You’re Not Crazy, Lazy, or Depressed.
It’s Called Fibromyalgia!
Contrary to what some doctors may have told you, you’re not crazy, lazy, or suffering from an antidepressant drug deficiency. I know how frustrating it is to continue to look for answers from doctors who don’t understand what you’re going through. These are the same doctors who tell you to get more sleep (right!), take it easy, get more rest, exercise more, and eat better. Or they send you off to a psychiatrist for more antidepressant medications. This clearly shows that most doctors don’t get it.
"I’ve found that most fibromyalgia and CFS patients know more about the illness than their doctors."
"After specializing in treating and beating fibromyalgia for the last 11 years, I truly understand your frustration. But please know: you can feel better; you can get your life back."
Please read on.
I recently had the opportunity to be interviewed for an upcoming doctor's forum on fibromyalgia. I thought this interview would make a great newsletter. So, here it is. I hope you find it helpful.
Tom McCracken, interviewer (INT): Dr. Murphree, I enjoyed hearing you speak at last year’s conference. I have really enjoyed reading your books, as well. I guess the first question is: Can you explain why there is such a disparity in the way doctors treat fibromyalgia?
Dr. Murphree (DR. M): “Thank you. It takes an average of seven years and 12 different doctors before a person is properly diagnosed with fibromyalgia. Patients are often passed from specialist to specialist in an attempt to rule out autoimmune disorders (rheumatoid, lupus, etc.), neurological disorders (multiple sclerosis), hormonal disorders (thyroid, adrenal, estrogen, progesterone, testosterone, etc.), musculoskeletal disorders (herniated disc, osteoarthritis, etc.), and of course, psychological disorders. Sadly, many patients are told that they are simply depressed. And, unfortunately, each specialist attempts to diagnose the patient and prescribe them with the medications that they feel will help reduce their symptoms. A neurologist may prescribe Neurontin, an orthopedic doctor prescribes a non-steroidal anti-inflammatory, the psychiatrist recommends an antidepressant, and so on. Eventually, the patient is on several medications from several doctors, all attempting to treat the multitude of symptoms associated with fibromyalgia.
INT: So there’s no consensus on how to treat fibromyalgia?
DR. M: Well, there are various protocols, but none that are widely agreed upon. Instead, doctors typically treat the various symptoms of fibromyalgia with the latest fad drug. Lyrica seems to be the "latest and greatest" drug of choice. But, past history should temper our rush to proclaim a drug as a breakthrough for treating fibromyalgia. The traditional medical approach (drug therapy alone) hasn’t yielded much success. Each new popular drug has eventually proven to be ineffective in long-term management of fibromyalgia symptoms.
INT: Are you saying that drug therapy isn’t effective for fibromyalgia?
DR. M: We should consider the following statements from The American College of Rheumatology: On tricyclic medications Amitriptyline (Elavil): Four controlled trials have evaluated the efficacy of Amitriptyline in fibromyalgia… the longest trial showed no benefit when compared to placebo. Furthermore, use of the anti-anxiety medications Benzodiazepines, (Klonopin, Xanax, Ativan, etc.), corticosteroids, (medrol dose packs, prednisone, etc.), and nonsteroidal anti-inflammatory agents, (Mobic, Celebrex, Vioxx, Bextra, etc.), and pain medications have been shown to be ineffective and should be generally avoided.
INT: What’s left? So, you don’t recommend that patients take prescription drugs?
DR. M: No, I wouldn’t say that. Medications can be very helpful but, MEDICATIONS DON’T CORRECT THE PROBLEMS, THEY ONLY REDUCE THE SYMPTOMS. And, sometimes the side effects from the drugs are worse than the original symptoms. Doctors who’ve had lasting success with fibromyalgia, including myself and the doctors I employed, found that correcting the underlying cause(s) of fibromyalgia with the chemicals (nutrients) the body needs yields long-term benefits. Correcting the problem(s) is always preferred over simply chasing symptoms. Drug therapy alone only temporarily reduces symptoms and oftentimes creates further health problems. The number-one side effect of Ambien is flu-like symptoms: muscle aches, fatigue, and joint pain. Klonopin is associated with depression, fatigue, and “brain fog,” is extremely addictive, and depletes the natural sleep hormone melatonin. By the way, no one has a Cymbalta deficiency (latest drug du jour). However, they very well COULD have low serotonin and norepinephrine levels. Both of these neurotransmitters (brain chemicals) are made from amino acids, (5HTP, L-Phenylalanine and or SAMe), and the vitamins and minerals that act as co-factors. These all-natural nutrients are what the body uses to make the chemicals it needs to maintain, coordinate, and self-regulate optimal health.”
