Treatments for Chronic Pain, Fibromyalgia and Chronic Fatigue Syndrome
December 5, 2005
By Steven B. Ross, D.C., F.A.S.B.E. Dip; Am Academy Of Pain Management
Since the early 1990’s, Fibromyalgia has become an increasingly common diagnosis. It is estimated that 10%-20% of new patients in a rheumatology practice have Fibromyalgia Syndrome (FMS), and approximately 2% of the U.S. population (3-6 million people) are thought to have the condition.
As most doctors do not recognize the pattern of symptoms as Fibromyalgia, it is my belief that this number is much higher. Because of the widespread musculoskeletal manifestations of this condition, patients suffering from it are very likely to seek complimentary and alternative medicine. This paper will review FMS, with emphasis on complementary and alternative medicine.
Chronic fatigue syndrome symptoms overlap noticeably with Fibromyalgia symptoms. Both syndromes are often associated with sleep disturbances, flu-like aches, fatigue, and general malaise. However, Fibromyalgia syndrome is not typically accompanied by fever. Also, Chronic Fatigue Syndrome does not require pain to be present for its diagnosis, as does Fibromyalgia Syndrome.
The condition we now know as Fibromyalgia appears to have been recognized for many years, but was known years ago by other names. In the mid 1800's, European literature refers to a "neurasthenia' and "spinal irritation" (exaggerated tenderness to palpation).
In 1904, Sir William Gavers coined the term "fibrositis", which appeared in North America rheumatology texts in 1940. After WWII, 50%-70% of rheumatological referrals from the British armed forces were for fibrositis. In 1981, Yunas, ET. al. began using the term Fibromyalgia, since the condition was shown to not involve inflammation and in 1987, an editorial appeared in JAMA acknowledging the existence of Fibromyalgia.
Chronic Fatigue Syndrome
There is no known single cause of CFS. Some authorities believe it is a condition shared by many different underlying diseases rather than an entity unto itself. Others believe it is caused by a defect of the immune system. Hormonal deficits, low blood pressure, and viral infections have been studied as possible causes or contributors. The postulated causal link with Epstein-Barr virus hypothesized in the mid-1980s has been discounted.
There has been some correlation between chronic single or multiple viral infections, but CFS has also been noted in the absence of any apparent viral infection. Food allergies are commonly associated with this disorder, as is candidiasis, intestinal parasites and toxic chemical exposure.
Toxin exposure has been suggested to play a significant role in the development and progression of both Fibromyalgia and Chronic Fatigue Syndrome, as approximately 47-67% of patients with FM and 53-67% of patients with CFS have reported at least one episode of symptom exacerbation after specific chemical exposure.
Another area of interest is the link between intestinal dysfunction and FM. Although statistics vary, research suggests that up to 70% of patients with FM complain of symptoms associated with irritable bowel syndrome (IBS). IBS is a functional disorder characterized by chronic abdominal pain with alternating diarrhea, and constipation.
In comparison with healthy subjects, patients with IBS also tend to experience extra intestinal symptoms that overlap with FM complaints, including increased nerve sensitivity, morning stiffness, headaches, sleep disturbances, and fatigue.
Improved GI health can be achieved with a nutritional regimen known as the 4R-GI Restoration Program, which addresses the four primary stages of healing: Remove, Replace, Reinoculate, and Regenerate. This is an essential part of our “detoxification” program which we will discuss later.
The American Academy of Rheumatology has set forth the following criteria for the diagnosis of Fibromyalgia:
1) Subjective aching for at least 3 months.
2) Subjective stiffness for at least 3 months.
3) Widespread pain: (bilateral, above and below the waist, includes axial skeletal pain).
4) Tenderness to palpation (4 kg pressure) at 11 to 18 (bilateral) points as follows:
1. Upper trapezius (shoulders)
2. Supraspinatus (upper back)
3. Gluteal region (buttocks)
4. Pectoralis Major (2nd rib)
5. Inferior Sternoclydomastoid muscle ("lower cervical spine")
6. Greater Trochanter (hip joint)
7. Medial knee (inside of knee)
8. Suboccipital (base of skull)
9. Lateral Epicondyle (elbow)
In addition to the above criteria, sleep disturbance, fatigue, weakness, and irritable bowel syndrome may also be present.
