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.
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:
A colleague and someone that I learned directly from, Jeff Patterson DO, co-authored a recent blinded trial of dextrose prolotherapy vs. placebo injection or exercise therapy. The results suggested that prolotherapy is an effective solution for knee osteoarthritis with reductions in pain and stiffness and an increase in range of motion and function. Prolotherapy can be extremely beneficial for numerous types of joint pain and musculoskeletal complaints. Dr Glen Jarosz is a skilled practitioner of prolotherapy as well as numerous other regenerative injection therapies. Please contact him for a free consultation to see if you may benefit from these types of therapies.
June 04, 2013
Dextrose Prolotherapy Can Improve Knee Osteoarthritis
(HealthDay News) – For adults with knee osteoarthritis, dextrose prolotherapy is associated with greater improvements in pain, function, and stiffness compared with saline injections or at-home exercise, according to a study published in the May/June issue of the Annals of Family Medicine.
David Rabago, MD, of the University of Wisconsin School of Medicine and Public Health in Madison, and colleagues conducted a three-arm blinded, randomized controlled trial involving 90 adults with ≥3 months of painful knee osteoarthritis. Participants were randomized to receive blinded injection (dextrose prolotherapy or saline) or at-home exercise. Injections were provided at weeks one, five, and nine, with additional treatments at weeks 13 and 17, as needed. An exercise manual and in-person instruction were provided to exercise participants.
The researchers found that all groups reported an improvement in composite Western Ontario McMaster University Osteoarthritis Index (WOMAC) scores from baseline to 52 weeks. The improvement in WOMAC scores at 52 weeks was significantly more for the dextrose prolotherapy group compared with the saline or exercise groups, after adjustment for age, sex, and body mass index. In the prolotherapy group, the individual knee pain scores also improved more. High satisfaction was noted with prolotherapy and there were no adverse events reported.
“Prolotherapy resulted in clinically meaningful sustained improvement of pain, function, and stiffness scores for knee osteoarthritis compared with blinded saline injections and at-home exercises,” the authors write.
The Abstract From the Recent Study:
Dextrose Prolotherapy for Knee Osteoarthritis: A Randomized Controlled Trial
- David Rabago, MD1⇑, Jeffrey J. Patterson, DO1, Marlon Mundt, PhD1,Richard Kijowski, MD2, Jessica Grettie, BS1, Neil A. Segal, MD, MS3 andAleksandra Zgierska, MD, PhD1
- 1Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- 2Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- 3Departments of Orthopaedics & Rehabilitation, Epidemiology, and Radiology, The University of Iowa, Iowa City, Iowa
- CORRESPONDING AUTHOR: David Rabago, MD, Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53715,firstname.lastname@example.org
PURPOSE Knee osteoarthritis is a common, debilitating chronic disease. Prolotherapy is an injection therapy for chronic musculoskeletal pain. We conducted a 3-arm, blinded (injector, assessor, injection group participants), randomized controlled trial to assess the efficacy of prolotherapy for knee osteoarthritis.
METHODS Ninety adults with at least 3 months of painful knee osteoarthritis were randomized to blinded injection (dextrose prolotherapy or saline) or at-home exercise. Extra- and intra-articular injections were done at 1, 5, and 9 weeks with as-needed additional treatments at weeks 13 and 17. Exercise participants received an exercise manual and in-person instruction. Outcome measures included a composite score on the Western Ontario McMaster University Osteoarthritis Index (WOMAC; 100 points); knee pain scale (KPS; individual knee), post-procedure opioid medication use, and participant satisfaction. Intention-to-treat analysis using analysis of variance was used.
RESULTS No baseline differences existed between groups. All groups reported improved composite WOMAC scores compared with baseline status (P <.01) at 52 weeks. Adjusted for sex, age, and body mass index, WOMAC scores for patients receiving dextrose prolotherapy improved more (P <.05) at 52 weeks than did scores for patients receiving saline and exercise (score change: 15.3 ± 3.5 vs 7.6 ± 3.4, and 8.2 ± 3.3 points, respectively) and exceeded the WOMAC-based minimal clinically important difference. Individual knee pain scores also improved more in the prolotherapy group (P = .05). Use of prescribed postprocedure opioid medication resulted in rapid diminution of injection-related pain. Satisfaction with prolotherapy was high. There were no adverse events.
CONCLUSIONS Prolotherapy resulted in clinically meaningful sustained improvement of pain, function, and stiffness scores for knee osteoarthritis compared with blinded saline injections and at-home exercises.
For full text of this research study: http://www.annfammed.org/content/11/3/229.full
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.