Download Dr. Rodger Murphree

Treating and
Beating
Fibromyalgia and
Chronic Fatigue
Syndrome
Dr. Rodger Murphree
What Is FMS?
Fibromyalgia (FMS) is an illness
characterized by diffuse muscle pain, poor
sleep, and unrelenting fatigue. Leading
FMS researchers estimate that between 2%
and 4% of the general population suffer
from the syndrome. Ninety percent of those
diagnosed with FMS are women.
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Defining FMS
In 1990 The American College of Rheumatology first proposed the current criteria for
defining FMS. The diagnosis requires that all three of the major criteria and four or
more of the minor criteria be present:
Major Criteria:
1.
2.
3.
Generalized aches or stiffness of at least three anatomical sites for at least three months
Six or more typical, reproducible tender points
Exclusion of other disorders that can cause similar symptoms
Minor Criteria:
1.
2.
3.
4.
5.
6.
7.
8.
Generalized fatigue
Chronic headache
Sleep disturbance
Neurological and psychological complaints
Numbing or tingling sensations
Irritable bowel syndrome
Variation of symptoms in relation to activity, stress, and weather changes
Depression
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Other Symptoms
Other symptoms associated with FMS include:
1. Cognitive disorders- including "fibro fog,” memory lapses, difficulty
concentrating, and poor memory.
2. Depression.
3. Irritable Bowel Syndrome - swinging back and forth from diarrhea to
constipation.
4. Chemical sensitivities- odors, cosmetics, detergents, dyes, and additives.
5. Allergies.
6. Chronic infections – sinusitis, UTI’s, URI’s, sore throat, and lymph nodes.
7. Headaches - including TMJ and neck pain.
8. Disequilibrium- dizziness and balance problems may also be present when
standing.
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Mentally ill?
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Traditional Medicine Alone Often Fails:
From the American College of Rheumatology website on the tricyclic
medication Amitriptyline (Elavil)
Four controlled trials have evaluated the efficacy
of Amitriptyline in fibromyalgia… the longest-term
trial showed no benefit when compared with
placebo.
Furthermore, the overall degree of benefit appears
to be relatively small in relevant outcomes such as
improvement in pain, fatigue, and sleep.
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“Anti-inflammatory agents should be
generally avoided”
Furthermore, use of antianxiety
medications (Klonopin, Xanax, etc),
Benzodiazepines, corticosteroids, and
nonsteroidal anti-inflammatory agents
have been shown to be ineffective and
should be generally avoided.
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“Drug therapies are ineffective
over 15 year span”
Drug therapies are ineffective over 15 year span,
and our best therapies Amitriptyline (Elavil) and
Cyclobenzaprine (Flexeril), could not be
distinguished from placebo after 3 months of
therapy. Long term, follow-up observations
indicated that clinical findings for patients with
FMS did not change appreciably after 15 years.
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Believed to be causes of FMS and CFS
•
•
•
•
•
•
•
Trauma
Emotional/physical/mental stress
Yeast overgrowth
Chemical sensitivity
Allergies
Liver dysfunction
Leaky gut syndrome
• Low thyroid function
• Nutritional deficiencies
• Deficient serotonin
• Adrenal dysfunction
• Chronic viral/bacterial infections
• Endocrine disorders
• Autonomic disorders
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I Believe Stress and Chronic
HPA Dysfunction Cause
Fibromyalgia
Several studies have emonstrated how
chronic stress undermines the normal
hypothalamic-pituitary-adrenal axis (HPAAxis)
Stress is the underlying catalyst for the
onset of HPA axis (HPA) Dysfunction.