INT: So a doctor should avoid using prescription drugs and instead recommend amino acids, vitamins, minerals, and other nutrients?
DR. M: Prescription drugs can be very useful in reducing symptoms. If a person has excruciating pain from a herniated disc, then a Medrol (steroid) dose pack and Loritab are needed to give the patient the relief they need and deserve. And knowing how important deep, restorative sleep is, if someone can’t sleep by using 5HTP, melatonin, or other natural means, then by all means, they should be placed on a sleep medication that promotes deep, restorative sleep. However, most doctors start patients on drug therapy first, neglecting the cause, and merely attempting to cover up the symptoms.
INT: So, you do believe prescription drugs can be helpful?
DR. M: Yes, when used judiciously, they can be very helpful. However, once again, no one has a sleep-drug deficiency. The question should be: Why can’t they fall asleep on their own each night? Perhaps, it's from pain or low melatonin (sleep hormone) levels, or from medications they are taking. Some drugs – including SSRI (selective serotonin re-uptake inhibitors) like Celexa, Lexapro, Cymbalta, Effexor, Prozac, Paxil, etc., and tranquilizers including Klonopin, Ativan, Xanax, etc. – decrease and eventually deplete the natural sleep-promoting hormone, melatonin. It makes more sense to use the body’s own natural chemicals needed to promote deep sleep. This includes the amino acid 5-hydroxytryptophan (5HTP), which turns into serotonin, boosts melatonin levels, helps promote deep, restorative sleep, reduces pain, boost moods, reduces anxiety, gives you more mental clarity, and reduces or eliminates irritable bowel syndrome.
INT: What about the chronic pain associated with fibromyalgia? How do you treat this condition?
DR. M: Chronic, sometimes disabling, pain is by far the biggest complaint of those with fibromyalgia. Typically, someone with fibromyalgia will have diffuse muscle pain that may, or may not, respond to traditional medical therapies. While these drugs may offer relief for some who take them, they have potential side effects and quite often don’t help reduce fibromyalgia pain long term. A person taking NSAIDS (Celebex, Mobic, Alleve, Advil, Naproxen, etc.) is seven times more likely to be hospitalized for gastrointestinal adverse effects. The FDA estimates that 200,000 cases of gastric bleeding occur annually, and that this leads to 10,000 to 20,000 deaths each year. Pain medications, including narcotic drugs, can be very helpful in relieving acute and chronic pain. Unfortunately, pain medications eventually lose their effectiveness, have potential side effects, and may cause dependence.
The nerve-pain blocking drugs, or GABA inhibitors such as Gabitril (tiagabine) and Neurontin (gabapentin), are anticonvulsant medications originally used to control seizures. They’re now being used to block nerve-related pain (neuralgia) including pain caused by herpes zoster.
The new medication in this category is Lyrica. There are several side effects associated with their use, including somnolence (prolonged drowsiness or a trance-like condition that may continue for a number of days), dizziness, weakness, fatigue, double vision, edema (fluid retention), ataxia (muscular in-coordination), thought disorder, possible long-term ophthalmic problems (abnormal eyeball movements and disorders), tremors, weight gain, back pain, constipation, muscle aches, memory loss, asthenia (weakness), depression, abnormal thinking, itching, involuntary muscle twitching, serious rash, and runny nose.
Don’t these side effects sound like some of the symptoms associated with fibromyalgia?
INT: What about the drug Mirapex? I’ve heard some good things recently.
