Fibromyalgia Poorly Served By Drug Happy Rheumatologists

The term “fibro” was used to designate soft (or fibrous) tissue involvement and “myalgia” is Latin for “pain”. 

Fibromyalgia was originally thought to be a rheumatologic condition because - like a disease such as rheumatoid arthritis - it is characterized by musculoskeletal pain. But research has since shown that there are no abnormalities in the musculoskeletal system in people with fibromyalgia. Instead, the problem appears to lie in the pain processing pathways of our central nervous system.

The term Fibromyalgia was created by rheumatologist Dr. Frederick Wolfe in 1984 to describe a condition affecting primarily women.

Of course if you’re subscribed to my free Health Matters newsletter, http://drmurphreesnewsletters.com, you read my article about how Dr. Wolfe now denies that fibromyalgia is a real disease-Sad but true.

Before 1990, no guidelines for evaluating and diagnosing fibromyalgia existed. To reduce misdiagnosis and confusion, the American College of Rheumatology (ACR) sponsored a multicenter study to develop these criteria; the results were published in 1990. In 1992, at the Second World Congress on Myofascial Pain and Fibromyalgia, the diagnostic criteria for fibromyalgia were expanded and refined.

Since rheumatologists were the first health specialty to promote and ratify the diagnostic criteria for fibromyalgia, they became the doctors of choice for seeing fibro patients. It didn’t matter that may at least early on had no idea what fibromyalgia was or how to treat it-unfortunately this is often the case today. Many rheumatologists won’t take any new fibro patients or are openly skeptical about the condition.

I believe rheumatologists are the worst possible doctors to manage a fibromyalgia patient’s case. 

Why? There are several reasons -

Because they deal in hard to treat autoimmune diseases, and see patients other doctors don’t want to see, Rheumatologists have a lengthy waiting list-may take 3 months to be seen.

A waiting list of patients can create a lack of empathy for the longwinded, hard to treat fibro patient who needs more than a five-minute office visit every 3 months. “Who cares if you come back I have plenty of other patients waiting in line to be seen.”

Rheumatologist are trained to use drugs, usually incredibly toxic drugs, Methotrexate, gold salts, Plaquenil, Enbrel, etc.

Here is the warning box info for Enbrel:

WARNING

SERIOUS INFECTIONS AND MALIGNANCIES

SERIOUS INFECTIONS.

Patients treated with Enbrel are at increased risk for developing serious infections that may lead to hospitalization or death.

Most patients who developed these infections were taking concomitant immunosuppressant’s such as methotrexate or corticosteroids.

Enbrel should be discontinued if a patient develops a serious infection or sepsis.

Reported infections include:

Active tuberculosis, including reactivation of latent tuberculosis. Patients with tuberculosis have frequently presented with disseminated or extrapulmonary disease. Patients should be tested for latent tuberculosis before Enbrel use and during therapy. Treatment for latent infection should be initiated prior to Enbrel use.

Invasive fungal infections, including histoplasmosis, coccidioidomycosis, candidiasis, aspergillosis, blastomycosis, and pneumocystosis. Patients with histoplasmosis or other invasive fungal infections may present with disseminated, rather than localized, disease. Antigen and antibody testing for histoplasmosis may be negative in some patients with active infection. Empiric anti-fungal therapy should be considered in patients at risk for invasive fungal infections who develop severe systemic illness.

Bacterial, viral, and other infections due to opportunistic pathogens.

The risks and benefits of treatment with Enbrel should be carefully considered prior to initiating therapy in patients with chronic or recurrent infection.

Patients should be closely monitored for the development of signs and symptoms of infection during and after treatment with Enbrel, including the possible development of tuberculosis in patients who tested negative for latent tuberculosis infection prior to initiating therapy.

MALIGNANCIES

Lymphoma and other malignancies, some fatal, have been reported in children and adolescent patients treated with TNF blockers, including Enbrel.

Scary huh?

The black box warning for Plaquenil is just as scary.

Immunosuppressive medications used by rheumatologists for autoimmune diseases are fraught with danger. That is the reason these drugs are used only by rheumatologists and not by internists, family physicians, or other medical specialists. Rheumatology is a medical specialty developed to prescribe and monitor the side effects of these high-risk medications.

