The Dangers of Sleep Aids

Quality sleep is necessary not only for proper concentration and daytime alertness, but impacts health a variety of positive ways, including improved immune function, better memory, and decreased risk of obesity.[1]  Commonly used sleep aids such as Benzodiazepines and Zolpidem, help you to fall asleep faster and stay asleep longer, but do not improve deep sleep or REM (dream) sleep and often leave people groggy in the morning.[2]

Benzodiazepines are a type of hypnotic medication that is used by the body to increase the rate at which GABA is used.  GABA is a neurotransmitter that is known for inducing sleep and reducing anxiety.  Short term, these drugs have been shown to be an effective and helpful way to facilitate sleep.  Long term, on the other hand, the use of these medications is not recommended by doctors.  Benzodiazepines are associated with many risks including drug dependence, withdrawal symptoms, drug tolerance, dizziness, and risks of falling.  Rebound insomnia, which causes the symptoms of insomnia to worsen after stopping medications, is also common when people stop taking benzodiazepines.  According to the American Geriatric Society BEERS Criteria, a clinical tool that addresses potentially inappropriate medication use in older adults, the use of benzodiazepines should be avoided due to geriatric patient’ increased sensitivity to benzodiazepines and decreased metabolism of long-acting agents.[3]

The most commonly prescribed sleep aid in the United States is zolpidem (ambien).  The FDA has recently issued additional warning for drugs containing zolpidem (ambien, ambien CR, Edluar, and zopimist) recommending the bedtime dose be lowered especially for women. New data shows that blood levels in some patients can still be high enough in the morning to impair activities that require alertness including driving.

The impact of AM grogginess on function cannot be understated.  Kevin Wright, PhD published a study in JAMA in 2006, showing that patients who suffered with AM grogginess scored worse on cognitive and memory tests than patients who had stayed awake for more than 24 consecutive hours.[4]

Options to improve the quality of sleep without causing AM grogginess are more prevalent now than ever before and are a much safer and more effective way to manage insomnia and other sleep disorders.  Studies show that people can improve their insomnia by changing sleep habits.  Examples of this include going to bed consistently at the same time, having a darkened room, not using your bedroom for non-sleeping activities, and avoiding stimulants about 3 hours before bedtime.

Medical foods are a safe and effective option for patients with insomnia and other sleep disorders. Medical foods are amino acids and other nutrients, that when combined, correct the metabolic deficiencies of diseases and conditions.  They provide a solution that cannot be obtained from diet alone or supplements. They have been found to improve the quality of sleep without the morning grogginess or side effects of other prescription sleep medications. Medical foods may make getting a good nights’ sleep an achievable goal.



[1] Arch Dis Child 2006;91:881-884 doi:10.1136/adc.2005.093013

[2] Zolpidem Containing Products: Drug Safety Communication- FDA Requires Lower Recommended Doses (2013). Retrieved April 23, 2014. http://www.fda.gov/safety/medwatch/safetyinformation/safetyalertsforhumanmedicalproducts/ucm334738.htm

[3] AGS BEERS Criteria for Potentially Inappropriate Medication use in Older Adults (2012). Retrieved April 23, 2014. http://www.americangeriatrics.org/files/documents/beers/PrintableBeersPocketCard.pdf

[4] Adam T. Wertz, BS; Joseph M. Ronda, MS; Charles A. Czeisler, PhD, MD; Kenneth P. Wright, PhD

JAMA. 2006;295(2):159-164. doi:10.1001/jama.295.2.163.

The Cost of Pain

Pain and the treatment of pain affect every sector of our society with at least 100 million adult Americans reportedly suffering  from common chronic pain conditions, a conservative estimate because it does not include acute pain of children.[1]  The proliferation of pain in the United States has resulted in a sharp increase over the past decade in the overuse of narcotics. The prescribing of narcotics has become a popular option for the treatment of chronic pain associated with back injuries, headaches, arthritis, and fibromyalgia.

Chronic pain takes an enormous personal toll on millions of patients and their families, and leads to increased health care costs. Patients with chronic pain have more hospital admissions, longer hospital stays, and unnecessary trips to the emergency department. Such inefficient and even wasteful treatment for pain is contributing to the rapid rise in health care costs in the United States.

