Wednesday, October 27, 2010

Lyrica and Fibromyalgia

Lyrica is the first prescription medication approved to treat fibromyalgia.   Because fibromyalgia patients typically do not respond to conventional painkillers like aspirin, Lyrica affects the brain and the perception of pain.  Pfizer’s Lyrica, known generically as pregabalin, binds to receptors in the brain and spinal cord and seems to reduce activity in the central nervous system.
No one knows exactly how Lyrica works.  But some say that Lyrica does not work well enough to have warranted its FDA approval.  According to The New York Times, in clinical trials, patients taking Lyrica reported that their pain fell on average about 2 points on a 10-point scale, compared with 1 point for patients taking a placebo. About 30 percent of patients said their pain fell by at least half, compared with 15 percent taking placebos.
In 2004, Lyrica was reviewed by the FDA as a remedy for diabetic nerve pain.  The reviewers recommended against approving the drug, citing its side effects.  Lyrica causes weight gain and edema, or swelling, as well as dizziness and sleepiness. According to the New York Times, in 12-week trials, 9 percent of patients saw their weight rise more than 7 percent, and the weight gain appeared to continue over time.
But the FDA ignored the advice of Lyrica reviewers, and approved it anyway.  Then Pfizer asked the FDA to expand the approved uses of Lyrica to include the treatment of fibromyalgia, and the agency did so in June.  It was a good move for Pfizer.  According to the New York Times, worldwide sales of Lyrica reached $1.8 billion in 2007, up 50 percent from 2006. Analysts predict sales will rise an additional 30 percent this year, helped by consumer advertising.  During the first nine months of 2007, Pfizer spent $46 million on Lyrica ads alone.
While I welcome anything that will help my fibromyalgia patients, I’m not a big fan of Lyrica.
Why? It doesn’t seem to offer any real long-term relief and the side effects are potentially dangerous. 
There are many side effects that are considered "normal" of Lyrica. However, it should be noted that if these symptoms occur they should be brought to the attention of the prescribing doctor. You must keep in mind that the Federal Drug and Food Administration often approve drugs that will result in certain side effects. However, they do so on the notion that the benefits of the prescription will outweigh the consequences associated with side effects in the long run. The following outlines some of the "common" side effects of Lyrica:

Experiencing Weight Gain
Blurred Vision
Body Tremors
Possible Insomnia
Gastrointestinal Difficulties, such as Diarrhea and Constipation
Mild to Severe Headaches
Swelling in Hands
Dry Mouth
Swelling in Ankles
Possible Fainting

Traditional medicine alone isn’t very helpful for fibromyalgia- 70 percent of fibromyalgia patients seek out alternative methods.
I encourage my patient’s to use the Essential Therapeutics Fibromyalgia Jump Start Package.

Friday, October 8, 2010

Traditional Medicine Offers Little Hope For Fibromyalgia Sufferers

Excerpt from Dr. Rodger Murphree’s “Treating and Beating Fibromyalgia and Chronic Fatigue Syndrome.”

With so many different symptoms, it’s no surprise that fibromyalgia and CFS patients are typically taking 6–12 different prescription drugs. Lyrica, Elavil, Klonopin, Paxil, Effexor, Xanax, Trazadone, Neurontin, Zanaflex, Ambien, Lunesta, Cymbalta,  and Provigil have all been heralded as “the drug” for fibromyalgia. Some of these are helpful, some worthless, and some really dangerous.

Drug management alone typically fails to yield lasting relief from the most common fibromyalgia and CFS symptoms, and patients’ and doctors’ optimism over a new drug treatment eventually gives way to this sad reality. Oh well, a new drug with an even larger marketing budget is on the horizon. (Forgive my cynicism. I’ve just seen this situation so many times!)

Many of the most commonly prescribed drugs for fibromyalgia have side effects that are similar or identical to the symptoms of FMS and CFS. These similarities can cause a lot of confusion when doctors are trying to determine the effectiveness of treatment. Ambien, for instance, can cause flu-like symptoms, achy muscle pain, sore throat, and fatigue. Sounds like CFS, doesn’t it?

