Fibromyalgia in the Spotlight
LDN Research, and Other Findings About Fibromyalgia
Something big happened in the fibro world at the end of 2017.
Lady Gaga let the world know she has fibromyalgia. Lady Gaga’s Fibromyalgia Puts Illness in the Spotlight. Her Netflix documentary shows her suffering with this pain. It still is the “f-word” of medicine. Fibromyalgia needed a spokesperson. Ginevra Liptan, MD says we have made progress with fibromyalgia; many doctors at least now believe it’s real. Now the challenge is how do we treat these patients? LDN is a piece of it but not the whole story.
What is Fibromyalgia?
It is characterized by widespread muscle pain, brain fog, and challenged sleep. It’s a distinct entity that has overlapping symptoms that may appear to look like chronic Lyme Disease and Chronic Fatigue but it is an entity itself.
Dr. Liptan says 50% of her patients have pure fibromyalgia, without the other disease with overlapping symptoms. The other 50% have fibromyalgia plus other conditions occurring at the same time.
At Town & Country Compounding we do the best to work with the patient and the practitioner to offer other options for the patients.
*Northern New Jersey & NYC Area
A challenge with treating fibromyalgia is that there is still not a standard test to diagnose. Many lab tests and imaging often look normal. It’s still a clinical exam-based diagnosis.
In fibro patients, we see symptoms such as tender in muscles, fatigue, brain fog and unrefreshing sleep. We can all agree there is pain hypersensitivity. Your brain and spinal cord are turning up the volume on your senses.
However, it’s the tip of the iceberg. You should not look at just central sensitization. It’s a piece. Low dose naltrexone can help with the central sensitization.
Extreme Sensitivity to Pain
The brain has lost its ability to suppress pain signals and the spinal cord is ramping it up. A 2002 study with functional MRIs showed fibro patients experience pain at a lower pressure threshold. More areas of the brain were being activated in the fibro patients.
LDN can help calm the activity in the brain. Central sensitivity is important in understanding fibromyalgia. The brain has gone haywire and is overly listening to pain.
The Sympathetic Nervous System
Underneath all that – the Sympathetic Nervous System (SNS) is what fundamentally has gone haywire. It happens more in the genetically predisposed. It sometimes takes a triggering event; a trauma, injury, Infection (like Lyme Disease), motor vehicle accident, or possibly a viral virus. Then, the SNS is in overdrive. Normally the SNS is activated in response to trauma or a stressful event, flight or fight.
As soon as the danger has passed, the SNS calms down. In fibro, it no longer calms down. It’s like a smoke alarm that has gone off and the smoke is gone but the alarm goes off still. This interferes with sleep quality. Your brain doesn’t allow you to go in deeper sleep. Also, with the SNS, patients clench muscles for fight or flight, the fascia muscles. The fascia tightening is what helps mom lift a car off their kid or fight a mountain lion. It gives you temporary strength which is great but if activated all the time it wreaks havoc. Tense muscles get a lot of inflammation.
This interferes with digestion. Blood flow is diverted away from the gut when your flight or fight is activated. Poor digestion leads to IBS, leaky gut, therefore food sensitivities and chemical sensitivities. It affects hormones, and the immune system. This ultimately leads to central sensitization in fibromyalgia.
In fibromyalgia patients, you must also address sleep, improve digestion, immune dysfunction, and address hormonal imbalance.
Potential Use of LDN in Treatment
The brain contains microglial cells and when they discover an abnormality, these cells release chemicals into the body that cause fatigue, pain, cognitive disturbances and other symptoms common among fibromyalgia patients. With fibromyalgia, some researchers hypothesize this normal central nervous system response gets activated and doesn’t shut off. “It’s like the central nervous system thinks you have an infection when you don’t,”
Dr. Jarred Younger, who conducted two LDN/fibromyalgia studies at Stanford University explained. He believes LDN works because it calms the microglial cells and reduces brain inflammation. “This is one of the few drugs that can do that in the brain because it crosses the blood-brain barrier,” Younger said.
Many of the drugs that have been prescribed for conditions like fibromyalgia do not provide sufficient relief for the patients. Oftentimes, doctors are not familiar with prescribing LDN for painful and inflammatory conditions (among many other things), so it can be difficult to get a prescription. If you need help finding a doctor that is experienced with LDN and prescribing it in one of the states we are licensed in, please fill out our form.
The LDN Research Trust
Linda Elsegood, founder of the U.K.-based LDN Research Trust, has helped thousands of people gain access to LDN. She credits LDN with stabilizing her multiple sclerosis. At her worst, Elsegood was wheelchair bound, had no control of her bowels or bladder and had lost much of her sight and hearing. After 18 months on LDN, she was able to walk again on her own and had a reversal of most of her symptoms.
