Fibromyalgia Doctor Touts Ketamine for Pain and Depression Wonder Drug?
Health Rising has done several reports on how surprisingly effective Ketamine can be with pain and depression. The drug has a couple of strikes against it for sure; it's an anesthesia drug which can produce hallucinations (!) in high doses and has been used as a date rape drug to boot.
Ketamine has also, though, been successful in the difficult to treat chronic regional pain syndrome (CRPS). It achieved remission in about half the patients in a small CRPS trial. It works so quickly in depression that it may become the first anti-suicide drug. For some people who had about reached the end of their rope ketamine has proved to be a life-saver.
Stephanie had severe degenerative disc disease, fibromyalgia, ME/CFS and depression. As a young woman she had the spine of an 80 year old. She had undergone multiple surgeries and had tried almost everything without success yet ketamine infusions sent her from an 8/9 on the pain scale to a 2/3.
Recently Fibromyalgia News Today reported on another woman who was bedridden with severe fibromyalgia who's pain virtually disappeared while using ketamine.
“I was suffering from widespread chronic pain and fatigue for 25 years, and after a very long time, I was diagnosed with fibromyalgia in 2007. During this time, I was bedridden and did not have a functional life. My pain was managed with medication, but this did not help my condition.
“Finally, in 2014, I began intravenous ketamine treatment at the Florida Spine Institute with Dr. Hanna in Clearwater, Florida,” she said. “This treatment has virtually eliminated my fibromyalgia pain and need for pain medication. It has given me back a quality of life and increased energy to do things I hadn’t done in years.”
In April, Dr. Ginerva Liptan, author and FM patient, touted ketamine's effects on The National Pain Report. Liptan first found out about ketamine when several of her patients experienced significant pain relief for weeks after undergoing surgery. When she looked further she found they had all received ketamine IV's.
She suggested that ketamine maybe causing the "massively overstimulated" NMDA receptors in FM to "cool down" or reset for weeks at a time.
Ketamine can also be very effective at treating depression. The really intriguing thing about the ketamine depression studies thus far is that they tend to focus on the most difficult patients of all; people with treatment-resistant depression.
Thomas Insell, former director of the National Institute of Mental Health (NIMH) at the NIH felt ketamine might be the biggest breakthrough in depression ever:
Recent data suggest that ketamine, given intravenously, might be the most important breakthrough in antidepressant treatment in decades.
A nasal ketamine spray for depression, became, in fact, the first drug outside of cancer or an epidemic to be awarded a "breakthrough therapy" designation by the FDA. One case study referred to a man who's inconsolable grief was rapidly ameliorated by ketamine. The young man was so grief-stricken by the death of his wife that he was referred to the hospital. He had refused food, spoke in a tiny voice and broke out in crying spells. The doctors described him as having catatonic symptoms.
Upon receiving ketamine the patient briefly hallucinated (!) but after that began to communicate, was cheerful and started taking food orally. Three months later he was continuing to do well.
Dozens of studies are currently exploring ketamine's effectiveness in depression. Just this week a study found that ketamine rapidly improved fatigue in depression as well.
(Several academic centers (Yale University, University of California at San Diego, the Mayo Clinic, Cleveland Clinic) are now offering ketamine for severe depression.).
Other studies are exploring ketamine's use in neuropathic pain, autism, post-cancer pain, migraine and others. One interesting study is determining whether ketamine IV's can reduce cancer fatigue.
Neither fibromyalgia nor ME/CFS, of course, is depression but antidepressants are not simply antidepressants anymore; they're also pain drugs or even microglial inhibitors. Similarly depression is not simply "depression" anymore. Immune activation or inflammation probably contributes to or even causes about thirty percent of the depression found.
The fact that people using interferon who suffer from similar symptoms and brain abnormalities as ME/CFS patients suggests that the depression found in ME/CFS could very well result from immune activation.
Ketamine, it turns out, also appears to be an anti-inflammatory. It was recently found to reduce the levels of inflammation following hypoxia (low oxygen levels) - a condition of great interest in ME/CFS and FM. Could ketamine relieve the inflammation associated with low oxygen levels (and the fatigue, pain and mood issues) in ME/CFS and/or FM?
