Tag: medication

Evidence for New Fibro Drug Therapies: Options to Take to Your Doctor if Your Current Treatments aren’t Working

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Evidence for New Fibro Drug Therapies: Options to Take to Your Doctor if You Current Treatments aren't Working

New research into drug therapies helps people with fibromyalgia increase their treatment options. Learning about these new medication options can help you and your doctor you find the best treatment regimen for you.

If you live with fibromyalgia, you know firsthand that one of the primary features of this condition is a lower pain threshold compared to healthy people. There are a number of changes in the body caused by fibromyalgia that increase our sensitivity to pain. One set of changes affect how the spinal cord relays pain sensations from the body to the brain. Several drugs target specific receptors, called NMDA receptors, which are located in deep spinal neurons that carry sensory information to regions in the brain that relate to pain processing. NMDA receptors are activated by signals relayed to the spinal cord by peripheral neurons that sense pressure in muscles, tendons, etc. This type of receptor is activated by the neurotransmitter glutamate. Studies have shown elevated levels of glutamate in the brain and spinal cord of patients with fibromyalgia.[i] There is a strong correlation between elevated glutamate and increased pain in people with fibromyalgia. NMDA receptors can amplify pain signals in patients with fibromyalgia because they are activated to a greater degree by the presence of increased glutamate concentrations in the brain/spinal cord, which trigger pain signals sent to the brain by the deep spinal neurons.

NMDA receptors can be prevented from firing by certain compounds. Two drugs in particular seem effective at decreasing NDMDA receptor activation. One is called memantine. Memantine blocks NMDA receptors and decreases glutamate levels. “A randomised, double-blind study in 63 patients with fibromyalgia compared memantine… with placebo over a 6-month period. Compared to placebo there was a significant reduction in pain and pain threshold and improvement in global function, mood and quality of life”.[ii] Memantine was originally developed to treat diabetes, but has also been used to treat dementia; it has been found to also be effective in treating chronic regional pain syndrome.

Ketamine is another potent NMDA receptor blocker (yes, the illegal party drug). Studies have shown that it can effectively reduce pain for a subset of fibromyalgia patients “Thus, of 58 patients with fibromyalgia in the above 3 studies, 33 (57%) responded to low dose ketamine (0.3mg / kg) infusion, as defined by a reduction of pain by 50% or more.”[iii] However, studies have not adequately investigated long term use of ketamine. However, ketamine has been proven effective in treating chronic regional pain syndrome, which shares many similar characteristics to fibromyalgia.

Another interesting tip focuses on diet changes that can help lower pain levels. Glutamate is found in MSG (monosodium glutamate). Other related compounds, called excitotoxins, like aspartame, can cause harmful over-activity in the brain. “One study showed that 4 weeks of exclusion of monosodium glutamate (MSG), aspartame, and other excitotoxins, resulted in over 30% improvement in fibromyalgia symptoms in 84% of those who completed the diet”.[iv]

What about inflammation and fibromyalgia? A number of studies have found increased levels of pro-inflammatory messengers (called cytokines) in blood collected from FM patients.[v]  A drug called low-dose naltrexone has been investigated for its potential benefits in treating fibromyalgia because of its anti-inflammatory properties.[vi] Naltrexone is primarily used to treat opioid overdoses, but when taken at a low dose before bed, studies have found a statistically significant reduction in FM pain compared to the placebo. A recent study found that “after eight weeks of LDN administration, plasma levels of a range of broadly pro-inflammatory cytokines were decreased. In addition, we found that participants reported less pain and symptoms following LDN. Combined, these results support the hypothesis that LDN may help chronic pain conditions, such as fibromyalgia, by acting as an atypical anti-inflammatory medication”.[vii] Pain reduction was found to be 15% and symptom reduction 18%. While these results are modest, for many FM patients desperate for options, low-dose naltrexone could be a valuable part of their treatment regimen.

Evidence for New Fibro Drug Therapies: Options to Take to Your Doctor if You Current Treatments aren't Working

Works Cited

Littlejohn, G., & Guymer, E. (2017). Modulation of NMDA Receptor Activity in Fibromyalgia. Biomedicines 5 (5), 15-27.

Parkitny, L., & Younger, J. (2017). Reduced Pro-Inflammatory Cytokines after Eight Weeks of Low-Dose Naltrexone for Fibromyalgia. Biomedicines 5 (2), 16.

Ross, R., Jones, K., Bennett, R., Ward, R., Druker, B., & Wood, L. (2010). Preliminary Evidence of Increased Pain and Elevated Cytokines in Fibromyalgia Patients with Defective Growth Hormone Response to Exercise. Open Immunol J, 3, 9-18.

Citations

[i] (Littlejohn & Guymer, 2017)

[ii] (Littlejohn & Guymer, 2017)

[iii] (Littlejohn & Guymer, 2017)

[iv] (Littlejohn & Guymer, 2017)

[v] (Ross, Jones, Bennett, Ward, Druker, & Wood, 2010)

[vi] (Parkitny & Younger, 2017)

[vii] (Parkitny & Younger, 2017)

Could a Treatment for Herpes also be Effective for Treating Fibromyalgia?

