Life Extension Magazine

Life Extension Magazine July 2005

Case History

Therapeutic Options for Fibromyalgia

By Dr. Sergey A. Dzugan

By Dr. Sergey A. Dzugan

Dr. Sergey A. Dzugan

While chronic, widespread musculoskeletal pain (fibromyalgia) has been recorded since antiquity, only in the past two decades have researchers conducted significant medical and experimental studies on the subject. According to recent findings, 1.3-4.8% of the populations of Western industrialized nations suffer from fibromyalgia, and 80-90% of those affected are women.1,2 Approximately 6 million Americans (including 4 million women) suffer from fibromyalgia,3 which most commonly occurs between the ages of 30 and 60 years.4

Fibromyalgia is characterized by generalized joint and muscle pain without physical abnormality, and involves tenderness in certain areas of the body. The patient may also display stiffness, fatigue, sleep disturbances, cognitive impairment, sensitivity to noise and stress, menstrual disorders, irritable bowel syndrome, allergies, migraine, and depression. Physical examination and laboratory testing generally do not reveal any abnormalities.5-7 The American College of Rheumatology developed the diagnostic criteria for fibromyalgia, which include diffuse soft tissue pain for at least three months’ duration and pain when pressure is applied to 11 or more of 18 specific points on the body.5,8 The etiology (cause) of fibromyalgia is not known.

Common medical treatments for fibromyalgia include one or more of the following: antidepressants, nonsteroidal anti-inflammatory drugs (NSAIDs), analgesics (painkillers), psychoactive drugs, physical therapy, gentle stretching, exercises, stress reduction, cognitive-behavioral therapies, and lidocaine injections with or without hydrocortisone.9,10 Treatment of fibromyalgia, whether pharmacological or psychological, remains problematic, primarily symptomatic, and unsatisfactory overall. The medical prognosis for fibromyalgia is not favorable.11

Fibromyalgia is associated with significantly diminished quality of life and substantial financial costs.8

The following detailed patient case report highlights a novel integrative treatment program that was highly successful in treating this patient’s severe fibromyalgia.

Background

A 55-year-old woman suffering from fibromyalgia presented in June 2002. At the initial interview, her complaints included generalized pain, migraine, fatigue, poor energy level, severe depression, panic attacks, suicidal thoughts, insomnia, severe short-term memory difficulties, weight gain, constipation, and poor libido and sex drive. The patient reported that upon waking, she felt sore, stiff, and as though she never really slept. She described her life as filled with relentless pain and a struggle with constant fatigue and depression.

She was taking prescription medications for pain, depression, panic attacks, insomnia, and hot flashes (various analgesics, Wellbutrin®, Klonopin®, Ambien®, and Activella®). Over the past 15 years, the patient had tried many forms of treatment, including physical therapy, massage, acupuncture, chiropractic, and exercise, with little or no improvement of her fibromyalgia symptoms. She was moderately overweight (standing five feet, five inches, and weighing 168 pounds) and had had no menstrual cycle for the last 13 years. She had a history of premenstrual syndrome. She did not use tobacco or alcohol.

A once healthy woman, the patient developed pain in the cervical and lumbar regions of the spine more than 20 years ago. The condition started quite typically, with mild muscle pain accompanied by generalized aches and stiffness, followed by severe fatigue, poor short-term memory, irritability, and problems with bowel movements. She felt constant stress and usually woke up in the morning feeling extremely tired. Over the course of a few months, the patient developed insomnia, migraine, and severe depression. Diagnostic tests showed no evidence of joint damage or disease, nor did her medical history reveal any precipitating factors. She had no family history of fibromyalgia or migraine. Her pain was constant and severe, and interfered with daily function.

For months, the patient sought treatment from multiple specialists, who told her that her physical pain was psychiatric in origin and not related to specific physical morbidity. A rheumatologist diagnosed her condition as fibromyalgia. Dismayed over a lack of progress with her treatment, the patient unsuccessfully attempted suicide by overdosing on medication in 2000. After that, she was placed on several antidepressants, which were of marginal help in controlling her depression, panic attacks, and suicidal thoughts, but did not adequately relieve her pain.

Diagnosis and Treatment

We suspected that the patient’s symptoms were related to hormonal deficiencies resulting in neurohormonal and metabolic imbalance. The results of initial blood tests confirmed our suspicions, revealing that the patient had low levels of total estrogen, progesterone, and pregnenolone, as well as a “male dominance” pattern of relatively high testosterone in relation to estrogen and progesterone.

