CHRONIC PAIN: Fibromyalgia patients complain of widespread muscle pain and tenderness that waxes and wanes over time
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A drug commonly used to treat heroin addiction appears to ease the symptoms of fibromyalgia, a poorly understood but potentially debilitating condition that affects up to 12 million people in the U.S. (4 percent of the population), a small pilot study has found.
"We have a medication that seems to have low side effects and seems to reduce pain and fatigue [in fibromyalgia patients]," says Jarred Younger, a pain researcher at Stanford University School of Medicine and co-author of the study appearing today in Pain Medicine. "I think this is a potential treatment to add to the doctor's arsenal," he adds, noting that longer studies involving more patients are needed to confirm the results.
Fibromyalgia, a mysterious ailment whose symptoms include chronic widespread muscle pain, fatigue, sleep problems, anxiety and depression, often appears between the ages of 34 and 53 and is more common in women (affecting 5 percent of women and 1.6 percent of men in the U.S.), the researchers report. The U.S. Food and Drug Administration (FDA) has approved three drugs for treating fibromyalgia, but many patients don't respond to them, Younger says.
For 14 weeks, Younger and his colleague Sean Mackey, chief of the pain management division at Stanford, monitored the symptoms of 10 women ages 22 to 55 with fibromyalgia before, during and after they took small doses (4.5 milligrams per day) of naltrexone, a drug that for about three decades has been used to wean addicts off of heroin and other street drugs. (Naltrexone works by latching onto nerve cell receptors where heroin and other opioid drugs would dock, thus blocking their ability to act on the cells and induce a feeling of being high.) Using handheld computers, the women reported the severity of their daily symptoms on a scale of one to 100 (100 being the most severe). Every two weeks, they visited the researchers who downloaded the data entered in the computers and ran tests to measure the women's pain thresholds for pressure, heat and cold applied to the skin.
Their findings: the severity of pain and fatigue fell by 30 percent during the weeks the women were taking naltrexone compared with those in which they were taking a placebo. Two of the women said the drug gave them vivid dreams and one said she had nausea and insomnia the first few nights that she took the pills, but otherwise no side effects were reported.
Younger, who suspects fibromyalgia is an autoimmune disorder (in which the body's immune system attacks healthy tissue), speculates that naltrexone is alleviating fibromyalgia symptoms not by blocking nerve cell receptors but by dampening the activity of microglia—immune cells in the brain and spinal cord that produce pro-inflammatory cytokines, which excite nerve cells responsible for creating the sensation of pain.
"These results are promising," says Dan Clauw, an anesthesiologist at the University of Michigan at Ann Arbor's Chronic Pain & Fatigue Research Center who was not involved with the study. But Clauw is not convinced that naltrexone works by suppressing immune cells; he thinks low doses of the drug might stimulate nerve cells to release pain-alleviating endorphins.
Regardless of how the drug works, the scientists agree that more research is needed to confirm these preliminary findings. The Stanford team is already about two thirds of the way through a 24-week follow-up study involving 40 patients. And although Younger hasn't started analyzing the data, he says, "The participants seem happy…I think it looks good."
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24 Comments
Add CommentCould this drug be used in conjunction with opioid pain killers, which are routinely prescribed for all sorts of injuries and post-surgical recovery, to prevent the takers from developing addiction? I don't know enough about the chemical processes of addiction to say whether eliminating the "high" alone is enough to prevent dependency...
Reply | Report Abuse | Link to thisI am not surprised that Dr. Younger suspects that Fibromyalgia often presents itself as an autoimmune disorder. Fibromyalgia is obviously "caused" by some major aspect of the body mis-performing and producing erroneous signals. If you take one second to assume that that statement is true, then the next questions are "How does the condition get triggered?" and "Why?" I assert that the cause is not as one might think in a virus or bacteria, but from trauma. I have 20+ years at this and in my personal case (and in many people who I work with in getting them well), trauma is the culprit. Once the damage from trauma is eliminated, people begin to get well because the body regains the ability of healing itself, as God intended. I invite discussion and input at the Health Matters Show, http://www.healthmattersshow.com.
Reply | Report Abuse | Link to thisCinda Crawford
My wife is taking this for M.S. and it seems to help her sleep a bit and to take an edge off her symptoms. There is another site with more info with a recommended regimen for taking naltrexone at http://www.lowdosenaltrexone.org/ldn_and_ms.htm. It is called Low Dose Naltrexone or LDN.
