Book Notes: Pain Free 1-2-3
Chapter 6: Focusing on Muscle and Bone Pain
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Myofascial and Fibromyalgia Pain
Zanaflex also helps to decrease levels of substance P in the spinal fluid. This pain messenger is 300 percent of the normal level in fibromyalgia patients.
Permax (Pramipexole®), a medication used for Parkinson’s disease, has also been found to be helpful in fibromyalgia. In one study of 166 severe fibromyalgia patients, 22 percent discontinued treatment within the first two weeks because of mild to moderate side effects. Of those who tolerated the medication, increasing as tolerated over two months to an average dose of 1.5 mg at bedtime, 29 percent became pain-free, 43 percent had minimal pain, and 76 percent were improved. A larger study is currently underway. The medication is begun with 1/4 mg at bedtime and increased by 1/4 mg each week to a maximum dose of 2 mg at bedtime. If stomach pain occurs, Nexium® or similar medications are used during the first month. If restless leg syndrome worsens, Klonopin® is also added at bedtime. Both of these side effects generally go away as the dose is increased.3 Pregabalin® is another medication that is helpful for fibromyalgia pain. It was scheduled to be released in late 2004, but may not be allowed because of safety concerns.
Treating Osteoporosis and Bone Pain
1. It seems that even very low dose transdermal (by patch) estrogen replacement therapy improves bone density in menopausal women. The findings come from a study of 400 postmenopausal women aged 60 to 80 with thinning bones who received either the patch containing natural estradiol or a placebo. The results showed that women in the treatment group had improved bone density in the spine and hip and experienced reduced bone turnover. The lead investigator stated that the ultra-low dose estrogen patch offers a more natural approach to menopausal hormone therapy, because it is replacing circulating estrogen rather than increasing it. This study’s results were presented at the 52nd Annual Clinical Meeting of the American College of Obstetricians and Gynecologists (ACOG) 2004 held in Philadelphia.