The patient’s hormone levels were as follows (reference ranges shown in parentheses):

Hormone

DHEA-S

Pregnenolone

Total estrogen

Progesterone

Total testosterone

(Reference range)
Patient’s result

(65-380 ug/dL)
100

(10-230 ng/dL)
32

(61-437 pg/mL)
59

(0.2-28 ng/mL)
0.6

(14-76 ng/dL)
50

Based on these findings, the patient was treated with the following:

  • pregnenolone: 300 mg taken in the morning.
  • DHEA: 100 mg taken in the morning.
  • 7-keto DHEA: 70 mg taken at noon.
  • Triest gel (containing a 90:7:3 ratio of estriol, estradiol, and estrone): 1 cc in the morning on days 1-14, 0.8 cc in the morning on days 15-25, and 0.4 cc in the morning on the remaining days of each month.
  • progesterone gel (50 mg/ml): 0.8 cc in the morning on days 1-14, 1 cc in the morning on days 15-25, and 0.6 cc in the morning on the remaining days of each month.
  • testosterone gel (50 mg/ml): 0.2 cc in the morning, every other day.
  • Nutribiotic® MetaRest® (containing 3 mg of melatonin, 250 mg of kava root extract, and 10 mg of vitamin B6 per capsule): two capsules taken at bedtime.
  • NutriCology® ProGreens® (containing green foods, plant fibers, bioflavonoids, herbal extracts, and probiotics, including 3.5 billion Lactobacillus group, 1 billion Bifidobacterium group, and 0.5 billion Streptococcus thermophilus per scoop): one scoop taken in the morning.
  • Alacer CMA™ Calcium-Magnesium Ascorbate (containing 1860 mg of vitamin C as mineral ascorbates, 100 mg of calcium, 40 mg of magnesium, 10 mg of vitamin B6, 72 mg of magnesium citrate, and 200 mg of lemon and orange bioflavonoids per two tablets): two tablets taken at bedtime.
  • vitamin C as sodium ascorbate: one tablet taken three times a day.
  • glucosamine sulfate: 2250 mg taken in the morning.
  • Douglas Laboratories® RheumaShield™ (containing 10 mg of undenatured type II collagen and a proprietary blend of standardized devil’s claw root extract and bromelain per capsule): one capsule taken at bedtime with eight ounces of water.

In addition, the patient discontinued use of the prescription drug Activella® shortly after beginning this program. No dietary modifications were initiated.

Within the first two months, the patient began to show signs of improvement. At a follow-up visit one month after beginning treatment, she said her migraine was less frequent and severe, and her backaches, joint pain, and neck pain seemed to be significantly diminished. Her fatigue was improved slightly and her depression diminished somewhat. She reported that her sleep was improved significantly and that she felt more rested upon waking. She began to slowly decrease her sleep medication. After the first month of treatment, she felt significant enough improvement in her fibromyalgia symptoms to stop taking Wellbutrin® and Klonopin®.

Because the patient still complained of severe short-term memory problems and constipation, we recommended several additions to her program. To support healthy memory, we suggested phosphatidylserine capsules, 300 mg to be taken in the morning. To restore healthy gastrointestinal function and support sleep, we added Longevity Science® MagnaCalm (containing 420 mg of magnesium citrate per scoop), two scoops to be taken at bedtime. We suspected that the patient may have had altered intestinal flora due to her history of prescription drug use. To support healthy microflora of the gastrointestinal tract, we recommended increasing the dose of ProGreens® to one scoop taken twice a day, and initiating a one-month parasite-cleansing program using Unicity™ Paraway® Pack, a blend of herbs, fiber, and fructooligosaccharides. To further support optimal gut flora, we recommended that the patient decrease her dietary consumption of sugar. Additionally, we added Life Extension™ Natural Sex for Women (containing herbal and homeopathic extracts to support sexual vitality), two tablets to be taken in the morning. The patient also began to take HGH (human growth hormone) of 0.5 IU daily, six days per week. During the next month, her sleep and constipation problems resolved, her energy level increased significantly, and her depression was improved greatly. In addition, her sex drive was restored completely.

After four months of treatment, the patient reported that the majority of her symptoms had improved or disappeared. She no longer complained of fibromyalgia, migraine, depression, or fatigue. According to her husband, she was feeling “999% better” than she had in the past 20 years. A follow-up blood test showed marked improvements in her hormone profile (reference ranges shown in parentheses):

Hormone

DHEA-S

Pregnenolone

Total estrogen

Progesterone

Total testosterone

(Reference range)
Patient’s result

(65-380 ug/dL)
428

(10-230 ng/dL)
80

(61-437 pg/mL)
249

(0.2-28 ng/mL)
5.4

(14-76 ng/dL)
62

After more than two years of treatment, the patient is free of fibromyalgia symptoms and her other major health complaints. She exercises regularly, eats a balanced diet, and has lost five pounds. She remains on hormone-restorative therapy and continues taking a dietary supplement regimen. The patient was able to resume her normal daily activities, including full-time work in the family business.