Effects of the drug pyridostigmine along with exercise in treatment of fibromyalgia
A subset of fibromyalgia patients are known to have a dysfunctional hypothalamic-pituitary-insulin-like growth factor 1 (IGF-1) axis, which is diagnosed by low blood serum levels of IGF-1 and a reduced growth hormone (GH) response to physiologic stimuli. There is evidence that the drug pyridostigmine (PYD) can improve the acute response of growth hormone to exercise in fibromyalgia patients. Researchers at Oregon Health & Science University in Portland, OR, conducted a 6-month randomized controlled trial of pyridostigmine in conjunction with exercise, in order to evaluate the effectiveness of this treatment on fibromyalgia treatment. The purpose of this study was to evaluate the clinical effectiveness of 6 months of PYD and group exercise on [fibromyalgia] symptoms. The researchers randomized patients into one of four groups: PYD PYD plus exercise, PYD without exercise but with diet recall, placebo plus exercise, and placebo plus diet recall but no exercise. To assess the results of the treatments, they used the visual analog scale (VAS) score for pain, tender point count, and total myalgic score. They also used other secondary outcome measures including the Fibromyalgia Impact Questionnaire (FIQ) and scores for individual symptoms (fatigue, poor sleep, stiffness, and anxiety), as well as quality of life (QOL) evluation and level of physical fitness (lower body strength/endurance, upper and lower body flexibility, balance, and time on the treadmill).A total of 165 [fibromyalgia] patients completed baseline measurements; 154 (93.3%) completed the study. The combination of PYD and exercise did not improve pain scores. PYD groups showed a significant improvement in sleep and anxiety in those who completed the study and in QOL in those who complied with the therapeutic regimen as compared with the placebo groups. Compared with the nonexercise groups, the 2 exercise groups demonstrated improvement in fatigue and fitness. PYD was generally well tolerated.The research team concluded that “neither the combination of PYD plus supervised exercise nor either treatment alone yielded improvement in most fibromyalgia symptoms.” However, they noted that pyridostigmine (PYD) did improve anxiety and sleep, and exercise improved fatigue and fitness. They speculate that pyridostigmine (PYD) “may have improved vagal tone, thus benefiting sleep and anxiety; this notion warrants further study.” (Source: The Fibromyalgia Research Blog)
Pet scans show multidisciplinary treatment may alleviate neurological malfunctioning in fibromyalgia
The results of a pilot study published in Rheumatology International (July 20, 2007) show that clinical improvement in fibromyalgia can occur when a multi-disciplinary treatment program is able to increase a fibromyalgia patient’s limbic metabolism. According to researchers at Washington Hospital Center, Washington, DC, this indicates that there is limbic system involvement in fibromyalgia syndrome.Aberrant central neurological functioning is believed to contribute to the abnormal sensations of fibromyalgia (FM). This pilot study sought to determine if alterations in regional brain metabolism from baseline occur in FM after undergoing a multidisciplinary therapeutic regimen. Regional brain metabolic activity was estimated using (18)F-fluorodeoxyglucose positron emission tomography ((18)FDG PET). Nine participants with FM received an 8-week comprehensive treatment program. Serial testing with (18)FDG PET and the Fibromyalgia Impact Questionnaire were performed. Statistical analysis was performed using repeated Wilcoxon signed rank tests. A clinical improvement (FIQ median change 20.68, P = 0.005) was noted with treatment. With treatment, increases in brain metabolism were noted in various components of the limbic system (P = 0.004-0.1). An increase in limbic metabolism was noted with concomitant symptomatic improvement, suggesting that the limbic system attenuates FM symptoms. (Source: The Fibromyalgia Research Blog)
Women need more love, less drugs
There seems to be a proliferation of “real” diseases that “primarily affect middle-aged women.” That, for example, is how fibromyalgia is described (see “Drug Approved. Is Disease Real?”). The “real” adjective figures prominently in Pfizer’s TV ad for Lyrica, which was recently approved by the FDA for the treatment of fibromyalgia (see “Living with Fibromyalgia, First Drug Approved”).You’ve probably seen the commercial — if not, you can find it on the official Lyrica product site here.On the left/above is a frame from that video showing a woman in distress after reading from her diary about the pain she suffered “all over.” (God, look at the signs of distress in her face and neck!)She also took the time to write in her diary “But until June 2007 there were no medicines approved by the FDA to manage fibromyalgia.” I notice she used the word “manage” instead of “cure” or even “treat.” If she used anything else than the FDA approved language, I am sure she would have gotten a letter from the FDA. Damn that FDA! Haven’t they heard about the “free speech” rights of patients?But I digress, as usual.It’s not just this woman who I see suffering in TV drug ads. There’s that poor woman suffering from pain caused by depression in the Cymbalta TV ad and the woman who suffers from the “needles and pins” pain of restless leg syndrome (RLS).As I think more about these women, I’m beginning to believe they suffer more from lack of love than a “real” medical condition. Take that woman suffering from RLS … please (bada boom). At first I thought she was blaming it all on her poor husband over whom she threw the bed sheet in disgust. But then I noticed that