Nitroglycerin Treatment for FMS!!!t

Discussion in 'Fibromyalgia Main Forum' started by darude, Apr 23, 2005.

  1. darude

    darude New Member

    MMMMMM mine STARTED with this (they thought I was having heart attack and overloaded me with until I got severe headache)Our patients ranged in age from 15-76, consisting of 12 men and 26 women. In four patients with post-traumatic fibromyalgia and fibromyositis, the symptoms of fibromyalgia and fibromyositis completely resolved while on nitroglycerine. They are in the tapering phase, and the symptoms are not recurring of these fibromyositic and fibromyalgic conditions. The P300 in the 5 patients evaluated also showed improvement during the course of treatment. In 3 of these patients, this improvement was independently confirmed by the Neuropsychologists treating the patient. The other patients did not have ongoing neuropsychological follow-up. Examples 1 and 2 represent examples of the baseline TCD while patient was symptomatic, and a follow-up TCD with resolution of patient's complaints after a nitroglycerine sublingual spray. Examples 3, 4 and 5 represent examples of raw EEG tracing obtained on an average referential montage and two accompanying qEEG epochs. The first brainmap, Example 4 , shows examples of the distribution of the alpha frequency mu rhythm, frontally, temporally, and occipitally; and the second, Example 5 , is similar but shows that these mu rhythm frequencies are frequently in the beta range. On these maps, the frontal lobe is to the top, and the occipital lobe is inferior.

    In 19 patients with MS-like syndrome and 1 with MS associated with breast implants, a similar pattern of complaints, Electro-encephalographic and TCD findings was seen. Our patients ranged in age from 23-61. The pattern of complaints was the same as the whiplash patients. Headache, concentration and memory disturbances, visual blurring, intermittent focussing abnormalities, balance disturbances, ataxia, photophobia, and hyperacusis were complained of in all patients. The severity of the complaints, however, tended to be less than that of the whiplash patients, however, their complaints of memory and cognitive dysfunction and mood swings tended to be considered by the patient to be their most severe problem in all but the one case who was felt to have MS. Of the 10 patients who had MRI's performed, 2 had a few scattered UBO's consistent with small white matter infarcts, and one had large plaques consistent with MS on MRI and brain biopsy. All patients had fibromyalgia and fibromyositis.

    [This Message was Edited on 04/23/2005]
  2. Denamay

    Denamay New Member

    This is very interesting! was there a study re. nitroglycerine?

    I don't quite get it, are you saying that: you were given nitroglycerine because of heart symtoms and it relieved your fibro.?

    If so I can hardly wait to see my dr. Thanks arrlyn
  3. darude

    darude New Member

    I have full article and says that nitroglycerin can cure! Mine STARTED with nitroglycerin but I think it was coming off a huge dose so I wonder.
  4. elliespad

    elliespad Member

    I started looking for articles concerning this and I came across this. Interesting approach by Dr. Jay Goldstein.

    Jay A. Goldstein, M.D.’s Unique Treatment Protocol for Chronic Fatigue Syndrome & Fibromyalgia


    By John W. Addington
    Editor's note: As of April 2003, Dr. Goldstein has retired from medical practice and no longer maintains his website.

    "Miracles are happening in the lives of Chronic Fatigue Syndrome (CFS) and fibromyalgia (FM) patients every day, thanks to Dr. Goldstein." That's how Katie Courmel, writer and CFS patient, sums up the benefits to Dr. Jay Goldstein's unique CFS/FM treatment protocol.

    Dr. Jay A. Goldstein is director of the Chronic Fatigue Syndrome Institute of Orange, California. His background as a medical doctor is in psychiatry and family practice, but for a number of years now, he has specialized in the care of CFS and related disorders. Dr. Goldstein has lectured and written extensively on this topic, including his latest book, Betrayal of the Brain. To help explain Dr. Goldstein's approach in layman's terms, Katie Courmel has written the book, A Companion Volume to Dr. Jay A. Goldstein's Betrayal of the Brain.

