reactive hypoglycemia. At the time, the frequency of reactive hypoglycemia was relatively unknown.
- The complete range of salicylate containing products and their capacity to block the effects of guaifenesin was not well known during the study. Also, each patient seems to have a different sensitivity to products containing salicylates.
- Dr. Bennett concluded in his study that a placebo effect is likely the beneficial mechanism behind the success Dr. St. Amand sees in his patients. St. Amand reports that 20% of his patients improve with a 300mg dose of time released guaifenesin twice daily, while at 600mg (time released) twice daily, 70% of patients improve. St. Amand states that were there a placebo effect, the percentage of those who improve would not be dosage-dependent; assuming the level of care is equal at each dosage.
Additionally, he points out that guaifenesin treatment is trying. As the disease cycle reverses, patients feel symptoms intensify and new or dormant symptoms can surface. This causes some patients to doubt their progress during the initial stages of treatment; however, Dr. St. Amand reports that as good days begin to accumulate, patients will have more confidence and strength to go on with treatment.
Dr. St. Amand contends that the outcome of the Oregon study of guaifenesin treatment of fibromyalgia patients was due to faults such as blockade by salicylates and the failure to exclude hypoglycemics from the study. Another study in which these faults are corrected should be conducted.
(Source: www.guaidoc.com)
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