As we covered last week, Fibromyalgia differs from other pain conditions, such as rheumatoid and osteo arthritis, in that the pain originates in the brain versus the perceived site of pain. It is for this reason that NSAIDS and the majority of prescription pain medications—targeting the perceived site of pain in the muscle, versus the actual origin of pain in the brain—are ineffective for treating Fibro pain. In addition, commonly used medications such as Ibuprofen damage the stomach lining and can lead to the formation of stomach ulcers, whereas the active ingredient in Tylenol—acetaminophen—depletes the body of glutathione, an essential amino acid and antioxidant.
Compounding the problem is the fact that many prescription pain medications carry side effects that mimic the symptoms of Fibromyalgia, to include fatigue, muscle spasms, impaired memory and cognitive functions. Fortunately, there are many natural remedies that have proved safe and effective for treating Fibromyalgia pain, as Dr. Jacob Teitelbaum outlines in his book, From Fatigued to Fantastic (2007).
Rhus toxicodendron is a homeopathic remedy that is inexpensive and side-effect-free. Though it is likely not sufficient alone for long-term pain management, it is an excellent place to start, and can be used in conjunction with more aggressive pain management therapies.
Herbs such as wild lettuce, Jamaican dogwood, passionflower, and valerian root have a calming effect that is non-sedating and effectively relieves muscle pain and pain-related anxiety. Similarly, boswellia, cherry fruit, and willow bark—from which Aspirin is made—can decrease inflammation by inhibiting the enzyme cyclooxygenase (COX), while ginger inhibits the production of Substance P, the spinal fluid that allows for transmission of pain signals to and from the brain.
The combination of ribose and magnesium, found in supplements such as Ribose Cardio, can effectively relieve pain and support mitochondrial function production of ATP, the body’s primary energy source. Meanwhile, tryptophan—a powerful amino acid—works by raising the body’s serotonin levels, which in turn relieves pain, and essential fatty acids such as omega-6 and omega-3 have anti-inflamatory effects. EFAs are involved in hormone production, fluid balance, cell-membrane formation and support of the body’s immune system. Interestingly, symptoms of deficiency mirror many Fibromyalgia and Chronic Fatigue symptoms, such as sluggishness, memory loss, muscles aches, brittle nails and hair, GI upset, depression and moodiness.
While the side effects of many prescription drugs are not worth the benefits, a select few have proven to be effective and relatively light in experienced side-effects. Prescription pain medications such as Neurontin, Gabitril, and Lyrica work by increasing the body’s response to gamma-aminobutyric-acid (GABA)—often referred to as the “calming neurotransmitter.” Similarly, anti-depressants such as Cymbalta, Effexor, Paxil and Zoloft increase the production of serotonin while inhibiting Substance P spinal fluid. Essentially, these medications are effective because they target the brain’s pain-response center versus the perceived site of pain, and are most effective when taken in conjunction with natural and homeopathic remedies.
The natural and prescriptive remedies described above are designed to support the S.H.I.N.E protocol, to include Sleep, Hormone balance, Immunity support, Nutrition and Exercise. Next week, we will take a closer look at S.H.I.N.E, and the additional corresponding therapies our clinic provides.
Dr. Teitelbaum, Jacob. From Fatigued to Fantastic! 3rd ed. Garden City Park, NY: Avery Pub. Group, 2007. Print.
Platelet Rich Plasma Therapy, once reserved for elite athletes, continues to gain popularity among the general public. Research
is also overwhelmingly positive in the treatment of numerous musculoskeletal complaints. The following article shows the potential
for PRP to improve knee osteoarthritis also known as degenerative joint disease. This is especially exciting because medical
treatment for osteoarthritis is mostly inadequate. If you or someone you know is suffering from knee pain, or other joint pains,
PRP may be an effective treatment option for you. If you have any questions, you can contact me either via email or call the clinic.
Platelet-rich plasma (prp) treatment shows potential for knee osteoarthritis
Date: February 12, 2013
Source: Hospital for Special Surgery
Summary: A new study has shown that platelet-rich plasma (PRP) holds great promise for treating patients with knee osteoarthritis. The treatment improved pain and function, and in up to 73% of patients, appeared to delay the progression of osteoarthritis.
A study by researchers from Hospital for Special Surgery has shown that platelet-rich plasma (PRP) holds great promise for treating patients with knee osteoarthritis. The treatment improved pain and function, and in up to 73% of patients, appeared to delay the progression of osteoarthritis, which is a progressive disease. The study appears online, ahead of print, in the Clinical Journal of Sports Medicine.
“This is a very positive study,” said Brian Halpern, M.D., chief of the Primary Care Sports Medicine Service at Hospital for Special Surgery, New York City, and lead author of the study.