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Fibromyalgia Patients Have
Have Stressed out Their HPA-axis
The Fibromyalgia Network Reports
62% of Patients Say Emotional or
physical Stress Preceded Their
Symptoms
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Self Regulating Chart
Sex
Hormones
Thyroid
Hormone
Digestion
Blood
Pressure
Immune
System
Brain
Chemicals
Hypothalamus
Self-Regulating
Robot
Monitors, Coordinates,
and runs most systems
of the body
Stress-Coping
Abilities
Respiratory
System
Pain
Inflammation
Adrenal
Hormones
Sleep/Wake
Cycle
The Hypothalamus Regulates
These Functions
1. Blood pressure
2. Digestion
3. Skin temperature
4. Circadian rhythms
(sleep/wake cycle)
5. Hunger
6. Sex drive
7. Body temperature
8. Balance and coordination
9. Heart rate
10. Blood volume
11. Sweating
12. Blood vessel constriction
13. Adrenal hormones
14. Thyroid hormones
15. Metabolism
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A Vicious Cycle
•
•
•
•
Chronic stress disrupts HPA homeostasis/allodynia
Chronic pain disrupts sleep/wake cycle
This causes poor sleep
Poor sleep - fatigue, increased sensitivity to pain,
increased inflammation, suppressed immune function,
and lowers metabolism.
• Chronic poor sleep further depletes serotonin- IBS, more
pain, low moods, and Fibro fog
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Restoring Normal Autonomic/Hypothalamus
Function Is key to beating FMS and CFS
1.
Restoring/Boosting the essential
neurotransmitters serotonin and
norepinephrine.
2.
Restoring hormonal imbalances,
especially melatonin, cortisol, DHEA,
and thyroid. Estrogen, progesterone
and testosterone may also be low.
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Poor Sleep Leads to:
1. An increase in substance P, leading to an increase of pain.
2. A decrease in growth hormone production, leading to poor
repair of damaged muscle fibers.
3. Altered thyroid function
4. A decrease In energy production, leading to greater
fatigue.”
Research also shows that sleep deprivation markedly
increased inflammatory cytokines (pain causing
chemicals)—by a whopping 40%.
Presented at the Endocrine Society in San Francisco, by Vgontzas in June 2002
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Poor sleep has been linked to various health
problems including depression, fatigue, CFS,
FMS, and headaches.
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Substance P & Serotonin
Substance P is a chemical known as a
neurotransmitter. Substance P increases and
enhances pain receptors. Substance P is
normally kept in check by the neurotransmitter
serotonin. Unfortunately, FMS patients have
little if any serotonin to spare.
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Sleep Medications that do
Promote Restorative Sleep
9
9
9
9
9
Ambien
Elavil
Flexeril
Trazadone
Lunesta
These medications do promote deep restorative sleep.
However, they have potential side effects and usually start
to lose their effectiveness over time.
One of the potential side effects of Ambien is flu-like
symptoms, achy muscles, fatigue and “brain fog.”
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Potential Side-Effects of…
Trazadone
Flexeril
Elavil
Lunesta
Fatigue
Depression
Fibro Fog
Anxiety
Drowsiness
Fatigue
Weight-gain
Dizziness
Tics
Hang over
Hang over
Fatigue
Parkinson like
Fibro Fog
Fatigue
Hang over
Stroke
Upset Stomach
symptoms
Muscle stiffness
Hallucinations
Fibro Fog
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Other Sleep Medications
Benzodiazepines
Xanax, Restoril, Ativan, Valium, Tranxene, Klonopin
These medications don’t promote deep restorative
sleep and are associated with numerous side effects.
Such as: Depression, Fatigue, Fibro Fog,
Dependence, Tardive Dyskinesia, Insomnia.
These medications block the
sleep inducing hormone, melatonin.
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Benzodiazepines are addictive (within 2
weeks) and can cause a host of unwanted
side effects. Poor sleep, seizures, mania,
depression, suicide, ringing in the ears,
amnesia, dizziness, anxiety, disorientation,
low blood pressure...
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Nausea, fluid retention, tremors, sexual
dysfunction (decreased desire and
performance), weakness, somnolence
(prolonged drowsiness or a trance-like
condition that may continue for a number
of days), and headaches.
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Forty percent of those age 60 or older who
take tranquilizers, will experience tardive
dyskinesia For many, these tremors are
permanent.
These drugs deplete CoQ10 and melatonin
levels.