DR. M: Mirapex (pramipexole) belongs to a class of drugs known as dopamine receptor agonists. Dopamine is a neurotransmitter that helps regulate muscle movement as well as moods and pain. Mirapex was approved in 1997 for the treatment of Parkinson’s Disease. Recently, a study evaluating the effectiveness of Mirapex on the symptoms of fibromyalgia was conducted for the National Fibromyalgia Association. Run by Washington rheumatologist Dr. Andrew Holman, the study’s results were presented in the journal, Arthritis and Rheumatism. Mirapex patients experienced a greater reduction in symptoms than those receiving the placebo. 42 percent of those treated with Mirapex experienced at least a 50 percent reduction in pain symptoms, and 82 percent of patients taking Mirapex experienced some type of symptom relief. This was a small study of only 60 patients. However, the results do look promising.
But, before patients with fibromyalgia rush to get a prescription for Mirapex, please note that many of my patients who’ve tried Mirapex have experienced one or more of the following potential side effects: abnormal dreams, arthritis, chest pain, confusion, constipation, decreased sensitivity to touch, difficulty breathing, difficulty walking, dizziness, dizziness upon standing, drowsiness, dry mouth, hallucinations, increased urination, insomnia, involuntary movement (jerky motions), lack of appetite, memory loss, nasal inflammation, nausea, swelling, urinary tract infections, vision abnormalities, and weakness.
Less-common side effects may include decreased sex drive, delusions, difficulty swallowing, fever, general feeling of illness, impotence, inability to hold urine, muscle spasms or twitching, pneumonia, skin disorders, thinking abnormalities, uncontrollable restlessness, unfounded suspicions, and weight loss.
Rare side effects may include abnormal ejaculation, abnormal heartbeat, agitation, blood clots, blood in urine, blood circulation problems, convulsions, difficult or painful urination, enlarged abdomen, eye disorders, heart attack, heart problems, joint problems, lung problems, mental illness, muscular problems, prostate problems, severe chest pain (angina), and thirst.
Interestingly enough, the makers of Mirapex routinely mention that the side effects to Mirapex are mild and may include nausea and weight loss. Weight loss as a side effect is very appealing to some patients. But the point is, these pharmaceutical reps and the information that is presented in commercials don’t accurately convey all the potential side effects, even the common ones like joint pain, breathing difficulties, insomnia, tremors, etc.
The muscle relaxer Zanaflex was once the "latest and greatest" drug for fibromyalgia. It was being prescribed to fibro patients like candy to a baby. Unfortunately, Zanaflex doesn’t promote deep, restorative sleep and has caused at least six deaths due to liver failure.
Those who want to try Mirapex should do so. However, I think patients should be informed about the potential side effects. This goes for all medications. When was the last time your doctor explained how a drug worked, why they were prescribing it, and the potential side effects? There are good drugs that may offer symptom relief and are appropriate for those with fibromyalgia. And, there are several drugs that should never be recommended for fibromyalgia due to their potential side effects that actually make the syndrome worse: cholesterol-lowering drugs, beta blockers, tranquilizers, etc.
I go into great detail about the good and bad drugs in both my 3rd edition Treating and Beating Fibromyalgia and Chronic Fatigue Syndrome and Patients Self-Help Manual for Treating and Beating Fibromyalgia and Chronic Fatigue Syndrome.
Many of my patients are taking drugs that are actually causing their problems with depression, fatigue, pain, anxiety, etc. Patients should at least be informed about these drugs so that they can make decisions for themselves.
INT: Most of the people I know with fibromyalgia are taking prescription antidepressants. Do you think these are helpful?
DR. M: I go into a great deal of detail about why these drugs, including SSRIs, usually don’t work over time and how they can cause depression, anxiety, and can permanently deplete serotonin brain receptors. SSRIs don’t make serotonin; they only help a person hang on to and use the serotonin they already have. Unfortunately, most individuals with fibromyalgia don’t have any serotonin. There is nothing to re-uptake! No one has an SSRI (prescription antidepressant) deficiency. They may have a 5HTP, L-Phenylalanine, or SAMe deficiency, which are the amino acids that make serotonin, norepinephrine, and dopamine. Studies comparing 5HTP to prescription antidepressants generally used to treat fibromyalgia, including tricyclic drugs (Elavil) and SSRIs, showed 5HTP to be as or more effective than prescription medications. Read more about this in one of my recent newsletters.