Chronic Fatigue Syndrome Criteria
1) Persistent, severe fatigue brought on by less than 50% of normal exertion. This fatigue must have lasted for six months or longer, and must be unaffected by any amount of rest.
2) Low grade fever (around 101 degrees)
3) A sore throat
4) Lymph node tenderness
5) Generalized aches and pains
6) Sleep disorders
7) Psychologically related symptoms such as feelings of depression, isolation, and anxiety.
General Examination and Treatment Goals
The goal in any treatment regimen must begin with a thorough evaluation of prior treatment history. This must include which provider(s) have already been consulted. Prior treatment, medications, etc., including any successes and failures.
The goal in any treatment plan must take into consideration the patient’s ability to optimize sleep quality and quantity. Educating the patient with emphasis on the patient becoming the active director of their treatment. Increase exercise and activity through guided, achievable goals. Improve aerobic capacity.
Optimize posture, ergonomics, biomechanics, and assess diet and nutritional status as well as making the patient aware of other health care resources when appropriate. FMS and CFS is typically a multi-disciplinary problem.
Specific Treatment Considerations
When considering what determines your state of health, there are two aspects to be understood. One is your genetic heritage, which up until recently we thought was an unquestionable factor which unfortunately is beyond your control. The other is your environment, which fortunately you have considerable influence over. Of the environmental factors, second only to your thoughts and emotions is your diet and nutritional balance.
In all fairness, when looking to improve your health, perhaps nutritional factors should be considered and engaged even before your thoughts and emotions. There are several reasons for this:
1. Most find nutritional factors easier to control than their thoughts and emotions.
2. Certain nutritional factors make dramatic differences in your ability to think clearly, stabilize your moods and enhance your overall sense of well-being.
3. We can assess your nutritional needs with more accuracy than your mental-emotional needs.
4. We can effectively address your specific nutritional needs with targeted nutritional programs.
Let's now address the dietary fundamentals that will lay the foundation you will need in order to optimize the results of your targeted nutrition program. Contrary to what some might have you believe, your daily food and beverage choices do not require a degree in nutrition, just common sense and common practice. You start with the following distinctions:
1. Choose simple whole foods. Those that Mother Nature has always provided for us.
2. Eat them in their natural form, or as close to it as possible. Less processing generally means more nutritional value.
3. Eat as wide a variety of these minimally processed, whole natural foods as circumstances allow. This maximizes your exposure to various nutrients while minimizing your repeated exposure to potential contaminants (e.g. pesticides, insecticides, etc.).
4. Pay special attention to ensuring sufficient high quality, low fat proteins in your diet. Balance every 15 grams of protein with 2-3 cups of low starch vegetables as often as possible.
5. Be moderate with your starch intake. Stick to the less processed whole grains and whole vegetables.
6. Balance starch/carbohydrates with quality proteins wherever possible.
7. Be sure to get at least 3 pieces/servings (1/2 - 1 cup) of fresh fruit and 4-6 cups of fresh vegetables every day.
8. Reduce animal fats (fatty meats, dairy fats) and eliminate hydrogenated oils, trans fats and processed vegetable oils (i.e. all fried foods, margarines, commercial salad dressings, oils, sauces, confectionaries and baked goods). Instead, substitute monounsaturated oils for low heat stir-fries, light sautéing, salad dressings and baking (e.g., olive oil, canola and almond oils) and Omega3-rich, properly shielded (from air, light and heat) oils, such as flax, pumpkin and walnut for salad dressings and sauces. These nutritious oils are not to be cooked.
9. Drink at least 8 glasses of pure water daily.
10. Substitute herbal and naturally decaffeinated teas for caffeinated beverages and sodas (including chemical containing 'diet' drinks).