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CoQ10 Deficiency
A CoQ10 Deficiency can
lead to Depression
Fibro Fog/Confusion
As well as muscle
weakness and pain
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Stress
Stress is Responsible for 80-90%
of all Illnesses and Poor Health.
Chronic Stress is the Catalyst for
Poor Health
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Stress-Coping
Savings Account
Serotonin
Dopamine
Cortisol
DHEA
Human Growth
Hormone
Norepinephrine
GABA
Vitamins
Minerals
Antioxidants
Serotonin
We Are all born with a
Stress-Coping savings account
WITHDRAWALS
Traffic James
Poor Sleep
Pollution
Long Work Hours
Unhappy at Job
Mental Problems
Money Problems
Every moment of the day, we are making withdrawals
from our Stress-Coping Savings Account
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Stress Coping Account
Is Your Account Bankrupt?
If you make more
withdrawals than
deposits you bankrupt
your account
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Stress-Coping
Savings Account
X X
X
X XX
X
X X
X
XX X
X
X XX
X XX X
Serotonin
We make deposits into our
stress-coping savings account
by going into deep sleep
Deep Restorative Sleep
Delta Wave
Deposits
Deep Restorative Sleep Is The Key to
Rebuilding Our Stress-Coping
Savings Account
Stress-Coping
Savings Account
S S
S S
S
S
S
S SS
SS S
S
S S
S
SSS S
Serotonin
SEROTONIN
DEEP SLEEP
Deposits
SEROTONIN
• Less Pain - Blocks Substance Associated
with Increasing Pain (substance P)
Hormone - Boosts Mood
• Happy
Reduces anxiety
• Increases Mental Clarity
• Restores Normal Bowel Function - IBS
The Importance of Serotonin
Serotonin is a neurotransmitter or brain
chemical. It helps regulate sleep, digestion, pain,
mood, and mental clarity. Normal serotonin
levels help:
1. Raise the pain threshold (have less pain).
2. You to fall asleep and stay asleep through the night.
3. Regulate moods. “It’s the happy hormone.”
4. Reduce anxiety.
5. Reduce sugar cravings and over-eating.
6. Increase a person’s mental abilities.
7. Regulate normal gut motility (transportation of foodstuff) and irritable bowel syndrome (IBS).
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Serotonin Receptors
You have more serotonin receptors
in your intestinal tract than you do in your
brain. Low serotonin interferes with proper
intestinal function.
Symptoms associated with IBS, diarrhea, and
constipation, usually disappear within 1-2 weeks once
serotonin levels are normalized.
Goldberg et al. Modification of visceral sensitivity and pain in irritable bowel syndrome by 5HT3 antagonism (odansetm). Digestion 1996. Nov-Dec; 57(6): 478–83.
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SSRI and SSNRI Medications
Individuals with FMS are often prescribed a
selective serotonin re-uptake inhibitor (SSRI) or
selective serotonin and norepinephrine re-uptake
inhibitor (SSNRI).
Lexapro
Cymbalta
Celexa
Paxil
Prozac
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Zoloft
Effexor
Antidepressant Drugs
Have Potential and
Common Side effects...
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anxiety, depression, headache, muscle
pain, chest pain, nervousness,
sleeplessness, drowsiness, weakness,
changes in sex drive, tremors, dry
mouth, irritated stomach, loss of
appetite, dizziness...
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Nausea, rash, itching, weight gain, diarrhea,
impotence, hair loss, dry skin, chest pain,
bronchitis, abnormal heart beat, twitching,
anemia, low blood sugar, and low thyroid.
• Deplete melatonin levels.
• Tricyclic antidepressants deplete CoQ10.
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Selective Serotonin Re-uptake
Inhibitor (SSRI) Medications:
In almost half of the studies show that
up to 70% of those taking SSRI
antidepressant medications do just as
well by taking a placebo or sugar pill.
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Individuals on SSRI drugs
increased their Hamilton Rating
Scale 2 points compared to those
on placebo.
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Sleep disturbances, either insomnia or somnolence,
have been reported in about 25% of patients taking
serotonin reuptake inhibitors.