The point is that fatigue, pain and depression can probably be produced in many ways and any drug that powerfully affects pain or depression in another disease might be able to affect fatigue as well. We can't judge a drug by its name anymore.
Ketamine is not easy to find, is expensive and is not covered by insurance if you have FM or ME/CFS but it is becoming more available. One Portland provider charges $3,800 for six infusions over twelve days. The effects last anywhere from two to twelve weeks.
Ketamine's possibilities for ME/CFS and FM surely lie in future drugs that do not require infusions and have few side effects. Drug manufacturers realize that the potential for a blockbuster drug is present. Thus far they've found three molecular targets to aim future ketamine-derived drugs at. At least one ketamine derivative is reportedly in clinical trials for depression now.
Time will tell but the future of this anesthesia drug/antidepressant/pain reliever/anti-inflammatory looks to be bright. By : Cort Johnson Apr 6, 2016. Healthrising.org
Know Your Options: Common Fibromyalgia Medications and Its Side Effects :
True, there's no cure for fibromyalgia. On a good note, there are many pharmaceutical options to alleviate its many symptoms. The main types of fibromyalgia medications include antidepressants, anticonvulsants and pain relievers.
Fibromyalgia pain is related to an hyperactivity in the nervous system. Anticonvulsants, sometimes known as antiseizures, are given to affect the brain's chemicals to calm nerves and obstruct pain-signaling. They can ease the pain significantly and also improves sleep.
Lyrica is a good example of anti-convulsant which is approved to specifically treat fbromyalgia pain by FDA. About 150 mg tablets are to be taken each day, going up to 450 mg per day. Other anti-convulsant options include: Ativan, Depakote, Neurontin, Tegretol, Trileptal.
However, common side-effects of anti-convulsants are nausea, dizziness, fatigue, weight gain etc
Pain Relievers :
There are various types of pain relieving drugs of varying strength which can complement fibromyalgia drugs:
Analgesics: These are common painkillers which can be self bought at most drug stores. They include Aspirin, Ibuprofen and Acetaminophen. Tramadol, a much stronger painkiller is a common fibromyalgia drug only accessible when prescribed.
Muscle Relaxants: These help to ease tension in the muscles, reduce soreness, treat musle spasms and aid sleep. Some examples are Soma, Flexeril, Norflex, Skelaxin and Robaxin. Muscle relaxants may have side-effects such as drowziness and blurred vision.
Tender Points Injections: These are local anesthetic or painkillers that are injected at the tender points to relieve unbearable muscle pain. These injections are temporal and usually last close to a month.
Opioids: Opioids are the least recommended drugs as it can lead to addiction, cause short term side effects such as dizziness, nausea, vomiting, constipation, itch and lead to withdrawal symptoms in the long run. They are rarely prescribed and only given for severe pain cases. Some examples of these drugs include Oxycontin, Percocet and Vicodin.
Anti-depressants work to increase the feel good hormones in the brain: dopamine, serotonin and norepinephrine. They also increase the number of the body's organic painkillers. Anti-depressants are usually used to improve depression, fatigue and pain caused by fibromyalgia. There 3 basic types of anti-depressants as listed below. Often, a combination of anti-depressants is required for best results.
Serotonin reuptake inhibitors : (SSRIs): SSRIs helps to raise levels of serotonin and contain them within the brain. Some examples include Celexa, Paxil and Zoloft. SSRIs can cause side effects like headache, nausea, diarrhea, sexual dysfunction.
Serotonin and Norepinephrine reuptake inhibitors (SNRIs) : SNRIs helps to raise levels of both serotonin andnorepinephrine in the brain. Some examples include Cymbalta and Savella, both FDA approved to treat fibromyalgia pain. Common side effects of SNRIs are dizziness, nausea, vomiting and insomnia. SNRIs are also incompatible with monoamine oxidase inhibitor (MAOI), an older generation of anti-depressants, or with patients also sufferring from acute glaucoma.
Tricyclic Antidepressants: These help to maintain and raise the levels of dopamine, serotonin and norepinephrine in the brain. Common examples of the medication are Elavil ( Amitriptyline), Nortriptyline (Aventyl, Pamelor) and Sinequan. However, these drugs are unpopular due to its prominent sides effects like weight gain and fatigue. Furthermore, high doses have to be taken to take effect on mood.