Reply | Report Abuse | Link to thisGood luck with it. Jorj B.
I take LDN for my Secondary Progressive MS along with thousands of people worldwide. Nice to see established science catching up with the anecdotes. It works by boosting endorphins and opioid growth factor, which in turn restore the functioning of the immune and repair systems in the body by the way.
Reply | Report Abuse | Link to thisThank you for reporting on this important issue.
Reply | Report Abuse | Link to thisThere is a drug-free option to permanently eliminate chronic muscle and joint pain.
The book, Forever Free From Chronic Pain, written for the chronic pain sufferer, summarizes 40 years of research and clincal practice that led to the discovery of a previously unknown cause of chronic muscle and joint pain. The book also discusses the therapy developed to eliminate it permanently without the use of drugs or surgery. The doctor who made this ground breaking discovery and developed this innovative treatment suffered from chronic pain himself for 10 years. It was his own pain and that of his patients that led him drove him to find a solution that has allowed himself and thousands of others get their life back.
You can sign up for a free chapter of the book by signing up for the newsletter at: http://www.foreverfreefromchronicpain.com.
curious post from the prof there. I assume it's aimed to follow my previous post which is rather funny in context. I have my life with pain well under control thankyou and I don't need to dose up with drugs to do that either. But your words speak loudly of overblown claims too. It's better to try the sober approach in a scientific journal - just a bit of useful advice on presentation.
Reply | Report Abuse | Link to thisThe experience of pain appears to be a complex phenomenon with humans. The reason for the occurrence of pain can be physical, psychological, or a combination of both of these causes. And how one defines or describes the intensity of the pain they experience varies as much as the types of pain that exist. Although the origin may be the same from one person to another, the experience of pain is, in fact, a subjective emotional response to the sensation and perception of the pain itself.
Reply | Report Abuse | Link to thisThis is why the syndrome of Fibromyalgia is so difficult to define objectively and treat for health care providers, who are usually primary care physicians. Rheumatologists have said that Fibromyalgia Syndrome is the second most common musculoskeletal diagnosis after osteoporosis.
Fibromyalgia is a very controversial syndrome. Some doubt it is as prevalent as others believe (3 to 6 percent of the population, some have determined). About 80 percent of the sufferers that are diagnosed with fibromyalgia are women. Furthermore, fibromyalgia is not a disease- it is a syndrome. A syndrome is what you call something that has multiple symptoms that occur together. A disease, however, is an actual dysfunction of one’s physiology in some manner.
Fibromyalgia syndrome is considered a muscle condition that involves varying intensities of chronic pain for a prolonged period of time. As a result of this pain which is rather brutal with many sufferers, their physical function becomes limited. In addition, the location of the pain associated with fibromyalgia is determined by the health care provider according to at least 11 of 18 defined tender points at various locations on the human body.
Regardless, fibromyalgia is misunderstood by the medical community overall. To further complicate the subject of fibromyalgia syndrome, some have suggested that the pharmaceutical companies that make the only two medications actually approved for the treatment of fibromyalgia, which are the drug giants Pfizer with their drug Lyrica, and Eli Lilly, the maker of Cymbalta, have conducted what is known as disease mongering.
Disease mongering is when others expand the diagnostic criteria for a particular medical issue though various ways of informing the public of the potential undetected cases of such an issue through advertising, primarily.
Also, another method of disease mongering is though the funding of various related associations and societies through educational grants to be the voice for those who conduct disease mongering with deliberate intent to increase the profit of their medications. There is evidence to support this claim- with more funds from these companies dedicated to advertising much more than grants.
Yet it is clear that fibromyalgia syndrome exists, as there are so many diagnosed with this medical issue that share the same symptoms, which include other symptoms besides pain alone. And it often takes a great deal of time for a patient that has fibromyalgia to receive the correct diagnosis due to the absence of any objective diagnostic testing to assess this syndrome. The fibromyalgia patient often goes through numerous other diagnostic testing, such as blood work and X-Rays, as their doctor orders such tests to rule out other diseases and disorders that may be present with the symptoms expressed with fibromyalgia syndrome.