INT: Do patients have to stop taking their prescription antidepressants before starting one of the amino acids you recommend?
DR. M: No, patients can combine prescription antidepressants with 5HTP, SAMe, and amino acids. In fact, one European study showed that the combination of MAOIs, such as Nardil or Parnate, with 5HTP significantly improved FMS symptoms, whereas other antidepressant treatments were not effective.
INT: Are there other natural pain remedies that you recommend?
DR. M: There are several, and, along with restoring one’s deep, restorative sleep, the amino acids SAMe and DL-Phenyalanine are two good options. Before starting my detective work to find other causes of pain, I like to have my patients try one of these first:
S-adenosyl-l-methionine (SAMe): Several studies involving SAMe and fibromyalgia patients yielded substantial improvement in overall pain levels (as
well as depression). S-adenosyl-l-methionine (SAMe) comes from the amino acid methionine and acts as a natural anti-inflammatory and blocks pain without the side effects associated with NSAIDs. SAMe helps boost serotonin and epinephrine levels (boosts energy and are potent antidepressants). It also helps increase the production of endorphins. Endorphins are the body’s natural pain-blocking chemicals and are more powerful than morphine.
DL-Phenylalanine: DL-Phenylalanine is a combination of the D and L form of the amino acid phenylalanine. DL-phenylalanine blocks the enzymes responsible for the breakdown of endorphins and enkephlins, substances within the body that help relieve pain. One clinical study shows that subjects taking DL-phenylalanine had a remarkable improvement in their condition. Improvements were seen in 73 percent of low-back pain suffers, 67% percent with migraines, 81 percent with osteoarthritis, and 81 percent with rheumatoid arthritis. There are several other options in reducing pain and inflammation, including high doses of fish oil, glucosamine sulfate, malic acid, high doses of magnesium, MSM, repairing leaky gut, and hands-on therapies like chiropractic, physical therapy, and massage therapy.
INT: What about the fatigue that goes with fibromyalgia? What causes this debilitating fatigue that fibromyalgia patients complain of?
DR. M: There are a variety of reasons for the fatigue seen in fibromyalgia. Certainly, poor sleep is one of them. However, low norepinephrine levels are a common occurrence. Many of my fibromyalgia patients have experienced stressful lives that eventually deplete their stress-coping glands – the adrenals – of the stress-coping hormones cortisol and DHEA. And, studies show that 40 percent of those with fibromyalgia also suffer from low thyroid function.
INT: Ok, where do you start?
DR. M: Re-establishing deep, restorative sleep is the first priority, preferrably with 5HTP and melatonin, if needed. Prescription drugs that do promote deep, restorative sleep (Elavil, Trazadone, Ambien, Lunesta, and Flexeril) should be the last resort and should be taken with 5HTP. Then, repairing adrenal-hormones deficiencies are probably the next step to establishing healthy energy levels.
Adrenal fatigue is known to cause many of the same problems associated with CFS and FMS, including:
• hypoglycemia (low blood sugar)• hypotension(low blood pressure)
• neural mediated hypotension (becoming dizzy when one stands up)
• fatigue
• decreased mental acuity
• low body temperature (a sign of low thyroid function)
• decreased metabolism
• a compromised immune system
• decreased sense of well-being (depression)
• weight loss• hyperpigmentation (excess skin color changes)
• loss of scalp hair
• excess facial or body hair
• vitiligo (changes in skin color)
• auricular calcification (little calcium deposits in the ear lobe)
• GI disturbances
• nausea
• vomiting
• constipation
• abdominal pain
• diarrhea
• crave salty foods
• muscle or joint pains
Individuals with fibromyalgia who suffer from adrenal fatigue (99 percent) will find that their stress-coping abilities are shot. They don’t handle stress very well. They will try to avoid stressful situations. Stress will make their symptoms worse and cause them to have flare-ups. If they have a day when they feel good, they may overdo it (clean the house, paint the playroom, go grocery shopping, etc.). Then, they usually crash the next day. Therefore, restoring proper adrenal function is a crucial step in building up a person’s stress-coping abilities. I believe that adrenal fatigue is a major contributory factor to the symptoms associated with fibromyalgia.