THIS OFTEN LEADS TO MORE DRUGS TO
TREAT THE ANTIDPRESSANT SIDE EFFECTS.
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Down-Regulation
The Longer You’re on SSRI Meds,
The more likely you are to deplete
your serotonin receptors.
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SSRI’s
Prozac
Celexa
Zoloft
Paxil
Lexapro
SSRI’s are like gasoline additives that help
you get more “milage” from the serotonin
being released into the brain.
S SS
SS
N S
S
S SN S
N SS S
N
Normal Brain
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S
S
S
S
S
N
N
Gasoline Additive
When your brain is running on “FUMES” …
a gasoline additive won’t help
Most individuals with Mood Disorders don’t have
any Serotonin or Norepinephrine to re-uptake!
S SS
SS
N S
S
N
S
S
S
N SS S
N
Normal Brain
S
S
N
Fibro Brain
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5HTP
SEROTONIN
5HTP
5-Hydroxy
Tryptophan +
Vitamins B6,
B3 and
Magnesium
= SEROTONIN
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5HTP increases your natural sleep
hormone melatonin by 200%
This in turn promotes deep
restorative sleep
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Stress
Stress Coping Glands
Most of my patients have not only
bankrupted their stress coping
savings account but have also
exhausted their stress coping glands,
the adrenal glands.
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Stress
General Adaptation Syndrome
The general adaptation
syndrome (GAS) is divided
into 3 phases.
• Fight or Flight
• Resistance Reaction
• Adrenal Exhaustion
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The General Adaptation Syndrome
Divided into 3 phases
Fight or Flight
The first phase is known as the "fight or flight response.”
This response is an alarm reaction.
The fight or flight response encourages the body to go
on red alert and be ready for physical and mental activity.
The heart beats faster to provide blood to the muscles
and brain. The breath rate increases to supply extra
oxygen to the muscles, heart and brain. Digestion and
other functions not essential for maintaining the alarm
reaction are halted.
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Stress
Stress and Nutritional Deficiencies
Low Thyroid Function
Stress, depression, anxiety and fatigue are all
associated with low thyroid function.
Thyroid hormones help regulate concentration,
mental clarity, moods, and proper brain chemistry.
T3 therapy is more effective in reducing the
symptoms associated with depression than SSRI
antidepressants.
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Adrenal Burn Out
The majority of patients I see for chronic illnesses,
including FMS and CFS , are suffering from adrenal
exhaustion. They have literally burned their stress
monitoring organ out. Between years of poor sleep,
unrelenting fatigue, chronic pain, excessive
stimulants, poor diet, and relying on a plethora of
prescription medications, the adrenal glands and the
hormones they release have been used up.
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Corticosteroids
Cortisol is secreted by the adrenal glands that rest above each
kidney. The adrenal gland is divided into the outer cortex and the
smaller inner medulla. The cortex produces cortisol and
dehydroepiandrosterone (DHEA).
Cortisol helps increase cellular energy, mental clarity,
immune function, and acts as a potent anti-inflammatory.
DHEA helps increase mental clarity, well-being, stress
coping abilities, immune function, and libido.
Cortisol and DHEA help a person have more resistance to stress.Individuals with FMS have
been shown to have a deficiency of cortisol. Brain Behav. Immun. 2004 Jul; 18(4):314-25.
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Adrenal Cortical
Glandular Extracts
Those taking over-the-counter
adrenal cortical glandular
supplements usually repair their
adrenal glands within 6 months.
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Medical Myth
Vitamin and Mineral Supplements Aren’t Helpful for
Treating Disease
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The Importance of
Vitamins and Minerals
In a cross-sectional study of
150 consecutive patients
referred to a clinic in
Minnesota for the evaluation
of persistent, nonspecific
musculoskeletal pain, 93%
had serum levels indicative of
vitamin-D deficiency.
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Vitamin and Mineral
Supplements
B-vitamins play a crucial role in the
production of neurotransmitters. A
deficiency in any of the B-vitamins
will increase the risk of mood
disorders.