    CFS and FM as Neurosomatic Disorders
    Dr. Goldstein's CFS/FM protocol revolves around his understanding of these ailments as neurosomatic disorders. In helping to define such disorders, Dr. Goldstein says patients afflicted "do not feel, think, or function properly because the brain does not handle information properly." According to his research, Dr. Goldstein believes brain circuitry and transmittal of data for proper bodily function and health have become altered in conditions like CFS. Further, Dr. Goldstein comments "how the brain, the immune system, and the hormonal system simultaneously regulate the function of each other…is usually 'out of whack' in various ways in patients with neurosomatic disorders."

    Dr. Goldstein believes that neurotransmitters, chemical substances that act as information messengers in the brain, are abnormally low in this condition. Norepinephrine and dopamine are two such neurotransmitters lacking in CFS patients. When these are decreased, the brain has difficulty assessing relevance of the numerous messages it constantly receives. Because of this, mentally challenging situations such as taking a test or sensory stimulating situations such as a shopping at a mall can be overwhelming.

    Another cause of this easily distractible state is elevated levels of substance P. Substance P is a chemical that transmits pain messages. Overproduction of substance P results in increased sensations of pain. Dr. Goldstein believes elevated amounts of this pain messenger found in CFS and FM are interrelated with their hypervigilant state, and can contribute to anxiety and panic attacks.

    Cause of Neurosomatic Disorders
    Dr. Goldstein enumerates four factors as influential in the onset of neurosomatic disorders. To begin with, persons can have varying degrees of genetic susceptibility to this kind of ailment. A second contributing factor is if during childhood one is made to feel unsafe for intervals of time. Such developmental problems can increase substance P and cause hormone levels to deviate. A third influence could be viral infection in the brain that alters proper neurotransmission. Dr. Goldstein describes the fourth factor as a potential outcome of the first three: "impaired flexibility of the brain…to deal with changing internal and external circumstances."

    Despite all this talk about altered mental states, Dr. Goldstein does not believe that CFS is purely psychiatric in origin as some imply with the phrase "it’s all in their heads." Dr. Goldstein explains it this way, "The ludicrous and overly restrictive term 'psychosomatic' should be discarded into the rubbish bins of history. It states that apparently [unexplainable] symptoms must be a result of mysterious ‘unconscious’ conflicts which cannot be measured or even proven to exist."

    "Receptor profiling" is a method of diagnosis used by Dr. Goldstein to determine which of the brain's biochemical pathways are not functioning properly. This involves administering a series of drugs to the patient, one at a time. Each of these drugs is known to target specific brain pathways. Thus a patient responding to a particular drug indicates the brain pathway likely to be contributing to that particular patient's symptoms. Once that is known, various drugs that can normalize the faulty pathway are tried.

    Katie Courmel lets patients know what to expect during their first appointment with Dr. Goldstein. "If you visit Dr. Goldstein's office, you may spend as much as two or three hours of your first day in an initial consultation with the doctor. This involves a detailed reading of your entire case history, with questions and answers interjected. During this period, Dr. Goldstein will begin his drug treatment protocol, starting with those drugs that have the most fast-acting profile. He may try naphazoline 110 eye drops, which may take effect within seconds. He may also try nitroglycerine under your tongue, which may act within minutes. You will then take a series of tablets or capsules that are longer-acting, taking effect within 30 to 45 minutes."

    "Throughout this process, Dr. Goldstein will frequently ask how you are feeling. If you suffer from pain, he will check the sensitivity of a few select FM 'tender points' to help assess the effectiveness of a drug. If you suffer primarily from fatigue and find a drug that revives you, Dr. Goldstein may have you run up and down stairs to see if the drug really works. If cognitive disorders are a main complaint, you might read and discuss a magazine article after the administration of a drug that makes your head feel clearer."

    Once this diagnostic process is complete, Dr. Goldstein will be able to tailor a treatment regimen specific for each patient.

    Treatment Plan
    Dr. Goldstein's primarily treats through the use of various combinations of medications. He explains his care this way, "The goal of therapy is to induce the brain to secrete the appropriate amounts of chemical neurotransmitters so that information to be processed will be selected appropriately. I have devised a decision tree which helps me to rapidly discover in most cases which brain chemicals and receptors might be dysregulated. This process usually takes about an hour at the initial visit.

