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Effective Treatment, Approaches for, Chronic Fatigue, Fibromyalgia and, Myofascial Pain |
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by Jacob Teitelbaum, M.D.
Effective Treatment,
Approaches for,
Chronic Fatigue,
Fibromyalgia and,
Myofascial Pain
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For years, many of us have dreamt of
the day when we would see the headline:
“Effective Treatment, For Chronic
Fatigue Syndrome, Fibromyalgia
(CFS/FMS) and, Myofascial Pain
Syndrome (MPS), Developed.” We are
very excited to, report that, using an
integrative, medicine approach,
that day has arrived.
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Our study, titled “Effective Treatment
of Chronic Fatigue Syndrome and
Fibromyalgia—the Results of a
Randomized, Double-Blind,
Placebo-Controlled Study” (Journal
of Chronic Fatigue Syndrome—see the
full text at www.vitality101.com),
showed that over 90 percent of patients
improved with treatment (p<. 0001 vs.
placebo). After two years of treatment, the
average improvement in quality of life was 90
percent. Many patients no longer even qualified
for the diagnosis of CFS or fibromyalgia after
treatment. Interestingly, many of the same
principles for treating fibromyalgia also apply
to myofascial pain syndrome.
A new day is dawning in how CFS/
fibromyalgia/MPS is being treated. In support
of our work, an editorial in the Journal of the
American Academy of Pain Management (the
largest multidisciplinary society of pain specialists in United
States) noted that the comprehensive and aggressive metabolic
approach to treatment detailed in the Teitelbaum study are all
highly successful approaches and make fibromyalgia a true
treatment responsive disorder. Our study and years of clinical
experience make this approach an excellent and powerfully
effective part of the standard of practice for treatment of people
who suffer from fibromyalgia and myofascial pain syndrome.
It is important to recognize that these syndromes can be
caused and aggravated by a large number of different triggers.
When all these different contributing factors are looked for, and
treated effectively, patients improve dramatically and often get well.
What is causing these illnesses?
As we noted above, CFS/FMS/MPS is not a single illness. Our study
has shown that it is a mix of many different processes that can be
triggered by many causes. In our experience, CFS/FMS acts as a circuit
breaker, with the hypothalamus decreasing its function to protect
the individual in the face of what is perceived to be an
overwhelming stress (just like a fuse in a house). This stress can be
caused by any of a number of infections or injuries. In these situations,
patients can often give the time that their illness began
almost to the day. In others, the illness had a more gradual onset.
This may have been associated with hormonal deficiencies (e.g.,
low thyroid, estrogen, testosterone, cortisone, etc.) despite normal blood tests. In others, it may be associated with chronic stress, antibiotic use with secondary yeast overgrowth and/or nutritional
deficiencies. Indeed, we have found well over 100 common
causes of and factors that contribute to these syndromes.
What these processes have in common is that most of them
can suppress a major control center in the brain called the
hypothalamus. This center controls sleep, the hormonal
system, temperature and blood flow/blood pressure. When
patients don't sleep deeply, their immune system also stops
working properly and they will be in pain. When we realized
this, the myriad symptoms seen in CFS/fibromyalgia suddenly
made sense. It also gave us a way to treat patients effectively.
Four main categories of problems need to be treated.
A half-century of work by Dr. Janet Travell, the White House
physician for Presidents Kennedy and Johnson and author of
The Trigger Point Manual, showed that the same problems
caused by hypothalamic suppression resulted in muscles getting
stuck in the shortened position. Chronic muscle shortening
then causes myofascial and fibromyalgia pain. Since she
laid the groundwork for effective treatment of these processes,
our research team dedicated our published study to her
memory. These are the four key areas that need to be treated
for the patient's "circuit breaker to turn back on" and for
fatigue and muscle pain to resolve:
- Disordered sleep
Most patients with these illnesses find that they are unable to
get 7.8 hours of deep sleep a night without taking natural
and/or prescription sleep treatments. In part, this occurs
because hypothalamic function is critical to deep sleep.