he was sleeping with his back to her. Wouldn’t she feel better if they slept like spoons in a drawer — you know, in a loving embrace?I notice that other women in some drug ads are very happy and pain-free, especially the ones in the Cialis and Levitra ads (surprisingly, women are missing in the recent Viagra ads — see “Viva Viagra Ad is No Cure for Morte Sales”). And don’t forget that woman in the Amitiza ad (see “Amitiza DTC Ads Won’t Win Any Awards, But…”). She obviously has a loving relationship with her husband and looks VERY happy. Of course, she’s just “dropped the boys off at the pool,” but we don’t see her blame her husband who obviously stays at home while she goes off to work. Maybe that’s the key to a great marriage?Of course, the happiest women of all are the ones in the Botox reminder ads! They “remind” me of The Real Housewives of Orange County. They are beyond love and sex with their husbands and have the money to sublimate their desires through cosmetics, shopping, and eating lunch out every day.I think women like the fibromyalgia sufferer could benefit from more love, not drugs. But then, I’m a product of the “make love, not war” sixties, which makes me biased (although some of us did use “drugs” back then — but NOT me. Kids, in case you’re reading this, get back to your books!).P.S. I am ready to be pilloried in your comments! (Source: Pharma Marketing Blog)
Gabapentin an effective treatment for fibromyalgia
New research shows that the anticonvulsant medication gabapentin (Neurontin®), which is used for certain types of seizures, can be an effective treatment for the pain and other symptoms associated with the common, often hard-to-treat chronic pain disorder, fibromyalgia. In a randomized, double-blind clinical trial of 150 women (90 percent) and men with the condition, Lesley M. Arnold, M.D., director of the Women’s Health Research Program at the University of Cincinnati College of Medicine, and colleagues found that those taking gabapentin at dosages of 1,200 to 2,400 mg daily for 12 weeks displayed significantly less pain than those taking placebo. Patients taking gabapentin also reported significantly better sleep and less fatigue. For the majority of participants, the drug was well tolerated. The most common side effects included dizziness and sedation, which were mild to moderate in severity in most cases. Fibromyalgia is a chronic disorder characterized by chronic, widespread muscle pain and tenderness, and is frequently accompanied by fatigue, insomnia, depression, and anxiety. It affects three million to six million Americans, mostly women, and can be disabling. The precise cause of fibromyalgia in not known, but research suggests it is related to a problem with the central nervous system’s processing of pain. As with some other chronic pain conditions, people with fibromyalgia often develop a heightened response to stimuli, experiencing pain that would not cause problems in other people. Yet, unlike many other pain syndromes, there is no physical evidence of inflammation or central nervous system damage. Although gabapentin has little, if any, effect on acute pain, it has shown a robust effect on pain caused by a heightened response to stimuli related to inflammation or nerve injury in animal models of chronic pain syndromes. Researchers have suspected that it might have the same effect in people with fibromyalgia. The new research, published in the April 2007 edition of Arthritis & Rheumatism, indicates the suspicions were correct. Although the researchers cannot say with certainty how gabapentin helps reduce pain, Dr. Arnold says one possible explanation involves the binding of gabapentin to a specific subunit of voltage-gated calcium channels on neurons. “This binding reduces calcium flow into the nerve cell, which reduces the release of some signaling molecules involved in pain processing,” she says. How gabapentin improves sleep and other symptoms is less clear, and there are probably different mechanisms involved in fibromyalgia symptoms. “Gabapentin improved sleep, which is an added benefit to patients with fibromyalgia who often report unrefreshing or disrupted sleep,” Dr. Arnold says. What is important is that people with fibromyalgia now have a potential new treatment option for a condition with few effective treatments. “Studies like this give clinicians evidence-based information to guide their treatment of patients,” says Dr. Arnold. Commenting on the study National Institute of Arthritis and Musculoskeletal and Skin Diseases Director Stephen I. Katz. M.D., Ph.D., said “While gabapentin does not have Food and Drug Administration approval for fibromyalgia, I believe this study offers additional insight to physicians considering the drug for their fibromyalgia patients. Fibromyalgia is a debilitating condition for which current treatments are only modestly effective, so a study such as this is potentially good news for people with this common, painful condition.” The study was supported by the National Institutes of Health’s National Institute of Arthritis and Musculoskeletal and Skin Diseases. Arnold LM, Goldenberg DL, Stanford SB, Lalonde JK, et al. Gabapentin in the treatment of fibromyalgia: A randomized, double-blind, placebo-controlled, multicenter trial Arthritis Rheum. 2007;56(4):1336-44. [Abstract] (Source: Latest entries from www.anxietyinsights.info)
Headache Specialist Recommends Over-the-Counter Supplements to Prevent Migraines
Over-the-counter (OTC) supplements use in headaches, migraines, and fibromyalgia can be controversial, especially since they are not rigorously tested like prescription drugs. Nevertheless, there is a good deal of science behind some OTC supplements. I have my favorites that I like to recommend, and