    I use medications which target one particular receptor and administer them in nasal sprays and eye drops. They attach to receptors on nerves in the head and may cause a patient to feel better, or sometimes worse, within seconds. I then may use other rapidly acting medications which affect the same, or related, receptors. My goal is that the patient feels completely normal. He/she remains in the office trying selected medications in succession until all symptoms resolve. This result requires an average of three office visits, but may occur in two seconds or two years."

    There are several medications that have proven to be very useful for patients who have been bedridden for a year or longer. Dr. Goldstein calls these his "resurrection cocktail." A main component of this "cocktail" is ketamine administered intravenously or through a gel. Other components provided intravenously are ascorbate, lidocaine, and thyrotropin-releasing hormone. Nimotop and Neurontin, both administered orally, are also included in the list of medications most likely to aid CFS patients.

    Most of Dr. Goldstein's CFS patients benefit from his therapy. Courmel says that 50% of patients feel dramatically better after the first day. Another 25% feel better the next day and eventually a further 20% substantially improve. That leaves 5% of patients that Dr. Goldstein is not able to help much.

    Natural Treatments
    PLEASE NOTE: DR. GOLDSTEIN HAS RETIRED FROM MEDICAL PRACTICE AS OF 2003. While Dr. Goldstein's primary focus was on drug therapy, there are natural treatments and nutritional supplements he recommended to his patients as well. These included Acetyl-L-Carnitine, Vitamin B-12, DHEA, Ginkgo Biloba, Ginseng Saponins, Gotu Kola, Honey Bee Venom, Kava Kava, and St. John's Wort (Hypericum). Source Materials:
    Courmel, A Companion Volume to Dr. Jay A. Goldstein's Betrayal of the Brain. (1996)

    Galvin, Receptor Profiling as a Guide to Treatment

    Goldstein, Betrayal of the Brain (1996)

    Goldstein, My Current Approach to Neurosomatic Disorders,

    Goldstein, The Pathophysiology and Treatment of Chronic Fatigue Syndrome and Other Neurosomatic Disorders: Cognitive Therapy in a Pill Alasbimn Journal, 2(7) (April 2000)

  5. elliespad

    elliespad Member

    Bump for comments/discussion.
  6. Jeanette62

    Jeanette62 New Member

    I found this info very interesting. I was recently prescribed Nitroclycerin by a new doc I'm seeing for fibro pain, but haven't used it yet. It seems every time I'm in a lot of pain I have a bad migraine to go with it and it's not recommended to take it when you already have a headache.

    My doctor did have me try it in his office to see if it would work for me and it did. After taking the nitroglycerin, it was as if the pain magically went away. The doctor pressed on all the tender points and they no longer hurt. I've always been one to save pain med until my pain level is at it's worst. It's still so unpredictable for me so by the time I need the meds I have a migraine to go with it. Maybe I should take it for the everyday pain once in awhile so the pain doesn't elevate. I've also been having daily headaches and migraines for close to 3 weeks now with only a couple of headache free days.

    My doctor said the Nitro works because most fibro patients are deficient in nitrogen in their bodies and the nitroglycerine helps bring those levels back to normal. If I remember correctly from his discussion the low levels is what causes the pain. The supplements and vitamins he has me on will eventually bring my nitrogen levels back to normal, but it takes time so in the mean time the nitroglycerin will help reduce the pain.

    Has anyone else been prescribed Nitro for fibro pain and if so how is it working for you?

    [This Message was Edited on 11/29/2005]
  7. Kimelia

    Kimelia New Member

    I would be interested in learning more if anyone has had experience...
  8. darude

    darude New Member

    When this all started i collapsed and was unconsious. I was taken to er by ambulance ( came round in ambulance). I had chest pain so they kept giving me the nitro! Anyways it gave me the worst headache of my life which lasted for three months and rendered me bedridden. I'm thinking now that maybe my body needs it? Make sense. I now have lesions on brain but doc said NOT MS! Then what is it I ask, Another MRi in January and will discuss the nitro.