A healthy life is an active one. Regular exercise is essential for maintaining optimal health. The long term success of any health care program will be diminished if you do not exercise at least to a moderate degree on regular basis. Exercise increases the body's metabolic rate and therefore will help you achieve your ideal weight, although that is not the main reason for doing it. Exercise increases circulation, and improves the delivery of nutrients to the cells in our body that need them.
Exercise improves the removal of metabolic waste products from the body's cells and the elimination of toxins from your body. It will improve your heart's strength and performance, as well as cause the production and release of chemicals in your brain that make you feel good, the so-called "runner's high" produced by endorphins. So exercise has multiple positive benefits, and should be included in your regular schedule and become a part of your life.
To get the most benefit from an exercise program, you must bring your heart rate up to approximately two-thirds of its maximum, and keep it there for a minimum of 15 minutes, at least 3 times a week.
Exercising daily will produce results much faster than every other day and 30 minutes is better than 15! Be sure to listen to your body and do not over do it.
Remember: Inch by inch, anything is a cinch! Just about any form of activity that will meet the above criteria is fine. Walking, jogging, swimming, dancing, bicycling, etc. All can fit nicely into the category of "aerobic exercise", so you do not need to buy a color-coordinated outfit and join an aerobic dance class to get your exercise.
Of course, if you want take up "aerobics", it's great exercise as well. Good shoes with a strong arch support, and loose, comfortable clothes will work fine. The most important thing is to make exercise enjoyable, so that it becomes a regular part of your life, just like eating and sleeping. You must use it, or you will lose it!
Rest and Relaxation
Let us define what is meant by proper rest. Ideally it means: freedom from work or physical activity; freedom from disturbance of mind or spirit, peace of mind. The purpose of proper rest is to restore, to bring back to a former or original condition.
There are presently many theories as to why we require rest or sleep, what happens mentally and physiologically while we sleep and even how much each individual really needs. Based on the information that we have, a rational approach serves to unravel some of the mystery surrounding sleep and the essentials of proper or adequate rest.
When individuals are sleep-deprived their most common complaints are mental fatigue or confusion and musculoskeletal discomfort. These conditions are relieved by subsequent rest. We therefore may extrapolate that sleep is essential to maintain mental clarity and to neutralize structural stress.
The physiology behind the restoration of mental capacity is not yet well understood, however, it would appear to be associated with renewing neurotransmitting chemicals and cell membrane potentials throughout our bodies. These processes in turn are dependent, at least in part, upon the length of rest, the quality of one's nutrition, and the state of one's mind.
Rest also provides time for your logical, analytical `left' brain to relax its dominance and thus allow the emotional and imaginative `right' brain valuable time for `creative' expression. Thus, one of the keys to effective rest is learning how to turn down the volume of your `left' brain while you tune into your `right'! This is where regular use of an exceptional guided imagery tape can be so useful. The physiology behind the other major function of rest and sleep, structural recuperation, is more important.
There is relentless force acting upon our physical structure, day by day, week after week: The constant force of gravity. The more effectively one learns to be aware of this force and to deal with it intelligently, the less destructive its influence. Failure to pay heed and to effectively reduce the effect of this downward pull on our bodies, often results in chronic and recurrent musculoskeletal discomfort (stiff, sore shoulders, neck, and back: hip, knee and ankle distress). Degenerative disc and joint disease, myofascial problems and even headaches.
How then may we better cope with these stresses, especially with those related to the earth's gravity? While most of us are aware of the need for a good night's sleep, too few recognize the need for proper rest and relaxation. Both those who are engaged in heavy physical labor and business executives or white collar workers alike are subjected to a variety of physical stressors throughout their `working hours'.
There is mounting evidence that those who manage to obtain some rest and more resourceful postures during the day not only live more comfortably and work more effectively, they also live longer! Once convinced of the benefits, how does one go about obtaining proper rest during business hours? Proper rest refers to "those inactivity’s which serve to aid restoration of optimal mental and physical function" (i.e. good health).