The rheumatologists mentality has been conditioned over the years to continue prescribe more and stronger symptom suppressing drugs. This is a disastrous approach for fibromyalgia patients. Most fibro patients can’t tolerate drugs - they only make them worse. Drugs don’t make you healthy, they can be helpful but they don’t make you healthy. The only way to reverse fibromyalgia is to get healthy!

Using an atomic bomb like Enbrel or Plaquenil to treat fibromyalgia symptoms is not only stupid, it is incredibly dangerous!

Traditional medicine and drug therapy is a dead end for fibro patients. You can read my past blog Traditional Medicine Fails Fibro below or even better:

You can listen to my past First Tuesday of the Month Fibromyalgia Teleconference recordings here:

http://drrodgermurphree.com/fibro-conference-recordings/

My fibro blog- Traditional Medicine Fails Fibromyalgia

http://treatingandbeatingfibroblog.blogspot.com/2010/12/traditional-medicine-offers-little-for.html

May 12th is National Fibromyalgia Day

Should we celebrate National Fibromyalgia Day? Well yes and no. I don’t believe it is appropriate to celebrate a disease or even a day that recognizes a disease.  Wouldn’t it be great if there wasn’t an awareness day because fibromyalgia doesn’t exist anymore?

Wishful thinking I know, but celebrating fibromyalgia doesn’t feel right.

True, those in the fibromyalgia community don’t have anything to celebrate but we can appreciate just how far we have come.

When I first started treating fibromyalgia, some seventeen years ago, the public didn’t know what the illness was or even how to pronounce it. Heck, most doctors didn’t know much of about fibromyalgia.

Fortunately healthcare professionals and the public at large have over the years continued to learn more and more about fibromyalgia-at least at this point most everyone has heard of fibromyalgia.

So while we aren’t celebrating anything on May 12^th we can be appreciative that the skepticism from family, doctors, and the public is thankfully being put to rest.

Unfortunately we still have some STUPID doctors who think that fibromyalgia doesn’t exist-“it’s all in your head.” Clearly ignorance and arrogance is still alive and well as some stupid doctors choose to write fibromyalgia off as another hypochondriac disease.

Wish they could be in your shoes for a few days. I bet they’d change their minds. Let them go 4-5 nights without sleep and battle diffuse achy all over pain day in and day out and I bet they’d be demanding federal dollars for a cure for fibro.

Clearly there is much work to be done so that those with fibromyalgia aren’t made to feel like they are lazy, crazy, or simply depressed.

National Fibromyalgia Awareness Day is a great way to educate others about a very real disease. We need more research and we need more understanding-the more the better.

We also need to proactive and not wait on “the cure.” Please realize that traditional medicine alone isn’t going to cure fibromyalgia. There will not be a magic pill or combination of magic drugs that will prevent or cure fibro-sorry but it just isn’t possible.

You can read my blog about this topic here-

http://treatingandbeatingfibroblog.blogspot.com/2010/12/traditional-medicine-offers-little-for.html

I’m not anti-drug-they can be helpful. But drugs don’t make you healthy-they cover up your symptoms and do not correct the problem. Now this can be life saving but covering up symptoms while ignoring the cause can also be dangerous.

You can read more about this topic

http://treatingandbeatingfibroblog.blogspot.com/2010/12/ill-take-my-chances-with-complementary.html

Unlike type II diabetes in which the symptoms, elevated blood sugar, can be treated and managed with one drug like Metformin, fibromyalgia has several problems, sometimes dozens of symptoms that must be treated in order for the patient to feel dramatically better.

Of course covering up the symptom, elevated blood sugar instead of correcting the cause, being overweight (95% of time) really doesn’t make sense either….

But in fibro patients using one drug after another to treat the various symptoms, insomnia, chronic pain, fatigue, depression, headaches, etc., is a recipe for disaster-one drugs side effects lead to another drug.

The drugs being used for fibromyalgia don’t work, at least long term, and potentially have numerous life draining side effects.

You can read more about these drugs at the links below

Savella-Cymbalta

http://treatingandbeatingfibroblog.blogspot.com/2010/10/fibromyalgia-drug-savella-another.html

Lyrica

http://treatingandbeatingfibroblog.blogspot.com/2010_10_01_archive.html

Neurontin

http://drmurphree.blogspot.com/2010/10/neurontin-for-everything.html

The only way to beat fibromyalgia, and you can beat fibromyalgia, is to get healthy.