Alternative Therapies :
Myofascial release therapy:
Tai Chi .... and Qi Gong : Tai Chi, actually called Tai Chi Ch'uan and Qi Gong are forms of Chinese exercise with rhythmic flowing movements that is thought to have a therapeutic effect on the internal organs and balances the body's energy. It may help to reduce high blood pressure, stress and decrease the incidence of osteoporosis. Tai Chi and Qi Gong also may improve coordination and balance and best of all our sense of well-being. These are systems practiced for health maintenance, healing and increasing vitality.
Herbal supplements :
Myofasical release :
Ice and Heat :
Pool exercises :
Warm Water Aerobics Therapy
Exercise is crucial in improving fibromyalgia. Of all types of exercise, warm water aerobics is considered to be the most effective for fibromyalgia patients. Warm water aerobics therapy helps to stretch and strengthen your muscles, improve flexibility and balance and reduce body stiffness and pain. It can also help to improve mood and relieve stress. Doctors and physiotherapists alike highly recommend warm water aerobics as a form of therapy to complement fibromyalgia medications. There are two factors that make warm water aerobics ideal for fibromyalgia patients:
Water: Water assist fibromyalgia patients in movement. Its bouyancy helps to support the weight of the patient allowing patients to move with more ease. At the same time, water resistance helps in stretching and strengthening the muscles and joints which is crucial in relieving body pain.
Warmth: As in sauna or hot springs, warmth has a therapeutic effect on your body. Warm water helps soothe pain and aches hence allowing them to exercise with more ease. Warm water also induces relaxation and help in lifting mood.
Rest, Pacing, Reducing stress, Practice relaxing : deep breathing and deep muscle relaxation.
Behavioral: stress, depression,
Improve nutrition :
Instead of taking an oral medication to treat fibromyalgia, a transdermal medication is applied and absorbed through the skin. This allows the medication to enter the bloodstream to provide pain relief quickly. There are several types of transdermal medications including ointments, gels, creams and patches. These topical medications can often be bought over-the-counter, but there are prescription transdermal medications as well. Most transdermal medications used for fibromyalgia provide the sufferer with some pain relief.
How Transdermal Medications Work : These medications are absorbed through the largest organ of the body, which is the skin. Your skin performs many functions including regulating your body temperature and controlling the loss of fluids. Since your skin has many layers and includes a network of blood vessels, topical medications enter the bloodstream at a steady rate, helping to provide long lasting pain relief.
In addition to being absorbed into the skin to allow the medication to enter the bloodstream, they also work on the nerve endings in the skin. The skin is covered by a multitude of nerve endings which receive different messages about the conditions around you. If they receive pain messages, they are sent to the spinal cord and travel to the brain. However, topical pain medications block messages triggering pain from being received from the brain.
Types of Transdermal Medications for Fibromyalgia :
Transdermal medications are becoming popular among fibromyalgia sufferers because of the benefits they have over oral medications. These benefits include ease of use, fewer side effects and long-lasting pain relief. There are several types of topical medications that can help provide pain relief patients need to feel better and to have more freedom of movement. Here are some of the transdermal medications that are usually prescribed to fibromyalgia sufferers.
Zonalon Cream – 5% Doxepin. This topical medication contains doxepin, which is a tricyclic anti-depressant. It helps relief pain by block receptors that send and receive pain messages and by also blocking sodium channels. The cream also stimulates opioid receptors that help to enhance pain relief. Zonalon can help to provide significant pain relief for fibromyalgia patients. The cream takes about three weeks to become fully effective and it can be applied up to four times a day.
Menthol Creams- Menthol is an ingredient that can be found in peppermint and other natural oils. It is often used in over-the-counter analgesic creams to help provide pain relief as they help block kappa opioid receptors. When creams with this ingredient are applied, there is a cool, tingling feeling on the skin. The menthol will then warm up, helping to provide relief for stiff muscles. When regularly used, menthol creams will help to increase pain tolerance.