Tranquilizers are often prescribed for restless leg syndrome; achy, tight muscles; and sleep problems. But these drugs deplete the sleep hormone melatonin, which then leads to a disruption of a person’s circadian rhythm (sleep-wake cycle). Instead of promoting deep restorative sleep, these drugs prevent it!
It’s important to realize that your drug or drugs may be causing or contributing to some or all of your symptoms. I spend a great deal of time with my new patients reviewing and discussing their current drugs—how they interact with each other, and the potential side effects.

I often find that by asking the right question, I can help the patient realize that her symptoms began or worsened soon after the drug treatment began.
Sometimes, though, I do find drug-induced symptoms that began months after the start of the drug treatment. Drugs deplete essential nutrients that the body needs to properly function, but it can take weeks, months, or even years for the drug to fully deplete the nutrient and for you to see the side effects surface.

Still, not everyone can be drug free, and most of my patients are on at least one prescription medication. But the least offensive drug should be used—sparingly—and only to manage symptoms unresponsive to more natural therapies.

A study conducted by the Mayo Foundation for Medical Education and Research demonstrates the need for FMS and CFS treatment beyond drug therapy.

Thirty-nine patients with FMS were interviewed about their symptoms. Twenty-nine were interviewed again 10 years later. Of these 29 (mean age 55 at second interview), all had persistence of the same FMS symptoms. Moderate to severe pain or stiffness was reported in 55% of patients, moderate to a great deal of sleep difficulty was noted in 48%, and moderate to extreme fatigue was noted in 59%. These symptoms showed little change from earlier surveys. The surprising finding was that 79% of the patients were still taking medications to control symptoms. We can conclude that the medications weren’t making a significant impact.

Conventional medical treatments for FMS and CFS is a controversial topic, and I certainly have no desire to offend the many brilliant medical doctors out there. Still, in my experience, most traditional doctors continue to rely on prescription medications to treat fibromyalgia, even though their own studies show them to be ineffective and potentially dangerous.

They still just don’t get it. Those with fibromyalgia and CFS are sick and they want to feel well, not drugged.

Just try to find a doctor who really knows anything about these illnesses. Most don’t. It’s even harder to find one who is having any lasting success treating these illnesses. How many folks with fibromyalgia get well under the care of a traditional rheumatologist?

I speak to fibromyalgia support groups across North America, and I can tell you what the answer is: very few. The three-month wait for a new patient appointment typically ends in a two-hour interview and exam followed by a 10-minute visit to discuss test results, and then several prescription drugs and a follow-up appointment every 3–6 months.

And let’s face it, those with fibromyalgia are medical misfits, they don’t usually respond to medications like other folks. The ACR has, like many physicians, thrown up their hands and admitted they have little if anything to offer for those suffering from fibromyalgia. They focus more on helping their patients “cope.” At least they’re honest about their limitations.

Traditional Doctors Are Often Opposed To Natural Medicine
I find that people in general are usually down on what their not  up on.

Many conventional doctors are quick to ridicule nutritional
therapies, even though these therapies have consistently shown themselves effective in treating fibromyalgia. This prejudice just doesn’t make sense.

The usual accusation is that “there are no controlled studies.…”

But actually, there are numerous studies that validate the use of nutritional supplements to manage and often correct the symptoms of poor health. There are over 1,000 studies demonstrating the positive effects of various supplements and foods in the treatment of hypertension alone. And hundreds of studies demonstrate magnesium’s benefits in treating high blood pressure, angina, heart arrhythmias, chronic pain, muscle spasms, anxiety, mitral valve prolapse, and fatigue.

Dr. Janet Travell, White House physician for Presidents John F. Kennedy and Lyndon B. Johnson, and Professor Emeritus of Internal Medicine at George Washington University, co-wrote Myofascial Pain and Dysfunction: The Trigger Point Manual, which is acknowledged as the authoritative work on muscle pain. In one chapter alone, Dr. Travell references 317 studies showing that problems such as hormonal, vitamin, and mineral deficiencies can contribute to muscle pain and soreness.

And modern medicine itself, despite the millions of dollars spent to promote it’s superiority over other forms of health care, is largely an art—with a lot of unproven science. The Office of Technology Assessment, under the authority of the Library of Congress, published a year-long study entitled “Assessing the Efficacy and Safety of Medical Technology.”