Several treatments for osteoarthritis exist, including exercise, weight control, bracing, nonsteroidal anti-inflammatories, Tylenol, cortisone shots and viscosupplementation, a procedure that involves injecting a gel-like substance into the knee to supplement the natural lubricant in the joint. A new treatment that is being studied by a small number of doctors is PRP injections. PRP, which is produced from a patient’s own blood, delivers a high concentration of growth factors to arthritic cartilage that can potentially enhance healing.
“You take a person’s blood, you spin it down, you concentrate the platelets, and you inject a person’s knee with their own platelets in a concentrated form,” said Dr. Halpern. “This then activates growth factors and stem cells to help repair the tissue, if possible, calm osteoarthritic symptoms and decrease inflammation.”
In the new study, researchers at Hospital for Special Surgery enrolled patients with early osteoarthritis, gave them each an injection of PRP (6-mL), and then monitored them for one year. Fifteen patients underwent clinical assessments at baseline, one week, and one, three, six, and 12 months. At these time points, clinicians used validated tools to assess overall knee pain, stiffness and function, as well as a patient’s ability to perform various activities of daily living. At baseline and then one year after the PRP injection, physicians also evaluated the knee cartilage with magnetic resonance imaging (MRI), something that has not previously been done by researchers in other PRP studies. The radiologists reading the MRIs did not know whether the examination was performed before or after the PRP treatment.
“The problem with a lot of the PRP studies is that most people have just used subjective outcome instruments, such as pain and function scores,” said Hollis Potter, M.D., chief of the Division of Magnetic Resonance Imaging at Hospital for Special Surgery, another author of the study. “But even when patients are blinded, they know there has been some treatment, so there is often some bias interjected into those types of studies. When you add MRI assessment, it shows you the status of the disease at that time, regardless of whether the patient is symptomatic or asymptomatic or they have good or poor function in the knee. You find out what the cartilage actually looks like. We can noninvasively assess the matrix or the building blocks of cartilage.”
While previous studies have shown that patients with osteoarthritis can lose roughly five percent of knee cartilage per year, the HSS investigators found that a large majority of patients in their study had no further cartilage loss. “The knee can be divided into three compartments, the medial compartment, the lateral compartment and the patellofemoral compartment,” said Dr. Halpern. “If we look at these compartments individually, which we did, in at least 73% of these cases, there was no progression of arthritis per compartment at one year. That is very significant, because longitudinal studies suggest a four to six percent progression of arthritis at one year.”
Treatment with PRP was also useful in improving pain, stiffness and function. The investigators found that pain, measured by a standard test called the Western Ontario and McMaster Universities Arthritis Index, significantly improved with a reduction of 41.7% at six months and 55.9% at one year. On a pain scale commonly used by clinicians called the Visual Analog Scale, pain was reduced by 56.2% at six months and 58.9% at one year. Functional scores improved by 24.3% at one year. Activity of Daily Living Scores also showed a significant increase at both six months (46.8%) and one year (55.7%).
“We are entering into an era of biologic treatment, which is incredibly ideal, where you can use your own cells to try to help repair your other cells, rather than using a substance that is artificial,” Dr. Halpern said. “The downside is next to zero and the upside is huge.” Dr. Halpern pointed out, however, that the study is a small case series and PRP needs to be pitted against a traditionally treated group in a randomized, controlled trial.
Osteoarthritis, which causes pain and joint stiffness, impacts over 27 million Americans and is a leading cause of disability. According to statistics from the Centers for Disease Control and Prevention, overall osteoarthritis affects 13.9% of adults aged 25 and older and 33.6% of those older than 65. The disease is characterized by degeneration of cartilage and its underlying bone within a joint as well as bony overgrowth. Disease onset is gradual and usually begins after the age of 40.
Other HSS investigators involved in the study include Salma Chaudhury, M.D., Ph.D, Scott Rodeo, M.D., Catherine Hayter, MBBS, Eric Bogner, M.D., and Joseph Nguyen, MPH.
The above story is based on materials provided by Hospital for Special Surgery.Note: Materials may be edited for content and length.
- Brian Halpern, Salma Chaudhury, Scott A. Rodeo, Catherine Hayter, Eric Bogner, Hollis G. Potter, Joseph Nguyen. Clinical and MRI Outcomes After Platelet-Rich Plasma Treatment for Knee Osteoarthritis. Clinical Journal of Sport Medicine, 2012; 1 DOI: 10.1097/JSM.0b013e31827c3846
It is interesting to note that the classical tender points of fibromyalgia are over tendon and ligament insertions. These insertion points have the lowest pain threshold of any somatic structure, meaning, even a small stimulus can be interpreted as a large amount of pain. Weak or lax ligaments are potential nociceptors (nerve stimulus receptors) in fibromyalgia, and that this is potentially correctable with prolotherapy.