Our goals here include assisting the nervous system in its ability to cope with the stresses upon it, and assisting the physical body in compensating for the wear and tear of manual activities and the effects of gravity. All that is normally required is 15 to 20 minutes, twice daily, (in addition to your usual night sleep) to counteract the onslaught of stress-related fatigue and wear and tear.
One of the most effective practices involves getting off your feet and laying supine on your back on a firm surface. Any carpeted floor will do nicely. The knees should be bent up toward your chest until your thighs are at right angles to your trunk, perpendicular to the floor, with your lower legs resting on a chair seat, couch, or even a box with padding on top.
Stress can be very damaging to your health. While it is true that without some stress we would not be able to function, excessive stress will ultimately wear you down and make you sick. Dr. Hans Selye studied the effects of stress throughout his life, and identified "dis-stress" as being the most damaging. He stated that this harmful stress had a distinct impact on health and could eventually cause a variety of body systems to deteriorate.
Drs. Holmes and Rahe, in a series of studies done on military personnel, showed that stress could also have a cumulative effect. They catalogued many different stressors, ranging from mild ones such as traffic tickets, to the profound stress associated with the loss of a loved one. They showed that people who were subjected to multiple stresses over a two year period had a much higher likelihood of becoming seriously ill than those not under such stress. This illustrates the importance of eliminating "dis-stress" whenever possible.
How can you reduce stress?! Sometimes it is difficult. Perhaps the stress comes from the type of work you do, and it is not economically feasible to change. You can, however, change the way you deal with that stress. The harmful effects of stress can be minimized if we learn to deal with stressful events in a positive manner. Relaxation tapes, meditation techniques, and biofeedback can all help. Regular exercise has the additional benefit of helping you rid your body of the negative effects of stress (please refer to the section on exercise for more information). A relaxing walk in the park or along a beach can work wonders! If you would like more help in this area, just ask.
The body requires two forms of energy to function: biochemical, provided by the food we eat, and electrical, provided by the brain and nervous system. One cannot function without the other. You can improve the biochemical part by being careful about what you eat, taking your supplements to fill in any "gaps" in your diet or overcome unique metabolic, environmental or genetic circumstances, and ensuring that digestion and absorption are functioning optimally.
The electrical component, however, depends on structural integrity.
The brain acts as a control center, producing the energy that flows out through the spinal cord to the rest of the body via the network of nerves. Every function of the body, from the contraction of muscles allowing movement, to the digestive processes, to the production and repair of cells, to our immune function; literally everything depends on proper supply of electrical energy from the brain through the nerves.
Chiropractic is the science of making sure that those nerve signals reach their destination with maximum impact and value. Your personalized, multifaceted chiropractic program will work to ensure that no structural problem impedes optimal electrical energy flow throughout the body. The nutritional program outlined in this report helps to ensure that your biochemical energy needs are also being met. The two depend on one another!
Weight Management/ Detoxification
Your questionnaire responses and our assessment may indicate that you may benefit from a comprehensive weight management program. In our office, we utilize a program that emphasizes a proper, healthy weight loss regimen. This is an exciting program for us to recommend due to both its exceptional results and the simplicity of design.
Unlike many weight management programs, it involves less time spent in food preparation by providing an easy to use single-meal-replacement drink as well as a predetermined food shopping list. Included is a comprehensive patient guide, in addition to this report. We have found the results extraordinary and often include the resolution of other symptoms, such as, bloating, mood swings and fatigue spells. Our hope is you will experience a noticeable increase in your energy, endurance and overall well-being.
Toxins exist everywhere and can lead to serious health problems. They are in food and the environment, and persist because of our insufficient metabolic ability to rid the body of all that we are exposed to on a daily basis. They can drain the body of energy and make you more susceptible to disease and infection. Toxins tend to concentrate in the liver and gastrointestinal tract, both places responsible for eliminating toxins from the body. Since everyone is exposed to toxins, everyone can use a detoxification treatment on a regular basis.