The study showed that only 10–20 percent of all present-day medical practice have been shown to be beneficial by scientific controlled clinical trials. The study concluded that the vast majority of medical procedures now being utilized routinely by physicians are “unproven.”

Or how about, “Nutritional supplements aren’t regulated and therefore are dangerous.” Too much might make you queasy, but no one dies from taking vitamins, minerals, and other essential nutrients! The same can’t be said about drug therapy.

The great physician Oliver Wendell Holmes once said, “A medicine…is always directly hurtful; it may sometimes be indirectly beneficial. I firmly believe that if most of the pharmacopoeia [prescription drugs] were sunk to the bottom of the sea, it would be all the better for Mankind and all the worse for the fishes.”
Prescription drug therapy attempts, for the most part, to cover-up symptoms. This approach does little to correct the underlying problem(s).

After seventeen years of specializing in treating and beating fibromyalgia I’ve learned that traditional medicine alone yields little if any long-term results.
The best hope for those with fibromyalgia is to find and work with a doctor who practices integrative medicine-combining judicious use of prescription drugs (short-term if possible) and natural therapies (vitamins, minerals, and other nutrients).
Combining prescription drugs (when needed) with natural supplements allows the symptoms associated with fibromyalgia to be corrected, not just covered-up.

Subscribe to my Health Matters email newsletter-it is free to join and gives you free access to all my past tele-conferences (including those on fibromyalgia, heart disease, depression, hypothyroid, fatigue, and more).

Thursday, October 7, 2010

Chronic Fatigue Syndrome and Stress

The majority of patients report some preceding moderate to serious physical stress (such as a chronic viral infection) or emotional event (often an episode of depression or chronic mental stress). Some experts theorize that such events, especially in people with certain neurological and genetic abnormalities, may overwhelm a person’s ability to regulate her own homeostatic self-regulating systems. I believe there is a great deal of truth to this idea (though admitting so may not endear me to those who believe that CFS is the result entirely of an infectious agent). I do believe that infectious agents can and do trigger CFS, but stress and infection go hand in hand. Stress weakens the body’s immune system, and an overtaxed immune system is quite stressful.

HPA-Axis Dysfunction 
Some researchers are investigating abnormalities in CFS patients of the brain system known as the hypothalamus-pituitary-adrenal axis. This system produces or regulates hormones and brain chemicals that control important functions, including sleep, response to stress, and depression. It’s our self-regulating, homeostatic system. The HPA axis is a major part of the neuroendocrine system, which controls reactions to stress. It regulates various body processes such as digestion, the immune system, and metabolism, and it’s generally suppressed in CFS patients.

Low Cortisol Levels 
A number of studies on CFS patients have observed deficiencies in cortisol levels, a stress hormone produced in the hypothalamus. Cortisol suppresses inflammation, increases stamina, boosts mental and physical energy, and coordinates cellular immune activation. Cortisol deficiency may be why CFS patients consistently demonstrate a severely compromised resiliency to stress. (Although stress is commonly thought of as resulting from emotional or psychological causes, certain infections may cause severe unrelenting internal biochemical stress.) As a diagnostic marker for CFS, however, individual cortisol levels aren’t useful. 
Typically, the altered cortisol levels noted in CFS cases fall within the accepted range of normal, and only the average between cases and controls reveals a distinction.

Oxidative Stress 
Some of the symptoms of CFS, such as impaired cognition, may result from brain abnormalities. Several studies have reported significantly more abnormalities on MRI among CFS subjects relative to controls. Other studies have revealed lesions within the brains of CFS patients, and Single Photon Emission Computed Tomography (SPECT) scanning has repeatedly demonstrated a decrease of blood flow in the brain. In one study, decreased regional cerebral blood flow throughout the brain was observed in 80% of CFS patients! These observations may explain the “brain fog,” poor mental clarity, and fatigue associated with CFS. They might also demonstrate CFS’s association with oxidative (free radical) stress. Oxidative stress is a general term used to describe the level of damage to a cell, tissue, or organ caused by the reactive oxygen species (ROS) These very small, highly reactive molecules can affect any cell or system, including the brain. Most ROS come from normal internal bodily reactions, but external sources include first- and secondhand cigaret smoke, environmental pollutants, excess alcohol, asbestos, ionizing radiation, and bacterial, fungal, or viral infections. Supporting this oxidative-stress theory is the fact that antioxidant therapy has been proven helpful in the treatment of CFS. In one study involving CFS patients who required bed rest following mild exercise, 80% were deficient in Coenzyme Q10 (CoQ10), a potent antioxidant. After three months of supplementing with 100 mg. of CoQ10, 90% of the patients had a reduction or disappearance of clinically measured symptoms, and 85% had decreased post-exercise fatigue. 
You can read more about CFS on my site.

