By John W. Addington
Editor’s note: As of April 2003, Dr. Goldstein has retired from medical practice and no longer maintains his website.
“Miracles are happening in the lives of Chronic Fatigue Syndrome (CFS) and fibromyalgia (FM) patients every day, thanks to Dr. Goldstein.” That’s how Katie Courmel, writer and CFS patient, sums up the benefits to Dr. Jay Goldstein’s unique CFS/FM treatment protocol.
Dr. Jay A. Goldstein is director of the Chronic Fatigue Syndrome Institute of Orange, California. His background as a medical doctor is in psychiatry and family practice, but for a number of years now, he has specialized in the care of CFS and related disorders. Dr. Goldstein has lectured and written extensively on this topic, including his latest book, Betrayal of the Brain. To help explain Dr. Goldstein’s approach in layman’s terms, Katie Courmel has written the book, A Companion Volume to Dr. Jay A. Goldstein’s Betrayal of the Brain.
CFS and FM as Neurosomatic Disorders
Dr. Goldstein’s CFS/FM protocol revolves around his understanding of these ailments as neurosomatic disorders. In helping to define such disorders, Dr. Goldstein says patients afflicted “do not feel, think, or function properly because the brain does not handle information properly.” According to his research, Dr. Goldstein believes brain circuitry and transmittal of data for proper bodily function and health have become altered in conditions like CFS. Further, Dr. Goldstein comments “how the brain, the immune system, and the hormonal system simultaneously regulate the function of each other…is usually ‘out of whack’ in various ways in patients with neurosomatic disorders.”
Dr. Goldstein believes that neurotransmitters, chemical substances that act as information messengers in the brain, are abnormally low in this condition. Norepinephrine and dopamine are two such neurotransmitters lacking in CFS patients. When these are decreased, the brain has difficulty assessing relevance of the numerous messages it constantly receives. Because of this, mentally challenging situations such as taking a test or sensory stimulating situations such as a shopping at a mall can be overwhelming.
Another cause of this easily distractible state is elevated levels of substance P. Substance P is a chemical that transmits pain messages. Overproduction of substance P results in increased sensations of pain. Dr. Goldstein believes elevated amounts of this pain messenger found in CFS and FM are interrelated with their hypervigilant state, and can contribute to anxiety and panic attacks.
Cause of Neurosomatic Disorders
Dr. Goldstein enumerates four factors as influential in the onset of neurosomatic disorders. To begin with, persons can have varying degrees of genetic susceptibility to this kind of ailment. A second contributing factor is if during childhood one is made to feel unsafe for intervals of time. Such developmental problems can increase substance P and cause hormone levels to deviate. A third influence could be viral infection in the brain that alters proper neurotransmission. Dr. Goldstein describes the fourth factor as a potential outcome of the first three: “impaired flexibility of the brain…to deal with changing internal and external circumstances.”
Despite all this talk about altered mental states, Dr. Goldstein does not believe that CFS is purely psychiatric in origin as some imply with the phrase “it’s all in their heads.” Dr. Goldstein explains it this way, “The ludicrous and overly restrictive term ‘psychosomatic’ should be discarded into the rubbish bins of history. It states that apparently [unexplainable] symptoms must be a result of mysterious ‘unconscious’ conflicts which cannot be measured or even proven to exist.”
“Receptor profiling” is a method of diagnosis used by Dr. Goldstein to determine which of the brain’s biochemical pathways are not functioning properly. This involves administering a series of drugs to the patient, one at a time. Each of these drugs is known to target specific brain pathways. Thus a patient responding to a particular drug indicates the brain pathway likely to be contributing to that particular patient’s symptoms. Once that is known, various drugs that can normalize the faulty pathway are tried.
Katie Courmel lets patients know what to expect during their first appointment with Dr. Goldstein. “If you visit Dr. Goldstein’s office, you may spend as much as two or three hours of your first day in an initial consultation with the doctor. This involves a detailed reading of your entire case history, with questions and answers interjected. During this period, Dr. Goldstein will begin his drug treatment protocol, starting with those drugs that have the most fast-acting profile. He may try naphazoline 110 eye drops, which may take effect within seconds. He may also try nitroglycerine under your tongue, which may act within minutes. You will then take a series of tablets or capsules that are longer-acting, taking effect within 30 to 45 minutes.”
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“Throughout this process, Dr. Goldstein will frequently ask how you are feeling. If you suffer from pain, he will check the sensitivity of a few select FM ‘tender points’ to help assess the effectiveness of a drug. If you suffer primarily from fatigue and find a drug that revives you, Dr. Goldstein may have you run up and down stairs to see if the drug really works. If cognitive disorders are a main complaint, you might read and discuss a magazine article after the administration of a drug that makes your head feel clearer.”
Once this diagnostic process is complete, Dr. Goldstein will be able to tailor a treatment regimen specific for each patient.
Dr. Goldstein’s primarily treats through the use of various combinations of medications. He explains his care this way, “The goal of therapy is to induce the brain to secrete the appropriate amounts of chemical neurotransmitters so that information to be processed will be selected appropriately. I have devised a decision tree which helps me to rapidly discover in most cases which brain chemicals and receptors might be dysregulated. This process usually takes about an hour at the initial visit.
I use medications which target one particular receptor and administer them in nasal sprays and eye drops. They attach to receptors on nerves in the head and may cause a patient to feel better, or sometimes worse, within seconds. I then may use other rapidly acting medications which affect the same, or related, receptors. My goal is that the patient feels completely normal. He/she remains in the office trying selected medications in succession until all symptoms resolve. This result requires an average of three office visits, but may occur in two seconds or two years.”
There are several medications that have proven to be very useful for patients who have been bedridden for a year or longer. Dr. Goldstein calls these his “resurrection cocktail.” A main component of this “cocktail” is ketamine administered intravenously or through a gel. Other components provided intravenously are ascorbate, lidocaine, and thyrotropin-releasing hormone. Nimotop and Neurontin, both administered orally, are also included in the list of medications most likely to aid CFS patients.
Most of Dr. Goldstein’s CFS patients benefit from his therapy. Courmel says that 50% of patients feel dramatically better after the first day. Another 25% feel better the next day and eventually a further 20% substantially improve. That leaves 5% of patients that Dr. Goldstein is not able to help much.
PLEASE NOTE: DR. GOLDSTEIN HAS RETIRED FROM MEDICAL PRACTICE AS OF 2003. While Dr. Goldstein’s primary focus was on drug therapy, there are natural treatments and nutritional supplements he recommended to his patients as well. These included Acetyl-L-Carnitine, Vitamin B-12, DHEA, Ginkgo Biloba, Ginseng Saponins, Gotu Kola, Honey Bee Venom, Kava Kava, and St. John’s Wort (Hypericum).
Courmel, A Companion Volume to Dr. Jay A. Goldstein’s Betrayal of the Brain. (1996)
Galvin, Receptor Profiling as a Guide to Treatment
Goldstein, Betrayal of the Brain (1996)
Goldstein, My Current Approach to Neurosomatic Disorders,
Goldstein, The Pathophysiology and Treatment of Chronic Fatigue Syndrome and Other Neurosomatic Disorders: Cognitive Therapy in a Pill
Alasbimn Journal, 2(7) (April 2000)
EDITOR’S NOTE: Dr. Goldstein’s website is no longer active (www.drjgoldstein.com).