Variables associated with those diagnosed with fibromyalgia syndrome include those patients with a history mental illness. They also tend to be overweight and live an inactive lifestyle, overall. Also, there seems to be an association with those diagnosed with fibromyalgia and these patients being in a state of low socioeconomic status.
Also in over 50 percent of those diagnosed with fibromyalgia, the patients are experiencing mental stress, emotional distress, as well as some sort of family conflicts as well. In fact, this stress amplifies the symptoms of fibromyalgia if these emotions are expressing themselves in the fibromyalgia patient. Insomnia is associated with fibromyalgia as well. It appears that mean age of onset of Fibromyalgia is around 40 years old, yet fibromyalgia syndrome can occur at any age.
Aside from systemic pain of varying degrees with the fibromyalgia patient, the patient experiences affective disorders typically. Since the symptoms of fibromyalgia also could indicate other disease states in 25 percent of the patients, usually X-Rays and blood work are examined to rule out other possible causes for the symptoms.
The Journal of the American Medical Association gave these symptoms the name of Fibromyalgia in the mid 1980s, as well as this association publically acknowledging that it is a disabling illness
There is evidence the cause is neurological. Upon examining the spinal fluid of a fibromyalgia patient, their serotonin levels are low, which is a neurotransmitter that has multiple emotional functions, as well as elevations of the neuro-chemical protein called substance P, which is the catalyst for pain. The patients also have elevated levels of what is called nerve growth factor (NGF). NGF is a protein molecule that, when elevated, is also associated with Alzeimer’s disease, and, believe it or not, one falling in love.
Furthermore, some fibromyalgia patents have had their brains scanned for abnormalities that may be present, and their brains in fact have shown varying degrees of structural dysfunction with their brains due to fibromyalgia.
So some suspect not only the cause may be some sort of central nervous system injury, but also there is evidence the syndrome is from some sort of viral infection, it has been reported.
Treatment of the fibromyalgia patient includes not only the drugs mentioned earlier, but also other medications for pain, anxiety, and insomnia in particular. Lifestyle changes are recommended for the fibromyalgia patient, as well as many other treatment methods in order to relieve their discomfort. Physical exercise is appropriately recommended for the fibromyalgia patient as well.
What is perhaps not recommended enough is cognitive or behavioral therapy for the fibromyalgia patient. There seems to be a strong association between fibromyalgia syndrome and psychogenic or psychophysiological causes for their symptoms.
Or, perhaps the fibromyalgia patient is suffering from some sort of guilt for some reason that is amplifies the unfortunate syndrome they are forced to tolerate.
Mea Culpa is Latin, meaning, ‘my fault’.
Pain is a Latin word as well. Its meaning: a fine or penalty.
Further research, however, is needed regarding this unfortunate syndrome experienced by so many others for no solid reason defined yet.
ww.fmaware.org
Dan Abshear
It sounds like there might be potential for problems with this down the road with burn out if it does work by releasing endorphins. How many endorphins can a body release before you crash and burn?
Reply | Report Abuse | Link to thisI appreciate sharing good information and want to say this regarding "mental illness and fibromyalgia" first of all, it is my understanding that until fairly recently fibromyalgia was classed by doctor's as a mental diagnosis.
Reply | Report Abuse | Link to thisAnyone who suffers chronic pain is subject to stress and depression.
I understand how stressful and tiring and depressing it is to feel the need to convince people you are sick with an unseen illness.
No doubt life changing events reflect on the home life especially when disabling pain is suffered by women given the ages quoted.
It makes sense that disabling pain would prevent regular exercise routine and weight gain may result also depressing.
Prior to becoming ill, I was quite active and ate a healthy diet to maintain balanced weight. I worked as a corporate secretary with a happy life until I became pain ridden with fms. I fought it, stayed active, would over-do and cause flareups that put me in the bed trying to buck it and keep my weight down and stay out of depression.
The doctor limited my activity to help prevent flareups.
Also, opinions are just that and probably do not apply to every patient as there may be a history of auto accidents and trauma associated with fms diagnosis but probably not all.
I do not think majority of or all fibromyalgia patients are lower income, overweight, depressed from a family with problems and so forth coming into the changed lifestyle and I think life changing illness could bring out these factors to consider, possibly.
They are not lower class or lower anything.