Possible Causes of Toxicities and Risks Include:
Aging, alcohol, bacterial toxins, burns, cigarettes, constipation, drugs, food additives, food allergies, fried foods, heavy metals, intestinal infections, silicone implants, stress, toxic chemicals, metabolites, and pesticides
Purification (also known as detoxification or cleansing) is the process of addressing the natural toxins in the body. The liver, digestive tract, kidneys, bladder, lymphatic system, lungs and skin are the major systems/organs that are involved in the neutralization and elimination of toxins.
Because we are exposed to high levels of foreign substances and over consume chemically-treated, synthetically-produced food, extra purification is needed. The program we use at our clinic utilizes whole food supplements, pure food and water to give the body the resources it needs so it can purify and rebuild itself naturally.
Our programs place emphasis on the liver and colon because these two organs play a major role in supporting the digestive system.
Many people who complete our purification program experience increased energy, better digestion, less bloating, clearer skin, shinier hair and a disappearance or lessoning of past conditions such as PMS, digestive problems, Fibromyalgia and chronic fatigue syndrome to name just a few.
Helpful Lifestyle Changes:
Breathe. Avoid stress and seek out ways to relax and resolve stressful conditions in your life. Get sufficient sunlight, exercise, and sleep. Counseling, meditation, and other therapies are proactive ways to relieve stress.
Helpful Dietary Changes:
Drink green tea, a dietary source of catechin. Eat a well-balanced diet rich in fresh fruits and vegetables. Eat artichokes, which help detox the liver. Eat foods in the Brassica family (cabbage, cauliflower, brussel sprouts). Increase intake of berries. Keep a food diary to detect individual patterns of sensitivity to foods. Fast regularly.
Supportive Nutritional Supplements:
Coenzyme Q 10 (Ubiquinone) antioxidant, carries oxygen to the tissues, strengthens immune system
Copper assists body detox
Folic Acid strengthens immunity
Magnesium helps reduce stress, used with Calcium
Vitamin B Complex multiple B vitamin aids in improving general health and helps relieve stress, aids liver function
Vitamin C antioxidant
Vitamin E antioxidant
Zinc antioxidant, strengthens immunity (should be taken with copper)
Supportive Herbs Properties/Function:
Acacia catechu source of catechin, fights free radicals
Dandelion blood and liver support, diuretic, treats liver damage, mild laxative
Garlic antibiotic, antimicrobial, antioxidant, inhibits infection, and strengthens immunity
Ginkgo biloba neutralizes free radical that are often produced during stress
Goldenseal detox, strengthens immunity
Hawthorn Berries increases circulation, source of Vitamin C
Milk thistle (Silybum) antioxidant, blood and liver detox and support, neutralizes free radical that are often produced during stress
Turmeric aids liver function
Uncaria source of catechin, fights free radicals
Low Level Laser Therapy
One of the most exciting areas of complimentary and alternative medicine today is the use of Low Level Laser Therapy (LLLT). Light has been used for healing for many centuries, starting with the Greeks and Romans who recognized the positive effects of sunlight. We know that when sunlight strikes the skin, our whole body feels the benefits. Even our brain is affected by sunlight. As scientists have understood more about the nature of light and its positive effects on the body, they have been able to develop techniques and devices that use light as part of the healing process.
What we usually call light is the visible part of the spectrum of electromagnetic radiation. We are all familiar with the rainbow effect and what we call light is that range of colors. Conventional light has a thermal effect; it warms up the skin. For example, ultraviolet light is the part of the spectrum that is responsible for tanning your skin; infrared light is used as a heat source.
Low-level laser light is compressed light of a wavelength from the cold, red part of the spectrum of electromagnetic radiation. It is different from natural light in that it is one precise color; it is coherent (it travels in a straight line), monochromatic (a single wavelength) and polarized (it concentrates its beam in a defined location or spot). These properties allow laser light to penetrate the surface of the skin with no heating effect, no damage to the skin and no known side effects. Rather, laser light directs biostimulative light energy to the body's cells which the cells then convert into chemical energy to promote natural healing and pain relief.