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Could a treatment for herpes also be effective for treating fibromyalgia?A recent study investigated whether it would be effective to  treat fibromyalgia patients with an anti-viral and anti-inflammatory drug combination that is normally used to treat the herpes virus (cold sores or genital herpes). The anti-viral drug used in this study also treats the shingles virus (which additionally causes chickenpox). Specifically, researchers tested a famciclovir + celecoxib drug combination called IMC-1. The study was based on the hypothesis that life stressors could re-activate latent viral infections  (viral infections from earlier in life that become dormant), which in turn cause fibromyalgia to develop. This hypothesis is based on anecdotal evidence of patients who develop fibromyalgia after experiencing infections and/or periods of stress. Does that sound familiar?

The results of this double-blind, placebo-controlled study were positive: participants receiving the anti-virals had significantly less pain and fatigue compared to participants who received a placebo. Encouragingly, IMC-1 was well tolerated by study participants, with few side-effects. Researchers concluded that the effectiveness of the anti-viral drugs suggests that the herpes virus may play a role in the development of fibromyalgia for some patients. Interestingly, this conclusion was based on the efficacy of the drug rather than testing the study participants for the herpes virus. I wonder whether this line of investigation could be expanded to include other potential viral triggers.

This hypothesis resonates with me because in the months before I developed fibromyalgia, I had a mumps infection, which I always attributed as a trigger for the onset of my fibromyalgia. In addition, I have had shingles, which the anti-viral used in the study also treats. This is a fascinating new area of research that will hopefully provide more answers and solutions to the treatment of fibromyalgia. In the meantime, if you have the herpes virus (or other significant viral infection) and fibromyalgia, I recommend taking this study to your doctor to see if IMC-1 might be an effective option for you!

Reference:

Pridgen, W. et al. (2017). A famciclovir + celecoxib combination treatment is safe and efficacious in the treatment of fibromyalgia. J. Pain Res., 10, 451-460. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5328426/

When the Forecast Calls for Fibro Fog: PillDrill Helps You Remember Your Medications

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I have been given this product as part of a product review through the Chronic Illness Bloggers network. Although the product was a gift, all opinions in this review remain my own and I was in no way influenced by the company.

I am an absent minded person.  I should have a beeper on my glasses, my phone and probably my mind, to help me find where they wander off to.  Fibro fog has made my memory even worse. Forgetting where you put your cup of coffee is an inconvenience, but forgetting your medication can be dangerous.  As you can imagine, I sometimes forget whether I took a prescription or accidentally take two doses.  I haven’t  found a reliable solution.  Using a medication reminder app is just another thing to forget. The PillDrill is different.  It is a unique medication tracking system that has actually worked for me.

pilldrill

What is it?  The PillDrill hub looks like a digital clock (which it is, too).  When it is time to take your medication, it flashes, beeps and shows the name of the medication(s) you have programmed it remind you about.  These reminder features are customizable, in case you don’t want it to make noise or to flash. The PillDrill has a scanning function. The device comes with scanning tags that you attach to your pill bottles or a weekly pill strip provided with your hub.  Once you have taken your medication, you scan it on the hub by touching the tag to the scanning button and it logs your dose as taken!  The PillDrill is managed using an app from your mobile device or computer.  It syncs using your wifi network.  The app is used to create and edit your medication schedule, get reminders, and log doses on the go.  You can set it up so that a loved one can also get notifications about your medication adherence.  The PillDrill comes with a “mood cube” that lets you track how you’re feeling during the day so you can monitor your daily health patterns.

Benefits: I have the hub on a side table in my living room. The flashing light ensures that I remember it is time to take my medications. On the go, the app notifications remind me on my phone. Scanning each medication has made sure I don’t accidentally take a second dose. Plus it’s kind of fun to scan the pill bottle! It’s helpful to have a record of when I have taken each medication for reference. Since I started using the PIllDrill, I haven’t forgotten a dose or taken a double dose.  In addition,  the device itself is aesthetically pleasing, and I like the teal and white colors.

Cons: I did face a few challenges using the PillDrill. I chose to put the scanning tags on my pill bottles rather than the weekly pill strip. The problem is that, once the bottle was finished, I didn’t have another tag for the new bottle. You are supplied with only about 25 tags. If I had used the weekly pill strip provided, I could have reused the tags (because they go on the strip rather than the pill bottle). Alternatively, PillDrill provides tag holders, which are attached to a pill bottle with an elastic band and can be used for successive pill bottles. It would have been great if more than 10 tag holders  had been provided so that I could have used them for all my supplements/medications. If you run out of tags, you need to purchase more from the PillDrill website. I recommend attaching the scanning tags to the weekly pill strip and using the tag holders.

When I put the tag on the lid of a supplement bottle that was made with metal rather than plastic, it didn’t scan. This can be avoided using a tag holder, but it would have been helpful to have been warned about this in the product help guide.

Finally, when I was attempting to sync the hub to my wifi network using the PillDrill app on my android phone, it was not effective. When I used my iPad, it worked easily. Having more troubleshooting instructions in the help guide would have been useful for this problem.

Final thoughts: The bottom line is that the PillDrill is effective at helping you remember to stick to your medication schedule and is a useful product for anyone with chronic illness who takes a number of pills each day.

The PillDrill is available here.