Drugs don’t make you healthy.

Using the essential, natural vitamins, minerals, amino acids, and supplements the body needs to repair itself, replenish serotonin, norepinephrine, cortisol, melatonin, thyroid, etc. is the best long term approach for treating and reversing fibromyalgia.

Using the right supplements along with losing inflammation storing fat, slowly building up to exercising on a daily basis, reducing or eliminating potentially dangerous drugs, and managing stress, allows your body to repair itself.

If you are tired of being sick and tired, tired of seeing doctor after doctor who continue offer more and more mind numbing drugs, going year after year stuck in a medical paradigm that treats symptoms, not causes, then I challenge you to be proactive and take a different course of action-get healthy.

Are you willing to be proactive and get healthy? Change your diet? Start the RIGHT (go easy) exercise program for you? Are you ready to start eliminate those bad health habits you know aren’t good for you-smoking, excessive sugar, etc?

New Patient Phone and In Clinic Appointments Are Available

Normally $399 still only $129

I’m committed to helping any many folks as I can beat fibromyalgia. I’ve helped thousands get their life back. Are you next?

Call 205-879-2383

The History of Fibromyalgia Awareness Day

In 1993, Tom Hennessy, the founder of RESCIND, INC.  (Repeal Existing Stereotypes about Chronic Immunological and Neurological Diseases) designated May 12 as International Awareness Day for Chronic Immunological and Neurological Diseases (CIND).

The date was chosen to memorialize the birth date of Florence Nightingale, the English army nurse who inspired the founding of the International Red Cross.  Nightingale contracted a paralyzing, CIND-like illness in her mid-thirties and spent the last 50 years of her life virtually bedridden.  Despite her illness, she managed to found the first ever School of Nursing.

Today, National Fibromyalgia Awareness Day activities take place worldwide in an effort to increase awareness of this chronic pain illness. Awareness Day seeks to help patients and organizations educate the general public, healthcare professionals, government officials, and legislative bodies.

National fibromyalgia and chronic pain organizations, as well as local support groups around the country, host events in or around May 12 to create awareness and generate media interest in their cause.

Fibromyalgia Pain Causes "Fibro Brain Fog"

Brain fog or diminished mental clarity is a common complaint from patients with fibromyalgia. 

The traditional drugs of choice for fibromyalgia include NSAIDS, antidepressants, anticonvulsant medications, muscle relaxants, tranquilizers, and pain medications. These drugs may provide short-term relief but their results are often fleeting and their side-effects are detrimental. It’s not unusual for FMS patients to be taking twelve or more prescription drugs, many of which contribute to erratic behavior. 

A new study finds that the degree of cognitive impairment for fibromyalgia patients is linked to the level of pain that they experience.

The study was led by Dr. Gustavo Reyes Del Paso of the University of Jaén, and presented at the Sixth World Congress of the World Institute of Pain. His team wanted to examine the connection between fibromyalgia and cognitive impairment, which has not been closely studied.

Fibromyalgia is often associated with depression, and anxiety. But a few studies have found that cognitive function – or how well the brain works – is not related to emotional disorders.

The researchers compared 35 fibromyalgia patients with 29 healthy people. Both groups were tested on a series of tests that measured how they performed on an arithmetic task. At the same time, their mental and cardiovascular states were assessed.

The fibromyalgia patients did worse across the board on the task. However, patients who were taking opiates to treat pain did significantly more calculations than those who weren't on medication.

The study builds on the mounting evidence that chronic pain is a critical factor in cognitive abilities.

Depression, anxiety, and other emotional disorders common in people with fibromyalgia play a secondary role when it comes to the brain.

Chronic Pain and Fibromyalgia

The diffuse muscle pain associated with fibromyalgia can be debilitating. Unless you’ve experienced the achy all over pain that accompanies fibromyalgia you can’t imagine the amount of discomfort, stress, and fatigue it creates. For those people who don’t know what fibromyalgia is like, I ask them to imagine waking up everyday with the flu from hell. 

The pain can become worse when the individual gets under more stress (depleting serotonin), the weather changes, and after being on certain prescription medications for extended periods of time (Ambien).