The History of Laser Therapy
The word "laser" is an acronym for Light Amplification by the Stimulated Emission of Radiation. The theory was first described by Albert Einstein (1879-1955) who paved the way for the development of the therapeutic laser.
The first low-level therapeutic laser was developed in 1962. By the end of the 1960's, Endre Mester in Hungary was reporting an improved healing of wounds through low-level laser radiation. Since then, scientists and doctors around the world have been using laser light to treat conditions that can affect all age groups.
High Power vs. Low Power Medical Lasers
There are two types of medical laser: high power and low power. High power lasers are used to cut through tissue. Low-level lasers, on the other hand, are used to stimulate tissue repair through a process of bio-stimulation.
Low-level laser therapy is the application of red and near infrared light over injuries or wounds to improve soft tissue healing and relieve both acute and chronic pain. Low-level therapy uses cold (subthermal) laser light energy to direct bio-stimulative light energy to the body's cells without injuring or damaging them in any way. The therapy is precise and accurate; and offers safe and effective treatment for a wide variety of conditions. The energy range of low level laser light lies between 1 and 2000 mW (milliwatts), while for surgical lasers the energy range lies between 3000 and 10000 mW.
How Does Low Level Laser Therapy Work?
Low-level lasers supply energy to the body in the form of non-thermal photons of light. Light is transmitted through the skin's layers (the dermis, epidermis and the subcutaneous tissue or tissue fat under the skin) at all wavelengths in the visible range. However, light waves in the near infrared ranges penetrate the deepest of all light waves in the visible spectrum.
When low level laser light waves penetrate deeply into the skin, they optimize the immune responses of our blood. This has both anti-inflammatory and immunosuppressive effects. It is a scientific fact that light transmitted to the blood in this way has positive effective throughout the whole body, supplying vital oxygen and energy to every cell.
The Physiological Effects of Low Level Laser Therapy
• Improved metabolism
• Increase of cell metabolism
2. Improved blood circulation and vasodilatation
3. Analgesic effect
4. Anti-inflammatory and anti-edematous effects
5. Stimulation of wound healing
How Does Low Level Laser Therapy (LLLT) Benefit Users?
* Relieves acute and chronic pain
* Increases the speed, quality and tensile strength of tissue repair
* Increases blood supply
* Stimulates the immune system
* Stimulates nerve function
* Develops collagen and muscle tissue
* Helps generate new and healthy cells and tissue
* Promotes faster wound healing and clot formation
* Reduces inflammation
Is Low-Level Laser Therapy for You?
1. Do you suffer pain from an old or new sports injury or accident?
2. Do you suffer from repetitive stress injuries such as carpal tunnel syndrome?
3. Do you suffer from lower back pain?
4. Do you suffer from migraine headaches?
5. Do you take pain medications more than three times a week?
6. Do you ever wake up in the night with pain?
7. Do you suffer from skin ulcers, bed or other pressure sores?
8. Do you suffer from acne or rosacea?
9. Do you have potential scarring from a recent surgery?
10. Do you suffer from herpes simplex (cold sores)?
Many acute and chronic conditions can be improved with laser use, including:
* Wound Healing
* Migraine headaches
* Lower back pain
* Repetitive Stress Injuries (RSI)
* Carpal Tunnel Syndrome (CTS)
* Sprains and strains
* Post-operative pain
* Tennis Elbow
* Golfer's Elbow
* Soft tissue injuries
* Post-operative wounds
* Pressure sores
* Herpes simplex
Perhaps the most important fact that we have found as a pragmatic clinician is the fact the LLLT seems to work when and where our previous therapies have failed. In our experience, we have had very few patients who have not received benefit from LLLT and many have received truly outstanding help for conditions that had previously defied all other therapies.