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Vitamin and Mineral
Supplements
The standard American diet (even if you eat fruits and
vegetables every day) is overloaded with toxic artificial
chemicals. Modern processing methods remove 25-75% of
the original nutrients.
A U.S. Food and Drug Administration study, which analyzed over 234
foods over 2 years, found the average American diet to have less than
80% of the RDA of one or more of the following; calcium, magnesium,
iron, zinc, copper, and manganese.
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S- Adenosyl-methionine (SAMe)
SAMe IS one of the best natural antidepressants
available. SAMe helps boost serotonin and
epinephrine levels. Combining SAMe with
prescription antidepressants reduces the failure rate
by 43%. There are over 100 peer-reviewed studies
showing that SAMe is a safe and effective
antidepressant.
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Essential Fatty Acid Imbalances
Research shows that low blood levels of
omega 3 essential fatty acids are
associated with depression. Restoring
proper omega 6 to omega 3 ratio’s is
important in optimizing neurotransmitter
function.
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Studies show that Folic acid is more effective than standard
prescription antidepressants.
92% of those treated with folic acid made a full recovery,
while only 70% of the control group (those taking
antidepressants) made a full recovery.
Studies that combining folic acid with a SSRI (Prozac) was
more effective than taking the prescription drug alone.
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Vitamin and Mineral
Supplements
Other studies have demonstrated
magnesium deficiency in well over
50% of the population.
A magnesium deficiency can
contribute to arteriolosclerosis,
fatigue, tight muscles, leg cramps,
insomnia, constipation, cardiac
arrhythmia, and heart disease.
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Loss of Optimal Health
Dr. Janet Travell, White House physician for Presidents John F.
Kennedy and Lyndon B. Johnson, and Professor Emeritus of
Internal Medicine at George Washington University co-wrote
Myofascial Pain and Dysfunction The Trigger Point Manual, which
is acknowledged as the authoritative work on muscle pain.
In one chapter alone, Dr. Travell and co-author, Dr. David Simons,
referenced 317 studies showing that problems such as hormonal,
vitamin, and mineral deficiencies can contribute to muscle pain and
soreness.
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Fatigue and Immune Function
*In a Scottish trial, patients with chronic fatigue syndrome were
given EFA supplements with great success. Placebo
controlled trials were held for 70 patients with persistent CFS
giving them linolenic acid (flax seed oil) and eicosapentaenoic
acid (fish oil). After 6 months, 84% of the patients in the group
receiving EFA supplements, and only 22% of those in the
placebo group rated themselves as better or much better.
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Fatigue and Immune Function
*In another successful study, 63 adults with CFS were
enrolled in a double blind placebo controlled study with
essential fatty acid therapy. The patient’s were ill for an
average of 1-3 years after a viral infection. They all suffered
from severe fatigue, myalgia (muscle pain), and a variety of
psychological symptoms. After one month, 74% of the
patients taking EFA supplements, and 23% of those on
placebo, assessed themselves as improved.
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Digestive Disorders
A majority of patients suffering from FMS
will also have one or more digestive
disorders.
Bloating, gas, indigestion, IBS, spastic
colon, reflux, malabsorption, etc.
Chaitow, L. “Fibromyalgia Workshop News 2000.
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Abnormal Thyroid Function
The symptoms of FMS and CFS are consistent with those
associated with low thyroid function; low body temperature,
cold hands and feet, tingling in the extremities, fatigue, and
depressed mental acuity.
Recent studies show that over 43% of individuals with FMS
have low thyroid function. It's estimated that those with
FMS are 10 to 250,000 times more likely to suffer from
thyroid dysfunction.
(Lowe, et al., 1997, pp. 31-58).
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Thyroid Blood Tests May Not
Be Accurate
Dr. Broda Barnes was the first to show that a low basal
body temperature was associated with low thyroid.
His first study was published in 1942 and appeared in
The Journal of the American Medical Association.
This study tracked 1,000 college students and showed
that monitoring body temperature for thyroid function was
a valid, if not superior, approach to other thyroid tests.
(Barnes, 1976).
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