Misunderstood
Fibromyalgia is confusing and often times misdiagnosed as almost all its symptoms are associated with other conditions. Since it affects up to 3% of the world’s population and may vary from a temporary to a permanent debilitating syndrome, sufferers experience problems due to the general absence of awareness about it. Among the sufferer’s complaints are that fibromyalgia is poorly recognized and often undiagnosed; that there are many unsuccessful and inconsistent treatments prescribed; and that numerous physicians lack any knowledge about the illness.

For example, Laura, a part-time journalist, began to experience pain in her left shoulder that soon affected her lower back and hips as well. At first she decided it was due to a muscle pull from her treadmill workouts, but when the pain lingered and worsened, preventing even a walk on the treadmill when she had previously been able to run, she realized that there was more involved.

Laura's doctors attempted to categorize her based on medical complexes that included the connective tissue diseases (multiple sclerosis, sarcoidosis, mixed connective tissue disease, and lupus erythematosis) because of the presence of elevated sedimentation rates and fluctuating ANA, ACE, and LE titers. She was operated on for a frozen shoulder, only to have the pain worsen and then spread to other joints to create reflux sympathetic dystrophy. She showed evidence of ‘trigger’ points, bursitis, and arthritis; she developed Raynaud’s phenomenon; she had dry eyes (Sjorgen’s Syndrome). She was treated with anti-depressants, anti-inflammatory drugs; and when these failed, Laura was offered chemotherapeutic medication,  Methotrexate!  She developed chronic fatigue and an asthmatic condition. What Laura was experiencing with this myriad of symptoms was disabling fibromyalgia.

Symptoms
According to the American Rheumatology Association, three factors must be present in order for the physician to diagnosis of fibromyalgia. There should be chronic widespread pain, an absence of some other condition causing the symptoms, and multiple ‘trigger’ points in the soft tissue.

Vague, non-specific muscular pain is the primary complaint associated with fibromyalgia. This pain is described as achy, throbbing, burning or stabbing and is accompanied by a feeling of exhaustion. There are associated tender or “trigger” points located in the region of the occiput (nape of the neck), trapezoid (shoulders), sterno-cleido-mastoid (front of neck), subscapular, sciatic notch ( hips), biceps tendon insertions, breast bone, fascia lata, and at the knees. Other related systemic symptoms include sleep disturbances, headache, chest pain, menstrual cramps, irritable bowel, diarrhea, bloating and abdominal pain. The majority of fibromyalgia sufferers are women (10:1 ratio with men) between the ages of 20 and 55.

Approaches to Diagnosis
The correct diagnosis starts with a thorough evaluation of patient symptoms matched to laboratory tests based on the life-pyramid.  Each hormone organ's normal serum values must be considered and replacement  must bring each into the normal range.

1) PINEAL DYSFUNCTION: Sleep disturbance are present uniformly. In numerous studies focusing on fibromyalgia. Volunteers develop fibromyalgia complaints if they repeatedly have their normal sleep patterns disrupted. However, if volunteers are able to exercise daily, they do not develop fibromyalgia-like symptoms. Sleep studies of fibromyalgia patients disclosed that they are unable to achieve stage IV (deep) sleep; their sleep patterns are interrupted by alpha waves. The significance is that deep sleep states are necessary for tissue repair and for the release of human growth hormone. We confirmed this by measuring Calciferol as Vitamin D3 0,25 OH and routinely find  them well below the normal range of 35-50miu/ml.

2) ANTERIOR PITUITARY DYSFUNCTION.  Muscle pain. Muscle pain in 6 of the 9 aforementioned locations is the diagnostic test of fibromyalgia. Travell described injection of ‘trigger’ points (as she did for J.F. Kennedy in 1960-1963) with either saline or a dilute Novocain-like solution as a means of breaking up the accumulated or ‘knotted’ muscle tissue. Physical therapy, massage, and deep heat are also temporarily effective. What factors the lack of sleep, lack of exercise, lack of appropriate energy systems, and lack of nutritional supplementation play have now been determined. Bennett was first to note the very low levels of Human Growth Hormone measured as Somadomedin-C now called Insulin-like Growth Factor (IGF-1) in fibromyalgia patients in 1991. Although Bennett was able to show a 75% improvement in fibromyalgia patients with replacement of growth hormone daily for 9 months, we prefer to start with a balanced approach to all the hormone systems involved reserving HGH for those individuals who are most ill and those slow to respond.