INT: What do you recommend to restore normal adrenal function?
DR. M: I’ve used the prescription drug cortisol in the past, but now recommend that my patients use over-the-counter adrenal cortex glandular supplements. These help repair and restore normal adrenal function and were the first medicines to be used before the synthetic drugs came along. They have few, if any, side effects when taken at low doses, and, unlike prescription cortisol, once adrenal function has been normalized (usually within 6-12 months), they can be discontinued without fear of relapse.
Most individuals with fibromyalgia will also suffer from low norepinephrine levels. Those with low norepinephrine levels will have low energy, find it hard to “get going,” suffer from a decreased sex drive, are bored, and often feel they need to hibernate and get away from it all.
INT: Effexor, Wellbutren, and Cymbalta help boost norepinephrine levels, right?
DR. M: Yes and no. Remember ,these drugs are like gasoline additives. They don’t make the neurotransmitter norepinephrine, they only help the brain hang on to the norepinephrine it already has. Once again, patients with chronic illnesses like fibromyalgia have usually depleted their neurotransmitters (brain chemicals), including norepinephrine. A prescription drug that acts as a gasoline additive won’t do much if there is no gasoline (norepinephrine) in the tank (brain). I like to use the amino acid SAMe, which boosts norepinephrine levels. SAMe has been shown to quickly and safely elevate norepinephrine levels. I find that my patients notice a difference within two to three days after starting SAMe. And, SAMe has pain-blocking abilities, as well as acting as a powerful liver antioxidant.
INT: You mentioned low thyroid. Can you discuss this a little further?
DR. M: Studies have shown that as many as 63 percent of fibromyalgia patients suffer from some degree of hypothyroidism, a percentage much higher than that of the general population. These symptoms can include severe fatigue, headache and migraine, PMS, easy weight gain, fluid retention, irritability, anxiety, panic attacks, depression, decreased memory and concentration, hair loss, decreased sex drive, unhealthy nails, constipation, irritable bowel syndrome, dry skin, dry hair, cold and/or heat intolerance, low self-esteem, irregular periods, chronic or repeated infections, and many other complaints.
INT: Ok, should all these fibromyalgia patients be placed on prescription thyroid hormones?
DR. M: Individuals with true hypothyroidism (TSH levels above 3.04) may find that synthetic T4 thyroid hormones (Synthroid, Levothyroid, Levoxyl, etc.) help reduce or eliminate many of their low-thyroid symptoms, including fatigue. Unfortunately, the majority of my patients who have symptoms of hypothyroid, have normal blood tests. Blood tests for thyroid function are often inaccurate since the tests measure how much thyroid hormone is in the blood stream and not how much is in the cells of the body. Thyroid hormone doesn’t do anything in the bloodstream. It only works when it gets in the cell. Blood tests don’t show us if thyroid hormone is in the cell. Therefore, we must make an educated guess that if “x” amount of thyroid hormone is seen in the blood then “x” amount must be in the cell. However, chronic stress not only reduces thyroid function, it also increases a hormone known as reverse T3 which blocks thyroxine, or T4, from becoming the more active triiodothyroxine (T3). It’s not unusual for me to see my patients who take T4 medications, including Synthroid, benefiting little from their prescription, while their low-thyroid symptoms actually become worse over the years. They return to their doctor to have their blood tested and dose adjusted only to feel no better than they did before starting the medication.
INT: If blood tests may be inaccurate, what can patients do to see if they have low thyroid?
DR. M: I recommend they monitor their body temperature, which was one of the original ways used to diagnose hypothyroid. Body temperature is determined by our metabolism (cellular energy), and thyroid hormones control metabolism. A temperature taken under the arm or under the tongue of 97.8 or below is a sign of low thyroid and should be treated no matter what the blood test shows.
Read more about this in my newsletter about Thyroid problems
INT: Thank you, Dr. Murphree. I look forward to your upcoming presentation.
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