Pain

Pain may arise from wear-and-tear arthritis (osteoarthritis), scar tissue, lactic acid (trigger points), allergic reactions, leaky gut, intestinal dysbiosis (yeast overgrowth), nightshade sensitivity, autoimmune disorders (rheumatoid arthritis), low serotonin levels or poor detoxification processes. Finding and successfully treating the source of chronic pain can be difficult. 

Pain is initiated from inflammatory chemicals that are released in response to injury. Pain acts as an alarm to warn us of potential danger. If you’ve ever placed your hand on a hot stove, you know pain acts as a potent deterrent to not make this mistake twice. Wherever there is pain, there is inflammation. Inflammation is a normal and important, bodily reaction. Inflammation allows the body to attack unwanted invading microorganisms (viruses, bacteria, etc.), remove damaged cells (from injury), eliminate toxins, and is part of the body’s repair process.

How the inflammatory system works

Trauma, infection, ischemia (reduced blood flow), toxins, poisons, and normal wear and tear cause damage and destruction to cells. This damage then triggers an orderly inflammatory response by the body’s self-regulating mechanisms. When cells become damaged, they release special enzymes. These enzymes digest the parts of the cell that have been damaged. If the damage is minor, the cell can repair itself. If the damage is severe, the entire cell is digested (autolysis) and a new cell is made. If a lot of cells (tissue) are damaged, either by trauma (sprained ankle, back joint, etc.) or autolysis (cell death from toxic exposure, radiation, etc.), certain chemicals are released into the surrounding tissues, producing inflammation and more pain.

Inflammatory chemicals

The first group of chemicals, histamine, leukotriens, and pro-inflammatory hormones (prostaglandins), cause the blood vessels to dilate or expand. The dilation of the blood vessels causes the area to become hot, red and swollen. The dilated vessels (capillaries) allow needed nutrients and white blood cells to get to the damaged (swollen) area. 

 The white blood cells are charged with digesting and removing damaged cells (phagocytosis). These white blood cells gobble up everything in sight. Foreign invaders or pathogens (viruses, allergens, free radicals, etc) release their own chemicals, many of which are toxic. The healthy tissue surrounding the damaged area releases anti-inflammatory prostaglandins (PG1 and PG3) to combat the inflammatory prostaglandins (PG2). Certain chemicals (proteolytic enzymes) are responsible for telling the white blood cells that their job is done. These chemicals sound the alarm for the white blood cells to stop attacking and digesting cells and tissues.

Proteolytic enzymes are manufactured to squelch the white blood cells from continuing to eat up cellular debris. As the damaged cells and tissues are removed, less of the pro-inflammatory chemicals and more of the anti-inflammatory chemicals are released. Once the inflammation process is finished, the body begins to repair itself.

The balance between inflammation, destruction, and repair is an ongoing process. Normally, this process is kept in check. When the process becomes unbalanced, chronic inflammation takes over. 

Inflammation is largely regulated by the prostaglandin hormones mentioned above.

Prostaglandins

Prostaglandins are a group of regulatory hormones produced in the body from fatty acids. There are several different groups of prostaglandins, but inflammation is largely controlled by Prostaglandin 1 (PG-1), Prostaglandin 2 (PG-2), and Prostaglandin 3 (PG-3).

PG-1, PG-2, and PG-3 are produced from essential fatty acids.

Essential fatty acids are essential for our existence. They can’t be manufactured by the body but must be obtained from the foods we eat. Essential fatty acids are made-up of polyunsaturated fatty acids (PUFAs).

PUFAs are divided into two families of essential fatty acids (EFA).

PUFAs are further broken down into Omega 3 (fish oils) and Omega 6 (vegetable oils).

Anti-inflammatory hormones

PG-1 and PG-3 come mainly from Omega 3 oils (fish oils) and are anti-inflammatory hormones. They help reduce and eliminate inflammation and pain. 

Arachidonic Acid (AA) PG-2 Causes Pain and Inflammation

AA is an essential fatty acid (EFA) in the Omega 6 family. AA is found in corn and corn oil products. Corn products are used as the prominent foodstuff in westernized livestock. Red meat, dairy, and pork products have a high AA content. 

The pro-inflammatory series PG-2 are made from arachidonic acid. Arachidonic acid is derived from the consumption of land animal foods (meats, cheese, eggs, etc.). Arachidonic acid stimulates the production of inflammatory chemicals including leukotriens (notorious in causing allergic reactions), thromboxanes, and prostacylins. Several research articles have demonstrated that the more animal fats a human eats, the more arachidonic acid they have in their blood and cell membranes and the more likely to have inflammation.