3) THYROID DYSFUNCTION.  Lack of energy, low body temperature, poor mineralization and the sensations of both panic and exhaustion typify thyroid disorders.  Only by measuring a full gambit of thyroid parameters can one substantiate the minor and major thyroid disorders.

4) ADRENAL DYSFUNCTION. Energy cycle deficiency. Studies of oxygen consumption and exertion show that fibromyalgia patients suffer from an inability to generate adequate energy at the cellular level. This may be influenced by a decreased availability of specific hormones that influence the energy cycle. These hormones are   DHEA, TESTOSTERONE and GROWTH HORMONE.

5) DEPRESSION: Depression is often the result of  a lack of energy and a normal effect of chronic illness. As long as the effect is 'external', meaning that the depression is a result of some event outside the body, it can be eliminated by removing the external problem. Therefore, correcting the underlying cause of fibromyalgia should relieving the sleep disturbances, reduce the muscle pain, and restore energy --and thereafter, relieve depression.

DHEA:
New Hope for Fibromyalgia, Chronic Fatigue States, & Connective Tissue Disorders
Studies conducted over the last few years have shown that the hormone DHEA, dehydroepiandrosterone, seems to be effective for easing fatigue and its accompanying symptoms. Blood samples taken in the aged population, in those with connective tissue disease and in those suffering from chronic depression, show abnormally low levels of DHEA. Recent research by this author also identifies that DHEA blood values are reduced in those experiencing fatigue, headaches, and stress-related symptoms; symptoms typically present in fibromyalgia patients as well.

DHEA supplementation has been shown to reduce these symptoms in lupus erythematosis patients as reported by Drs. VanVollenhoven and McGuire(1), Department of Arthritis and Lupus, Stanford University. They further reported an improvement in not only fatigue, but also reduction in protein loss from the kidneys and a decrease in prescription steroid use. Dr. SSC Yen(2) at the University of San Diego confirmed that supplementing DHEA brought renewed energy and a general feeling of well-being to 85% of the over 50 year old men and women whose DHEA-sulfate blood levels were substandard.

How DHEA Works
DHEA is a steroid hormone which is secreted by the adrenal glands in response to a chemical stimulus from the liver. The liver hormone is called IGF-1, insulin-like growth factor-1, a byproduct of human growth hormone stimulation. Due to stress, sleep interruption, and muscle fatigue, these patients experience first a dramatic reduction in growth hormone level, then IGF-I and DHEA. With time, the blood levels and symptoms often worsens.

Since DHEA, growth hormone and IGF-1 are best known for their roles in cellular growth and repair, low levels of all three are typical in fibromyalgia patients. These patients uniformly experience a decrease in not only muscle mass, but also in physical endurance and muscle strength. Further, skeletal repair may be lowered resulting in a greater risk in the future of skeletal diseases like osteoporosis and arthritis related states. Additionally, these hormones maintain the individual’s immunity. Fibromyalgia, chronic fatigue, and mixed connective tissue individuals are prone to frequent, chronic and lingering infections. They have ‘colds,’ sore throats, and infections or cuts that fail to heal typical for Ascorbic Acid (Vitamin C) deficiencies. Interestingly, vitamin C is concentrated in the azdrenal cortex where DHEA is manufactured.  Studies have been published that confirm that DHEA can stimulate the immune system and may enhance one’s ability to recover from and prevent these infections. DHEA supplementation can make more IGF-1 and growth hormone available by freeing them from carrier proteins.

The Hormonal Connection
One Theory: Dr. Robert Bennett, professor of medicine and chairman of the division of arthritis and rheumatic disease at Oregon Health Sciences University published one of the largest studies supporting a hormonal connection in the 1992 journal Arthritis and Rheumatism(3). Studying blood samples from two groups of women - 70 women with fibromyalgia and 5 healthy women of the same ages - he reiterated the presence of very low levels of a pituitary-associated hormone, IGF-1, in the women with fibromyalgia. IGF-1 levels parallel growth hormone secretion. The researchers speculate that the low levels of growth hormone, IGF-1 and DHEA in the women with fibromyalgia may contribute to muscle pain and fatigue. Experimental treatment involving the administration of growth hormone in these conditions is being conducted at Oregon Health Sciences University under the direction of Dr. Bennett. Thus far, growth hormone replacement[4] has been a dramatically successful treatment for some fibromyalgia patients.