Other conditions that LLLT has been found to be very effective for are the following: healing of open wounds; dermatitis; eczema; lack of granulation tissue formation (thus retarding wound healing); overcoming and softening scar tissue formation; fistulas; edema; cysts; bursitis; muscle inflammation, contusions, ruptures, atrophy and contractures; neuritis; neuralgia; nerve injuries; atrophy of nerves; paresis; paralysis; prolapsed disc disease; spondylitis; periostitis; spondylosis; bone fractures and fissures; arthritis, both rheumatoid and osteoarthritis; arthrosis; strains and sprains; dislocations (following reduction); tendonitis; epicondylitis; tendon strains and contusions; tendon ruptures and following tendon surgery; hematoma; tissue infiltration of blood after blood taking or injection.
Pain relief, improved sleep, and improved mood are examples of goals that prescription medicines can help you reach. Generally speaking, patients with Fibromyalgia do not tolerate medicines well. There are often side effects such as nausea, drowsiness, or lightheadedness. One person may tolerate a particular medicine, but the next person will get sick on it. Prescribed medicines can provide great benefits to many however; they should not be used in lieu of natural forms of treatment and treating the “cause” of the problem. Categories of drugs used in the treatment of Fibromyalgia can include:
2) Anti-inflammatory medicines
3) Antidepressant medicines (tricyclics and selective serotonin reuptake inhibitors)
4) Muscle relaxants
5) Sleep modifiers
6) Anti-anxiety medicines
7) Other medicines used to treat chronic pain
1) Analgesics: Analgesics are pain killers and can include over-the-counter medicines such as aspirin and acetaminophen, or prescription-strength pain pills like narcotics (opiates), codeine, Vicodin, Darvocet, Oxycontin and Percocet. Ultram is a pain reliever that differs from narcotics in its action on the central nervous system.
These medications do not alter the Fibromyalgia, but they can help take the edge off of pain. Narcotic medications have potential for adverse side effects including drowsiness, difficulty with concentrating, and addiction, so they should be used carefully.
Many people with Fibromyalgia are sensitive to codeine medicines, which can cause nausea or an allergic reaction. Ultram can cause allergic reactions in people sensitive to codeine, and a small number of people taking Ultram have seizures.
2) Anti-Inflammatory Medicines: Anti-inflammatory medicines include aspirin, nonsteroidal anti-inflammatories (NSAIDs) such as ibuprofen, Naprosyn, Lodine, Daypro, and Cox-II inhibitors, and corticosteroids such as prednisone or dexmethasone. These medications are both anti-inflammatory and analgesic. Some of these medicines, such as ibuprofen, are available both over the counter and by prescription.
Because Fibromyalgia is not a true inflammation, these drugs may be less effective in reducing pain. However, these drugs can be helpful in reducing pain that flares up with excessive physical activity, tendonitis, or bursitis, and should be used only as needed.
The major side effect of the anti-inflammatories is bleeding from gastrointestinal ulcers. This problem is more common the longer the medicine is taken. However, a new medication class is available, Cox-II inhibitors, which include Celebrex (Searle Pharmaceuticals), and Vioxx (Merck) are now under scrutiny with Vioxx currently pulled off the shelf. Post market studies now confirm that Vioxx raises the risk of serious cardiovascular events including heart attack and stroke. About 2 million people worldwide were on the drug at the time of its withdrawal. As with any medication, caution should be taken when using any Cox-II inhibitor.
3) Antidepressant Medicines: The antidepressant medicines include tricyclics (for example, amitriptyline, nortriptyline, doxepin, and trazodone), and selective serotonin reuptake inhibitors (Prozac, Zoloft, Paxil, Effexor, Serzone, and Celexa). These medicines can treat pain and alter sleep and mood disturbances seen in Fibromyalgia. The tricyclic medicines are effective, but frequent side effects include dry mouth and drowsiness.
4) Muscle Relaxants: Muscle relaxants can decrease pain in people with Fibromyalgia. Medicines in this family include Flexeril, Soma, Skelaxin, and Robaxin. The most common side effect is drowsiness, although Soma and Skelaxin cause less of it.