Also, I think there should be references to support these opinions stated in the fmaware.com post. Thank-you.
said >>Variables associated with those diagnosed with fibromyalgia syndrome include those patients with a history mental illness. They also tend to be overweight and live an inactive lifestyle, overall. Also, there seems to be an association with those diagnosed with fibromyalgia and these patients being in a state of low socioeconomic ..>
Quoting Dan Abshear: 'Variables associated with those diagnosed with fibromyalgia syndrome include those patients with a history mental illness. They also tend to be overweight and live an inactive lifestyle, overall. Also, there seems to be an association with those diagnosed with fibromyalgia and these patients being in a state of low socioeconomic status."
Reply | Report Abuse | Link to thisI'd really like to see where you're getting the statistics for this assertion. I personally know three FM sufferers, and not one fits these apparently ambiguous and highly subjective set of criteria. Citations from refereed, published studies would be very much appreciated.
Incidentally, the assertion that Lyrica and other medications are being pushed as FM treatments by "disease mongering" pharm companies is ridiculous. Two of the three patients I mentioned have used Lyrica with great success, and by doing so have been able to largely eliminate their use of opioid medications. If you know anything about pain meds at all, you're aware of the "wind up" pain that can accompany long term opioid use. Moving away from such medications as a long term solution for FM sufferers is a definite step forward.
Wow. Few thoughts. 1st. 10 sample size with 30% reduction is not a good enough sample for a disease that flares like fibro. THere's enough people with fibro, come on, Stanford? YOu can do better than this! I'd not even publish something swith numbers studied so small.
Reply | Report Abuse | Link to this2nd. Is there anything more hated than a fat, 'inactive' middle aged poor white woman? From these comments, I think not. Did it ever occur to anyone that something like fibro tends to make one poor and inactive, and then very possibly overweight?
I was a size 7 and in great shape when my symptoms first started. Even walking became painful.
There's never going to be any healing going on until people get done scapegoating, accusing, and blaming.
What if one suffers also Joint Hypermobility Syndrome? Fybromialgia apparently is secondary, and correlated, but JHS is purely mechanical bad function.
Reply | Report Abuse | Link to thisThe basic thing nobody asks is why do people take drugs of any sort? Why do we have these accessories to normal living to live? I mean, is there something wrong with society that's making us so pressurized, that we cannot live without guarding ourselves against it?
Reply | Report Abuse | Link to thismayes
<a href=http://www.drugstrategies.org/Treatment/Tennessee>Tennessee Drug Treatment Centers</a>
Information about the use of low dose naltrexone in autoimmune diseases, including CFS, can be found here:
Reply | Report Abuse | Link to thishttp://www.lowdosenaltrexone.org/ldn_and_ai.htm
Many peoples' bodies are out of kilter for various reasons. Therapeutic drugs attempt to normalize us so we can live worthwhile, meaningful lives. LDN helps to normalize the immune systems of people with autoimmune diseases. I'm taking it for Crohn's Disease and couldn't function without it. It's disingenuous to equate lawful prescription medications with illegal recreational drugs.
Reply | Report Abuse | Link to thisInformation about the use of low dose naltrexone in autoimmune diseases, including CFS, can be found here:
Reply | Report Abuse | Link to thishttp://www.lowdosenaltrexone.org/ldn_and_ai.htm
Information about the use of low dose naltrexone in autoimmune diseases, including CFS, can be found here:
Reply | Report Abuse | Link to thishttp://www.lowdosenaltrexone.org/ldn_and_ai.htm
Heroin is very dangerous drug, people use it for having relief and it is also used as recreational drug also. It is affecting people very badly. There are numerous side <A HREF='http://www.addiction-treatments.com/substance/Heroin/index.html'>effects of Heroin addiction </A>including respiratory arrest, coma and death. It has many effects on the CNS like drowzziness, disorientation and delirium and any other.
Reply | Report Abuse | Link to thishttp://www.addiction-treatments.com/substance/Heroin/index.html
This research is very interesting to me -- especially the part about blocking opioid receptors. This is why:
Reply | Report Abuse | Link to thisI was diagnosed with FM over 10 years ago. After 9 years of trying conventional Western medicine without luck, I gave in to several FM friends and tried dietary changes. One friend was the head of the San Francisco CFIDS support network, and she told me that every single person she knew with CFS or FM and had tested it was sensitive to gluten.