John Herr RPh, and Town & Country Compounding Staff with Linda Elsegood
After Linda’s remarkable recovery, she wanted to educate others on the benefits of LDN.
“I wanted people to know that there is a choice, if you’ve been told, like me, that there’s nothing else that can be done for you,” she said. “Look into LDN. Do your research…It is amazing the number of people who’ve found LDN works for them for so many different conditions.”
In addition to fibromyalgia, early research has found LDN to be useful in reducing the symptoms of certain autoimmune and central nervous system conditions, including multiple sclerosis, Crohn’s disease, rheumatoid arthritis and others. It’s unlikely that any of the major drug companies will ever study LDN because it’s an older, generic drug and little profit can be made from it. It falls to innovative researchers who secure donations and grants to fund trials.
Dr. David Yeazel with John Herr RPh & Linda Elsegood.
Further Study of LDN & Fibromyalgia
A recent newsletter was written by one of our colleagues Dr David Yeazel, MD, MPH:
Fibromyalgia is characterized by widespread musculoskeletal pain typically accompanied by sleep disturbances, chronic fatigue, memory issues, headaches, as well as depression and anxiety. The specific casual factors are still being defined but are thought to involve dysfunction in CNS processing of pain signals. Initiating events can include trauma, infection, surgery, and acute psychological stress, however many cases have no definitive triggering event having symptom severity gradually grow over time.
Women appear to be more likely to develop fibromyalgia,as do those with existing osteo and rheumatoid arthritis, and lupus. Given its tendency to run in families, a genetic mutation is suspected as making certain individuals more susceptible to developing the disorder.
The widespread pain that comes with fibromyalgia is often described as a constant dull ache, lasting more than 3 months. The fatigue reported is unrelieved by sleep, with poor sleep being commonly reported along with accompanying sleep disorders such as restless leg syndrome and sleep apnea. Cognitive impairments involve difficulties in the ability to focus as well as memory issues, collectively known as “fibro fog”. Co-morbidites include irritable bowl syndrome, migraine headaches, as well as temporomandibular joint disorders.
There exist only mediocre treatment options for the typical fibromyalgia patient, with only a minority of patients achieving significant, sustained relief. Because there is no cure, treatment options are aimed at minimizing symptoms. Medications include over the counter pain relievers such as acetaminophen, ibuprofen and naproxen. Prescription medication can include pain relievers such as Tramadol and traditional opioids, as well as antidepressants and anti-seizure medications such as gabapentin. Physical therapy, massage and acupuncture as typically recommended, as is stress reduction and exercise.
This study by Dr. Jared Younger was the first ever to evaluate LDN as an adjunct therapy in the treatment of fibromyalgia. Designed as a single-blind placebo controlled-crossover pilot study, ten women were given 4.5mg LDN and followed over a 12 week time period. The results were promising, showing six patients who were considered responsive achieving a greater than 30% reduction in symptoms. Overall cohort symptom reduction was 2.3% on placebo and 32.5% on LDN as compared to baseline. Secondary benefits reaching significance included reductions in daily pain, highest pain, fatigue, and stress.
Interestingly initial erythrocyte sedimentation rate (ESR) was shown to be a predictor for response point to LDN as a tool to address the inflammatory component of fibroymyalgia.
The authors concluded that low-dose naltrexone may be “an effective, highly tolerable, and inexpensive treatment for fibromyalgia”.
This article describes a well-designed pilot study demonstrating LDN’s safety, efficacy and low-side effect profile in the treatment of fibromyalgia, a clinical indication very difficult to successfully treat by traditional treatment protocols. Given these clinical factors, and the successful results of this study, LDN represents a possible effective primary or adjunct therapy option in the treatment of fibromyalgia.
Get the Help You Need to Improve Your Quality of Life
If you have a condition that involves pain, or opioid dependence, depression or something else listed in our previous blogs about LDN, please call us and we’ll work with you and your doctor to find the appropriate solution.
Town & Country Compounding offers several hormone saliva testing kits and helps analyze results through a scheduled private consultation with the patient. The pharmacy can then get in contact with your physician and help find a treatment plan that fits your needs. We can ship out to you just email or call the pharmacy.
- Turning Down the Volume on Fibromyalgia Pain (LDN, low dose naltrexone)
- LDN Research Trust
- Fibromyalgia symptoms are reduced by low-dose naltrexone: a pilot study. https://www.ncbi.nlm.nih.gov/pubmed/19453963
- Turning Down the Volume on Fibromyalgia Pain (LDN, low dose naltrexone)