Saturday, October 2, 2010

Fibromyalgia Drug Savella- Another Gasoline Additive

The FDA’s approval of Savella for the treatment of fibromyalgia, comes 19 months after the approval of Lyrica, the first drug approved for fibromyalgia and roughly nine months after the approval of Cymbalta.

Savella is similar to Cymbalta, both are antidepressants known as selective serotonin and norepinephrine reuptake inhibitors (SNRIs). These drugs are supposed to help a person re-uptake and use the serotonin (calming brain hormone) and norepinephrine (stimulating brain hormone) more effectively.

The approval of Savella was based on two clinical trials involving 2,084 fibromyalgia patients (1,460 on Savella and 624 on placebo).

About 25 percent of people taking Savella had a positive response. This was considerably better than the 13 percent who had a positive response to placebo.

However, while the maker’s of Savella will be sure to promote it as being twice as effective as a placebo, what they won’t say is what you now know- the drug failed to help 1,095 of the 1,460 participants in the study who were taking Savella.

There are no studies directly comparing Savella to Cymbalta, although it’s likely that because of their similar mechanisms of action they would be similar in effectiveness.

If you’ve read my book, “Treating and Beating Fibromyalgia and Chronic Fatigue Syndrome” or past articles on fibromyalgia,  you know that those with fibromyalgia have low serotonin and norepinephrine levels due to bankrupting their stress coping savings account.

Serotonin is a brain chemical that helps regulate deep restorative sleep, reduces pain, boosts mood and mental clarity, and controls digestion and elimination (IBS).
The brain chemical norepinehrine helps boost moods, mental and physical energy, and block pain.

Restoring serotonin and norepinehrine to optimal levels often yields dramatic improvement in the chronic pain, poor sleep, low moods, and brain fog associated with fibromyalgia.

But using SNRI drugs like Savella is analogous to using a gasoline additive to help your car get more mileage out of the gasoline in their gas tank.

Unfortunately, for the majority of the individuals who suffer with fibromyalgia and or depression, they don’t have any serotonin or norepinephrine in their brains to re-uptake.

A gasoline additive poured into an empty gasoline tank doesn’t help much, if at all. A SRNI drug given to someone with little to no serotonin or norepinephrine to re-uptake doesn’t do much- results are usually short-lived and disappointing.

Studies show that the use of antidepressants causes the brain to release less and less serotonin and norepinephrine over time. SNRI drugs work by blocking the removal of serotonin and norepinephrine from its synapse.
Over time, the brain tries to compensate by shutting down the nerves that produce these two neurotransmitters.

This is known as down-regulation. Eventually, the brain begins to reduce the number of serotonin and norepinephrine receptors–up to 40-60 percent in some parts of the brain–until they literally disappear from the brain.

Now the patient is really in trouble as depression, anxiety, chronic pain, irritable bowel, brain fog, and poor sleep become even worse.
This may explain why patients often switch from one antidepressant drug to another in hopes of feeling better.

Common side effects of prescription antidepressants may include anxiety, depression, headache, muscle pain, chest pain, nervousness, sleeplessness, drowsiness, weakness, changes in sex drive, tremors, dry mouth, irritated stomach, loss of appetite, dizziness, nausea, rash, itching, weight gain, diarrhea, impotence, hair loss, dry skin, chest pain, bronchitis, abnormal heart beat, twitching, anemia, low blood sugar, and low thyroid.

Savella may be helpful, certainly safer than Lyrica, but no one suffers from a Savella or antidepressant deficiency.