Transdermal Cream Side Effects:
One of the main benefits for using transdermal creams is the reduction in side effects. Since the medication is not taken orally, upset stomachs, diarrhea and nausea can be avoided. However, they do have some side effects. Some patients may experience a rash or irritation on the site where the medication is applied, some topical creams may cause allergic reactions, dry mouth, headaches and drowsiness are some of the other side effects that some users may experience.
Transdermal Patches - Medicated patches are the latest type of pain medication that can help reduce pain and provide relief over a prolonged period of time. There are several types of patches that can be used by fibromyalgia patients to relieve pain.
Fentanyl Patches: This patch is usually sold under the brand name Duragesic and it can provide pain relief for up to 72 hours. Since it is an opioid pain medication, it is usually recommended for patients that are already using some type of opioid medication and for those with opioid tolerance. It works by allowing fentanyl to bind to pain receptors to help provide pain relief.
Fentanyl has to build up in the bloodstream in order to work effectively, so it takes about 12 hours to begin to work. Since the opioids in the patch bypass the stomach, they have fewer side effects than oral opioids that can cause nausea, diarrhea and constipation.
Lidoderm Patch : 5% Lidocaine, Lidocaine is an anesthetic that is used in many areas of medicine and in dentistry. Anesthetics can be successfully used to treat fibromyalgia especially in the specific areas where the pain is at its worst. The lidoderm patch releases a constant supply of lidocaine into the skin. Lidocaine blocks pain signals before they reach the brain, which prevents the body from receiving signals to feel pain. Fibromyalgia patients report a reduction in pain when using the lidoderm patch and they also experience an improved ability to sleep after using the patch for three weeks. Up to three patches can be applied within 12 hours.
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Cannabis or Marijuana Helps Fibromyalgia?
Cannabis, also known by many other names, is a derivative of the Cannabis plant that is popularly used as a psychoactive drug and medication. This controversial drug, which many would know it as weed or marijuana, has taken a bad rap due to it being exploited for recreational purposes. However, apart from being the star of a party, Cannabis has many medical purposes including treating fibromyalgia.
What is Medical Cannabis :
This refers to cannabis in the form of medication, rather than for recreational purposes. It is said to be useful in treating several diseases and medical problems, ranging from nausea resulting from chemotherapy to glaucoma's high ocular pressure. Cannabis contains a wide variety of chemicals that has many applications. Fibromyalgia is one medical condition which it has proved to be highly effective in.
How does Medical Cannabis Work?
The Cannabis plant contains a wide variety of compounds that can affect both the brain and the rest of the body. The body is affected by a category of compounds termed cannabinoids that bind and interact with the brain's cannabinoid receptors. Of them, the most well-known cannabinoid is THC, which is responsible for cannabis' classic effects, among the 85 other cannabinoids in this plant.
Where fibromyalgia is concerned, however, THC is the most important cannabinoid as it binds with the brain's cannabinoid receptors that help to relieve the pain associated with fibromyalgia. THC also helps the patient relax and get over their feeling of exhaustion.
How is Medical Cannabis Administered?
Patients use a vaporizer in order to heat cannabis to the point of vaporization of the active ingredients of the plant. This provides the same effect and relief as smoking cannabis, but eliminates the risks of smoking. Hence, medical cannabis is a more controlled and low-risk treatment as compare to its recreational form.
How does Medical Cannabis Help Fibromyalgia?
Cannabis helps fibromyalgia patients by helping ease muscle stiffness and pain. For this, a strong variant of cannabis is recommended. However, it should be used with care and in controlled dosage as prescribed by a doctor as it could cause side effects like heavy drowsiness. Researchers on patients with fibromyalgia found that those who took cannabis were significantly better in mind and body than those who did not take it. They also found that it relieved fibromyalgia patients of pain to the extent of 50%.
Nabilone an Alternative to Medical Cannabis for Fibromyalgia
Looking at the map above, it is obvious that not all of us are fortunate to live in a medical marijuana legalized state. However, the good news for those who reside in places which do not legalized the use of medical marijuana is, a synthetic medical marijuana pill, Nabilone, was found to work successfully in reducing the pain and anxiety of fibromyalgia comparably. Well, the bad news is, in areas where medical marijuana is legal, many find that it is more economical and effective than Nabilone.
The Fibromyalgia Circle of Hope