by John C Lowe
page 1-5
by R Paul St Amand and Claudia Potter
page 5-17
We describe fibromyalgia and our treatment using the weakly uricosuric agent guaifenesin, and we critique the recent Oregon study of guaifenesin treatment of fibromyalgia. Guaifenesin has proven to be our most effective medication to date for the treatment of fibromyalgia. Salicylates from any other source will block the benefit of guaifenesin at a renal tubular level as they do in gout. Salicylates, which all plants make, are readily absorbed through the skin. Even small amounts in cosmetics and other topicals will negate or slow the effects of all uricosuric agents we have used. Many maps made during the treatment of patients' palpable lesions illustrate their becoming static or worsening in previously improving patients who unwittingly begin using such preparations. More than half of the usual skin preparations could block pain improvement. Many patients are carbohydrate intolerant and must also be treated through diet, Dietary corrections for hypoglycemia and avoidance of salicylates must be maintained or there will be no improvement. The conclusion of a study of guaifenesin treatment recently conducted in Oregon was that there is no difference in results between the guaifeneisin and placebo groups. It is likely that this outcome resulted from two faults: patients' use of hidden salicylate sources and failure to exclude hypoglycemics from the study. Another study in which these faults are corrected should be conducted.
by Gina S Honeyman
page 19-49
Fibromyalgia syndrome (FMS) is characterized by widespread pain and abnormal tenderness. The pain must be above and below the waist, on the right and left sides of the body, and in some axial region, for longer than three months. I report the successful metabolic treatment of a hypothyroid FMS patient and a euthyroid FMS patient. Before running treatment, both patients met the American College of Rheumatology (ACR) criteria for FMS. By the 8th week of treatment, the euthyroid patient no longer met the ACR criteria; by the 14th week of treatment, they hypothyroid patient no longer met the criteria. The treatment protocol is multidisciplinary. Recovery of these two patients, managed at an independent clinical site, supports the effectiveness of the treatment itself for both hypothyroid and euthyroid FMS. The outcomes of the two cases are reported in 3 systematic open trials and three double-blind trials. The metabolic therapy protocol developed by researchers at the Fibromyalgia Research Foundation appears to be a highly effective treatment for both euthyroid and hypothyroid FMS.
by Lewis E Mock
page 51-69
Repetitive strain injuries, athletic injuries, post-traumatic biomechanical problems, peripheral nerve entrapment, and many other common syndromes respond well to soft-tissue treatment. This paper discusses myofascial release treatment (MRT). It also has a procedural guide for the examination and treatment of the most common, clinically significant muscles of the upper extremity. This is part three of four parts.
by John C Lowe, Richard L Garrison, Alan Reichman, and Jackie Yellin
page 71-88
Background. In a previous study, T3 was found to be highly effective compared to placebos in the treatment of euthyroid fibromyalgia. In this replication study, the comparative effects of placebos and T3 were tested with 4 euthyroid fibromyalgia patients. A randomized double-blinded placebo-controlled crossover design was used.
Methods. Patients completed alternately two T3 phases and two placebo phases. The sequence for each patient depended on the medication with which she was randomly assigned to begin. Crossover from one phase to another was response-driven, based on changes in three measures of fibromyalgia status: mean tender point sensitivity by algometry, mean symptom intensity by visual analog scales, and pain distribution by the percentage method. Measurements taken repeatedly during each phase were used to determine when a patient's scores warranted a crossover. Patients also completed the Fibromyalgia Impact Questionnaire and Zung's Self-Rating Depression Scale at the end of each phase.
Results. Pared-samples t-tests showed a highly significant difference between scores in the placebo and T3 phases. Serial ECGs throughout the 8-month study, and urine and serum calcium, phosphorus, creatinine, serum alkaline phosphate, and bone densitometry at 6-month follow-up revealed no adverse effect from T3.
Conclusion. The highly significant difference between fibromyalgia measures in placebo and T3 phases, despite the small N, indicates a powerful therapeutic effect of supraphysiologic dosages of T3. Despite low TSH and free total T4 levels, and high free T3 levels, there was no evidence of thyrotoxicosis. Long-term safety of T3 use by euthyroid fibromyalgia patients has not yet been established
page 89-93
Transcribed by Angus Nicolson
6 November 1997