Unfortunately, many of the most common sleep medications
actually aggravate the sleep problems by decreasing the
amount of time spent in deep sleep.
For patients to get well, for their pain to resolve, and for
their immune system to recover, it is critical that they take
enough of the correct sleep treatments to get 8 to 9 hours
sleep at night. Although medications can help, I prefer to start
with natural therapies. An excellent one is Revitalizing Sleep
Formula by Enzymatic Therapies and includes theanine,
Jamaican dogwood, wild lettuce, valerian, passionflower and
hops. Taken one hour before bedtime, 1.4 capsules help
patients to get eight hours of refreshing sleep.
Other natural sleep aids include taking calcium and magnesium
at bedtime, 5-HTP (100.300 mg), and melatonin (3/10.1 mg).
Our experience with over 2000 patients and two research
studies have shown that getting at least six hours of sleep a
night is critical to people getting well. When one recognizes
that CFS/FMS is a hypothalamic sleep disorder—not poor sleep
hygiene—this approach makes sense.
- Hormonal deficiencies
The hypothalamus is the main control center, via the pituitary,
for most of the glands in the body. Most of the normal ranges
for our blood tests were not developed in the context of hypothalamic
suppression or these syndromes. Because of this
(and for a number of other reasons) it is usually necessary to
treat with natural thyroid, adrenal (e.g. glandulars such as
Adrenal Stress End and DHEA), and ovarian and testicular
hormones—despite normal blood tests. These hormones
have been found to be reasonably safe when used in low doses.
- Unusual infections
Many studies have shown immune system dysfunction in
FMS/CFS. Although there are many causes of this, research suggests
that poor sleep is a major contributor. The immune dysfunction
can result in many unusual infections. These include
viral infections, parasites and other bowel infections and most
importantly, fungal infections.
- Nutritional supplementation
Because the western diet has been highly processed, nutritional
deficiencies are a common problem. In addition, bowel
infections can cause poor absorption, and the illness itself can
cause increased nutritional needs. A few of the most important
nutrients include: a) vitamins—especially the B vitamins
(most at 25.100 mg/day), vitamin B12 (500.3000 mcg/day),
antioxidants (e.g., vitamin C and E); b) minerals—especially
magnesium glycinate, zinc and selenium; c) amino acids and
d) energizing and calming nutrients (e.g., malic acid and inositol).
The Energy Revitalization System by Enzymatic Therapy
replaces over 35 supplement tablets with one drink. Most
Americans would find this product to be excellent for maintaining
health and energy.
There are many other treatments available as well. Although
space does not allow for a full discussion of these in this
article, I discuss them at length in my book From Fatigued to
Fantastic! They can also be seen at my Web site (www.endfatigue.com), which contains a treatment protocol with over 270
effective therapies and detailed instructions for use.
Treatments are broken down by category (e.g., sleep, yeast
treatments, pain, etc.) with natural alternatives offered for all
prescriptions.
So how do I make pain go away?
Pain is now very responsive to treatment. Pain is the red,
flashing, warning light on your dashboard telling you that
something urgently needs attention. Unfortunately, in medical
school the full extent of most M.D.'s education about pain
management was to give Tylenol or Motrin family medications
and, if the patient had cancer, to consider narcotics.
Our next article will teach you how to figure out what pain is
telling you your body needs so you can both reclaim health and
vitality and have your pain go away. How to get pain free now is
discussed in my new book Pain Free 1-2-3! A Proven Program to
Get YOU Pain Free Now.
One last note. It is not enough to get well so you can go back
to a life you hate. My book, Three Steps to Happiness! Healing
Through Joy, can teach you how to get a life you love in three
easy steps.
Dr. Teitelbaum is medical director of the Annapolis Center for
Effective CFS/Fibromyalgia Therapies in Annapolis, Maryland
(410-573-5389) and author of the best-selling books From
Fatigued to Fantastic!, Three Steps to Happiness! Healing
Through Joy and Pain Free 1-2-3- A Proven Program to Get YOU
Pain Free! Available at bookstores and on the Web at
www.vitality101.com or www.endfatigue.com.
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