So, I eliminated gluten and casein (dairy protein). The results of my elimination diet were amazing to me, particularly because I had been very skeptical that it would work. Subsequent research showed me that these proteins can have an opioid-like effect in people who are not able to digest them completely. It had been very difficult to wean myself off of them and I attribute this to the addictive nature of opioids. But it was totally worth it. 90 percent of my pain is gone. Knots I had in my neck for years are gone. Low energy and mild depression are nearly gone. I subsequently cut out soy, corn, sugar and caffeine. Again, very hard -- but again -- very worth it. I feel better than I have in decades.
I still crave wheat/baked goods/gluten all the time. Whenever I give in to my cravings, I at first feel high and then crash really hard within several hours.
People with FM are highly sensitive to all drugs. Why not certain phytochemicals and/or proteins in foods? Not enough people think about these factors, though the list is growing. I'm not saying that food is causing FM or that this is a miracle cure for everyone, but it leads me to believe that there is an underlying enzyme imbalance or something that is resulting in ineffective metabolism of these substances, or a failure in the blood-brain barrier that somehow allows these substances to affect the brain. Or, there is an immune response to these things that result in the pain we feels.
What it appears is that there are "side effects" to these foods, just like medications. As someone pointed out above, pain can be a side effect of long-term opioid use. So, eating gluten and dairy could cause the side effect of pain in people who cannot metabolize it effectively and are highly sensitive to external stimulus.
So, it leads me to this: could the drug tested in this study be effective because it is blocking the opioid side effects from dietary proteins in a population that is particularly sensitive to those effects? It is competing for receptors with dietary opioids and blocking their effect?
Nowadays drug addiction is major problem lots of teenagers are addicted of this addiction and they dont know about their side effects or signs of drug addiction. The <A HREF=http://www.addiction-treatments.com/>signs of drug addiction </A>are such as, appetite changes, behavior changes, compulsive behaviors, Isolation problem, mental changes, Secrecy; these are just some of the common symptoms of drug addiction.
Reply | Report Abuse | Link to thishttp://www.addiction-treatments.com/
Drug rehabilitation centers offer special programs for the young and teenage girls that are affected from drug alcohol addiction or chemical substance abuse. Drug rehabs prescribe wide ranges of exclusive counseling, therapy and medication programs for drug addicted girls. Girls rehabs centers provide dual diagnosis programs that affect all the areas of life and withdraw all the symptoms of addictions.
Reply | Report Abuse | Link to thishttp://www.drugrehabscenters.com/
Heroin is one of the most harmful drugs. It is found in the form of dark brown powder or tar like substance. People consume it to relieve their tension and depression. The harmful health effects caused by heroin addiction are chronic constipation, decreased kidney function etc. Even discontinuation of this drug is not easy and the withdrawal symptoms include sweating, anxiety, pain in limbs, sleeplessness, bone ache, diarrhea, and fever.
Reply | Report Abuse | Link to thishttp://www.addiction-treatments.com/substance/Heroin/index.html
"As God intended?" Which god is this? Zeus? Thor? One of 116 gods in the Hindu religion? the god that football players pray to so they can obliterate their opponents? I guess this god hates the other team?
Reply | Report Abuse | Link to thisPlease leave cults off a scientific discussion...or did you reach heaven yesterday during the Rapture?
So you like Lyrica because it worked in two patients? and a total of two patients could move away from opioids?
Reply | Report Abuse | Link to thisLet's talk about Lyrica and Savella, the latest wonder drug for fibromyalgia and chronic pain and other syndromes. Every patient we put on Lyrica nearly committed suicide...and five patients reported the same thing with Savella. This was NOT listed as a very serious side effect until we filed many adverse reaction reports to the FDA. So now this side affect is mentioned in TV advertising.
A well known axiom of medicine is "neither be the first or last to prescribe a treatment." Come back when you have researched thousands of legitimate cases...and not after a pharmaceutical rep has given her well rehearsed spiel to you!
Anecdotal medicine is not scientific...leave it out of Scientific American. Besides...what is so terrible about opioids used judiciously and carefully? You make it sound as if we are dooming patients to a life of horrendous drug abuse..not true at all! Opioids are a safe pain medication without the side effects of aspirin, NSAIDS (GI bleeding, GI distress) or acetaminophen (liver failure).