Medicines in the antispasticity category have been used to treat muscle spasms. Two of these medicines, Zanaflex and Baclofen, have been shown to help reduce back muscle spasms and pain.
5) Sleep Modifiers: Various medicines including those already mentioned, are used to treat insomnia (analgesics, antidepressants, and muscle relaxants). True sleep modifiers include benzodiazepines like Restoril and the hypnotic non-benzodiazepines such as Ambien.
The most common reported concern about using sleep modifiers, especially benzodiazepams, is the habit-forming potential. Ambien is reported to be less habit-forming but can cause rebound insomnia when it’s stopped.
6) Anti-Anxiety Medicines: Anxiety is a common problem in Fibromyalgia and contributes to pain, muscle tension, and irritability. It can make depression and insomnia worse. Various medicines including antidepressants and muscle relaxants treat anxiety. Benzodiazepines such as Klonopin, Ativan, and Xanax, are commonly used medicines. These medicines also cause sedation and thus can improve sleep. Possible side effects include depression and decreased memory. Sometimes it is hard to determine whether symptoms are due to Fibromyalgia or are side effects of medication.
7) Other Medicines Used to Treat Chronic Pain: Other medicines can be used to treat pain. Some pain medicines were originally developed for a different purpose. For example, anti-seizure medicines known as neuroleptics (including Neurontin, Dilantin, Depakote, and Tegretol) were later found to be helpful in treating pain, particularly neuropathic pain. People with Fibromyalgia who have a lot of burning or electric shock feelings in their hands and feet may improve from a trial of neuroleptic medicines.
Other conditions associated with Fibromyalgia such as irritable bowel syndrome can cause severe cramping pain and may require separately prescribed medications. Medicines used to treat irritable bowel syndrome include Metamucil, Levsin, and Levbid.
Medications can play a very important part to any patients treatment protocol who is dealing with chronic pain and fatigue issues. However, the role of medications should not be used as a substitute to correct the cause of the problem if at all possible.
Referral and Co-Treatment
Fibromyalgia, chronic fatigue and chronic pain patients often have complex presentations, and may require management by more than one practitioner. The proper combination of therapeutic approaches may have a synergistic effect. The chiropractor may be in a unique position to facilitate or coordinate the referral and co-treatment process.
Following is a list of resources to consider, using clinical judgment and the patient's history:
1) Primary care provider, M.D.
3) Psychotherapist, counselor, or related professional
6) Physical Therapist
7) Personal trainer
8) Support group
As with any advice or recommendations, seek professional help when evaluating or starting a new health care program. Refer to the individual supplement or herb for complete information. The statements regarding nutritional supplementation and herbs have not been evaluated by the FDA. The products listed in this article are not intended to diagnose, treat, cure, or prevent any disease. This information is not to be considered medical advice or a substitute for current medical treatment. It is intended to help you make positive informed decisions about your health.
EDITOR’S NOTE: Dr. Ross has a phone consulting practice in which he consults with patients all over the nation. He can be reached directly at his clinic at 858-481-1131,and by my e-mail at firstname.lastname@example.org as well as through his website at www.drstevenross.com.
From Fatigued to Fantastic, Jacob Teitelbaum, M.D. Avery Publishing, N.Y., 2001.
The Fibromyalgia Survivor, Mark Pellegrino, M.D. Anadem Publishing, Columbus, OH, 1995
PO Box 31750
Tuscon, AZ 85751
6505 Alvarado Road
San Diego, CA 92120
Chronic Fatigue and Immune Deficiency Syndrome Assoc. of America
National Fibromyalgia Research Association
PO Box 500
Salem, OR, 97302 www.nfra.net
CFIDS/ME Fibromyalgia Information S.G.
14825 Midland Rd.
Poway, CA 92064
National Fibromyalgia Association
Lynne Matallana, Director
2200 Glassell Street, Suite "A"
Orange, CA 92865
Phone: (714) 921-0150
Fax: (714) 921-6920
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