Beneficial Hormonal Treatments:

The Growth Hormone Link
Both in states of fibromyalgia and chronic fatigue, there has been verification that IGF-1 (Somatomedin-C) levels are abnormally low. Low levels of IGF-1 are representative of low levels of growth hormone release.

There are few conditions that trigger growth hormone release. One is during stage IV sleep and another is with exercise. In fact, reports have confirmed that exercise will temporarily improve the effects of fibromyalgia. So will repeated ‘good night’ sleep and afternoon ‘naps.’  That is why in our patient population replacement Calciferol vitamin D) is so important!

Growth hormone, once released, has a profound effect on muscle tissue. Growth hormone affects not only the repair but the development of the muscle tissue itself. Dramatic new research has confirmed that growth hormone supplementation will convert type II muscle fibers into type I. Since the majority of the elderly display little energy or endurance with predominantly type II (fast twitch- no endurance) muscle fibers, rejuvenation may occur with the use of growth hormone. In a three month period of time, up to 30% of the muscle cells may convert back to type I.

Due to the unavailability of IGF-1 and the previous limit of growth hormone to only short statue children, most individuals suffering with fibromyalgia and chronic fatigue were denied hormonal therapy. Many drug therapies have been tried. But most often, these patients report a dismal and pain filled existence.

Now and the Future: Relief of Fibromyalgia
Now, fibromyalgia and chronic fatigue patients, as confirmed by Doctor Lichten, may find significant relief of symptoms with recombinant growth hormone. Growth hormone was officially released on August 8, 1996 for treatment of somatotropin deficient syndrome (low levels of hGH) in adults. Although the cost of growth hormone may be prohibitive for many suffers, its availability, not the $200 to $500 monthly expense, has been the limiting factor for others. That is why Dr. Lichten has made human growth hormone (hGH) available by medical protocol to patients with fibromyalgia and chronic fatigue. The selection criteria is based on symptomatology and the IGF-1 (Somatomedin-C) level below 160 ug/ml as measured by Quest Laboratories, United States.

Before treating with human growth hormone, fibromyalgia should be treated with DHEA at a cost of $15-$50 per month, Vitamin D at $4 per month, and testosterone at $10-$20 per month.  Flexeril® and Ketoprofen creams, Microhydrin®, along with vitamin and mineral of Creatinine, CoEnzyme Q10, and Super Malic® therapy may also be beneficial. Massage therapy, water aerobic exercises, stretching and DMSO, and rarely prescription medications such as Flexeril, Xanax, Humabid may limit or decrease the formation of trigger points. Otherwise, injection of trigger points often can relieve the most severe pain.

Conclusion
Further research is needed to determine the origin of the insult to the body that causes fibromyalgia syndrome. Since there is no one simple cure for fibromyalgia, we will attempt to keep abreast of the best and latest literature.

Early References:

1. VanVollenhover RF, McGuire JL. An Open Study of DHEA in SLE. Arthritis&Rheum 1994;37(9):1305-10.
2. Yen SSC, Morales AJ. Effect of Replacement Dose of Dehydroepiandrosterone in Men and Women of Advancing Age. J Clin Endo& Met. 1994;78:1360-67.
3. Bennett RM, Clark SR, Campbell SM. Low Levels of Somatomedin-C in Patients with the Fibromyalgia Syndrome. Arthritis & Rheum 1992;35(10):1113-1116.
4. Bennett RM. Myopain Conference, 1995.
5. Bennett RM. Emerging concepts in the neurobiology of chronic pain: evidence of abnormal sensory processing in fibromyalgia. Mayo Clin Proc 1999: Apr; 74(4): 385-98
6.Bennett RM. Disordered growth hormone secretion in fibromyalgia: a review f recent findings ad a hypothesizing etiology. Z Rheumatol 1998; 57 S 2: 72-6
7. Bennett R. Fibromyalgia, chronic fatigue syndrome, and myofascial pain. Curr Opin Rheumatol 1998 Mar; 10(2): 95- 103
8. Bennett RM, Clark SC, Walczyk J. A randomized, double-blind, placebo-controlled study of growth hormone in the treatment of fibromyalgia. Am J Med 1998 Mar;104(3):227-31

Contact Dr. Lichten at (248) 593-9999 or via email at drlichten@yahoo.com. Visit Dr. Lichten's website at http://www.usdoctor.com/.