Treatment of Consecutive Severe Fibromyalgia Patients with Prolotherapy,
- Dean Reeves, MD
Abstract: The potential of tendon and ligament triggers as primary nociceptors in fibromyalgia led to treatment of primary fibromyalgia patients with tendon and ligament strengthening injections. The injection of ligaments and tendons with proliferant (Prolotherapy) offers the advantage of creating increased strength of the connective tissue in the region of injection as well as affecting the pain cycle. Reduction in pain levels and increased functional abilities were seen in excess of 75% of patients with severe fibromyalgia in this study.
Journal of Orthopaedic Medicine Vol 16 1994 No 3
For full research article go to:
GABA is a brain hormone that promotes feeling of calmness and alert relaxation. The GABA system is at the center of fighting anxiety and keeping feelings of overwhelm at bay.
The very fact that anti-anxiety medicine like clonazepam, diazepam and alprazolam are some of the most frequently prescribed drugs, indicate that GABA system dysfunction is very prevalent today.
Symptoms associated with decreased GABA or imbalances in the GABA system:
- Feelings of anxiousness or panic without reason
- Feelings of dread
- Inner tension, easy excitability and inner restlessness
- Feeling overwhelmed without reason
- Restless mind
- Cannot turn off your mind when it is time to relax or sleep
- Concern or worry about things that are not significant
- Anxiety and inability to concentrate due to your mind jumping around
Drinking teas, black or green, and eating fermented foods help boost GABA activity in the brain, and focused supplementation has been shown to make a tremendous difference not only in calming feelings of anxiety and restlessness, but increasing brain levels of GABA.
GABA system dysfunction is dependent upon many modern lifestyle factors, which can be identified and corrected with appropriate lifestyle and focused GABA system specific nutrients for a steady and calm emotional state.
More and more research is being published about the benefits of prolotherapy for numerous musculoskeletal complaints, this particular one on knee osetoarthritis. Prolotherapy is a form of regenerative injection technique that is very effective at treating injuries to tendons and ligaments. It has also been shown to be beneficial for arthritis and discopathy. If you have pain or instability at or around a joint that impairs your daily activities, contact Dr Jarosz for more information.
Effect of Regenerative Injection Therapy on Function and Pain in Patients with Knee Osteoarthritis: A Randomized Crossover Study.
Dumais R, Benoit C, Dumais A, Babin L, Bordage R, de Arcos C, Allard J, Bélanger M. Pain Med. 2012 Jul 3. doi: 10.1111/j.1526-4637.2012.01422.x. [Epub ahead of print]
Dr. Georges-L.-Dumont Regional Hospital, Vitalité Health Network, Moncton, New Brunswick Centre de formation médicale du Nouveau-Brunswick, Moncton, New Brunswick Dieppe Family Medicine Unit, Dieppe, New Brunswick Department of Family Medicine, Université de Sherbrooke, Sherbrooke, Quebec Department of Mathematics and Statistics, Université de Moncton, Moncton, New Brunswick Research Centre, Vitalité Health Network, Moncton, New Brunswick, Canada.
Objective. We assessed the effectiveness of regenerative injection therapy (RIT) to relieve pain and restore function in patients with knee osteoarthritis. Design. Crossover study where participants were randomly assigned to receive exercise therapy for 32 weeks in combination with RIT on weeks 0, 4, 8, and 12 or RIT on weeks 20, 24, 28, and 32. Patients. Thirty-six patients with chronic knee osteoarthritis. Interventions. RIT, which is made up of injections of 1 cc of 15% dextrose 0.6% lidocaine in the collateral ligaments and a 5 cc injection of 20% dextrose 0.5% lidocaine inside the knee joint. Outcome Measures. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index of severity of osteoarthrosis symptoms (WOMAC) score (range: 0-96). Results. Following 16 weeks of follow-up, the participants assigned to RIT presented a significant reduction of their osteoarthritis symptoms (mean ± standard deviation: -21.8 ± 12.5, P < 0.001). WOMAC scores in this group did not change further during the last 16 weeks of follow-up, when the participants received exercise therapy only (-1.2 ± 10.7, P = 0.65). WOMAC scores in the first 16 weeks did not change significantly among the participants receiving exercise therapy only during this period (-6.1 ± 13.9, P = 0.11). There was a significant decrease in this groups’ WOMAC scores during the last 16 weeks when the participants received RIT (-9.3 ± 11.4, P = 0.006). After 36 weeks, WOMAC scores improved in both groups by 47.3% and 36.2%. The improvement attributable to RIT alone corresponds to a 11.9-point (or 29.5%) decrease in WOMAC scores. Conclusions. The use of RIT is associated with a marked reduction in symptoms, which was sustained for over 24 weeks.