Amino Acid Therapy/Nutritional Therapy
Neurotransmitters   or brain chemicals like serotonin and norepinephrine are produced from the amino acids 5-hydroxytryptophan (5HTP) and S-Adenosyl-methionine (SAMe).
These 2  amino acids along with B vitamins and certain minerals (one of many reasons why I recommend my patients take the CFS/Fibromyalgia Formula and the Fibromyalgia Jump Start Package) produce the brain chemicals serotonin and norepinephrine.

Use the Brain Function Questionnaire to Know if You’re Low in Serotonin and or Norepinephrine-

The Brain Function Questionnaire

The "S" Group (S for Serotonin)
Please check the items, which apply to your present feelings:
It's hard for you to go to sleep.
You can't stay asleep.
You often find yourself irritable.
Your emotions often lack rationality.
You occasionally experience unexplained tears.
Noise bothers you more than it used to. It seems louder than normal.
You "flare up" at others more easily than you used to.
You experience unprovoked anger.
You feel depressed much of the time.
You find you are more susceptible to pain.
You prefer to be left alone.

5HTP- Boosts Serotonin Levels
Supplementing with 5-hydroxytrryptophan (5HTP), a form of tryptophan helps raise serotonin levels. Studies show that 5HTP is as effective as antidepressant drug therapy including SSRI medications. One study showed that patients on 5HTP had a 50 percent improvement in their mood disorder symptoms.
Start with 50mg of 5HTP 30 minutes before bed on empty stomach with 4 ounces of grape juice. If you don’t fall asleep and sleep through he night keep increasing your dose by 50mg each night until fall asleep and sleep thgrough the night or reach 300mg. If you take 5HTP at bedtime on empty stomach and it wakes you up, take it during the day with food- start with 50mg a day and build up to 300mg a day with food (won’t make you tired or sleepy if take it with food).

The "N" Group (N for Norepinephrine)
Please check the items which apply to your present feelings:
You suffer from a lack of energy.
You often find it difficult to "get going."
You suffer from decreased drive.
You often start projects and then don't finish them.
You frequently feel a need to sleep or "hibernate."
You feel depressed a good deal of the time.
You occasionally feel paranoid.
Your survival seems threatened.
You are bored a great deal of the time.

The neurotransmitter Norepinephrine, when released in the brain, causes feelings of arousal, energy, and drive. On the other hand, a short supply of it will cause feelings of a lack of ambition, drive, and or energy.

S-Adenosyl-methionine (SAMe)- is involved in regulating the brain's neurotransmitters. SAMe has been shown through several recent, well designed, studies to be one of the best natural antidepressants available.
SAMe helps boost serotonin and epinephrine levels. It also helps increase the production of endorphins.

SAMe Helps Boost the Effects of Antidepressants
Research has already shown that SAMe increases both serotonin and norepinephrine levels (brain chemicals) and is a potent antidepressant by itself. Now researchers have shown that combining SAMe with prescription antidepressants reduces the failure rate by 43%.
There are over 100 peer-reviewed studies showing that S-adenosyl-methionine (SAMe) is a safe and effective antidepressant.

It also helps increase the production of endorphins. Endorphins are the bodies natural pain blocking chemicals and are more powerful than morphine.

SAMe helps manufacture and repair cartilage components. A study of osteoarthritis patients compared SAMe with NSAID drugs in its ability to reduce pain.

One double-blind study showed SAMe was superior to ibuprofen in the treatment of osteoarthritis.
Several studies involving SAMe and fibromyalgia patients yielded substantial improvement in over all pain levels (as well as depression).

Start with 400mg taken on an empty stomach (30 minutes before breakfast) in the morning and if needed increase up to 1200mg.

The best way to boost your serotonin and norepinephrine levels, improve your sleep, moods, IBS, mental clarity, and reduce your pain is to take the CFS/Fibromyalgia Jump Start Package and add SAMe.

You can learn more about ways to safely and effectively reduce your pain, IBS, fatigue, depression, brain fog, and episodes of poor sleep by ordering my book “Treating and Beating Fibromyalgia and Chronic Fatigue Syndrome.”

Dr. Rodger Murphree D.C., C.N.S.