   

Conversely, a diet high in fish or supplemented with fish oil (EPA) helps reduce inflammation.

A. Omega 3 Linolenic Acid

Omega 3 oils include are found in flax seed, soybean, walnut, and chestnut oils, as well as some dark green leafy vegetables.  Eicosapentaenoic Acid (EPA) and DHA (docosahexanoic acid) are Omega 3 derivatives and are only found in cold water fish. These fish include salmon, tuna, and mackerel

The average AA (PG-2 from vegetable oils and animal products) to EPA (PG-1 and PG-3 from fish oils) of Americans is approximately 11:1. For patients with inflammatory conditions and neurological disorders, the AA/EPA ratio is 20:1 or more.

This means that Americans are eating and storing 11-20 times the amount of inflammation causing hormones (from vegetable oils and land animals) in comparison to the inflammation reducing hormones (from fish oils). 

An AA/EPA ratio of 1.5:1 is considered ideal. This is the ratio found in Japanese populations which by the way have the highest life expectancy and the lowest rate of cardiovascular disease.

 Our inflammatory reactions and their chemicals are therefore largely determined by what foods (fatty acids) we eat. Since most Americans are carrying around at least 10-20 pounds of excess fat, it is no wonder that arthritis and other inflammatory diseases are out of control in our country. 

   The average adult weighs 150 pounds, 30% of this is fat. This means that on average a person is carrying around 45 pounds of inflammatory fatty acid hormones!

Fish Oil Reduces Pain and Inflammation

The supplementing your diet with fish oils along with reducing the intake of arachidonic acid foods (land animals) can yield significant results. 

Some studies have shown that supplementing with fish oils results in a dramatic reduction in a person’s leukotriens (one of the chemicals implicated in asthma) by 65%. This correlates with a 75% decrease in their clinical symptoms.

Another fish oil study, involving rheumatoid arthritis sufferers (often treated with incredibly toxic and life threatening prescription drugs) who took 1.8 grams of EPA fish oil and reduced their saturated fats (land animal foods), showed significant improvement over and above a placebo. 

Sleep deprivation and pain

One study showed that college students who were prevented from going into deep sleep (REM sleep) for a period of a week, developed the same symptoms associated with fibromyalgia (FMS) and chronic fatigue syndrome (CFS): diffuse pain, fatigue, depression, anxiety, irritability, stomach disturbances, and headaches. 

A study conducted by the University of Connecticut School of Medicine compared the sleep patterns and associated symptoms of fifty women with FMS. 

The study showed that a poor night’s sleep was followed by an increase in the subject’s symptoms including, increased pain.

Avoid instant coffee

Instant coffee contains substances which block the receptor sites for endorphins and may cause increased pain. 

Nightshades

In one study 70% of those with arthritis reported relief from chronic pain over a period of seven years after eliminating all white potatoes, tomatoes, peppers,(except black), eggplant, and tobacco.

Supplements That Help Reduce Pain

S-adenosyl-l-methionine (SAMe) comes from the amino acid methionine and acts as a natural anti-inflammatory and blocks pain without the side effects associated with NSAIDs. 

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

One double-blind study showed SAMe was superior to ibuprofen in the treatment of osteo-arthritis pain.

Several studies involving SAMe and fibromyalgia patients yielded substantial improvement in over all pain levels (as well as depression).

Dosage is up to 1,200 mg. taken on an empty stomach 30 minutes before breakfast each day.

Malic Acid is found in a variety of foods. It is a vital nutrient needed for the production of cellular energy (Krebs cycle). Malic acid helps boost cellular energy and reduce achy muscles. It removes unwanted waste material from muscle cells including lactic acid, a byproduct of oxygen deficiency. 

Lactic acid has been implicated as one reason for achy muscles. Lactic acid may accumulate in muscles after periods of anaerobic and aerobic exercise. It may also be involved in the trigger point pains associated with fibromyalgia. 

“Malic acid gave subjective improvement within 48 hours in one study.” 

Sherry Rodgers M.D., Pain Free in Six Weeks.     

Studies involving FMS patients who were taking magnesium and malic acid together showed dramatic reduction in pain levels that returned with in 24 hours of discontinuing the supplements.