The prevalence of pain has a tremendous impact on business.  A recent report by the Institute of Medicine indicated that the annual value of lost productivity in 2010 dollars ranged between $297.4 billion to $335.5 billion. The value of lost productivity is based on three estimates: days of work missed (ranging from $11.6 to $12.7 billion); hours of work lost (from $95.2 to $96.5 billion); and lower wages (from $190.6 billion to $226.3 billion)[2]. This billion dollar annualized price tag will likely climb as the U.S. population ages.

The cost of pain also includes the cost of treating side effects. The most commonly prescribed drug for pain is Non-Steroidal Anti-Inflammatory Drugs (NSAIDs).  Approximately 98 million prescriptions for NSAIDs were filled in the United States in 2012 (IMS 2012).  Although effective in treating pain and inflammation, NSAIDs are linked to adverse side effects which make them inappropriate for use in many patient populations.  There are several serious side effects and toxicity related to use of traditional NSAIDs which can lead to costly hospitalizations or death.

A study on the effects of NSAID induced side effects in the elderly reflected the average direct costs of GI side effects per patient-day on NSAIDs were 3.5 times higher than those of a patient-day not on NSAIDs. Seventy percent of the cost was attributed to GI events resulting from NSAID treatment. [3]

NSAIDs Image

Treatment of GI problems alone caused by the use of NSAIDs is estimated to add over 40% to the cost of arthritis care[4]

From the perspective of the healthcare system, minor GI side-effects and prophylactic gastroprotection against NSAID-related side-effects may consume even more healthcare resources than severe events because of their high prevalence.

Opioid use has resulted in increased hospitalizations, increased spending on opioid addiction and increased workplace costs.  The cost of the average lost time claim with long acting opioids is 900% higher than those without the use of opioids. U.S. emergency room visits have also increased.  The number of cases in which an opioid other than heroin was cited as a reason for an emergency room treatment in  2004 was 299,498 and in 2011 was 885,348, an almost 300% increase.[5]

While many assume that increase spending and use of pharmaceuticals for pain has had a positive effect on the overall mitigation of pain, there is little scientific data on the relationship between spending on pharmaceutical agents and pain resolution.  Simply treating the symptoms of pain have not proven to be effective nor cost saving in the long run. However, it is increasingly clear that there may be a positive relationship between the use of non-pharmaceutical interventions with or without the use of pharmaceutical and the resolution of pain.

#medicalfoods #NSAIDs #opiods #sideeffects


[1] IMS Health Data, California Workers’ Compensation Institute

[2] Institute of Medicine of the National Academies Report. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research, 2011. The National Academies Press, Washington DC

[3] Br J Clin Pharmacol. 2001 August; 52(2): 185–192. Cost of prescribed NSAID-related gastrointestinal adverse events in elderly patients

[4] Bloom, BS. Direct medical costs of disease and gastrointestinal side effects during treatment for arthritis. Am J Med. 1988; 84(2A): 20-24

[5] IMS Health Data, California Workers’ Compensation Institute

Pain Management without Harmful Side Effects

The reduction and management of pain can involve many approaches: prescription medicines, over the counter medicines, medical foods, cognitive behavioral therapy, physical exercise, surgery, nutritional modification, pain education, massage, biofeedback, music, guided imagery, laughter, distraction, acupuncture, and nerve stimulation.  Two or more approaches combined can have a synergistic or additive effect that is greater than the sum of the parts.  One approach, medical foods, has medicinal value that is just beginning to be understood and can be used as a stand-alone therapy or adjacent treatment for chronic pain.

Due to its’ additive effect and low side-effect profile, Theramine®, a medical foods, can be used with high-risk patients over the age of 65 as an alternative to NSAIDs or narcotics.  Adding Theramine to a pain treatment protocol can lead to a reduction in previously prescribed narcotics and minimize the use of NSAIDs or both.  The ingredients in Theramine are Generally Recognized As Safe (GRAS) by the FDA, have no risk of addiction or adverse GI or cardiovascular side effects.  Reducing the burden of adverse side effects while improving clinical outcomes is critical for the overall patient care and a return to activities of daily living.

Two studies comparing Theramine to a low dose NSAIDs in adults 18 years of age and above found Theramine to be more effective than either naproxen or ibuprofen alone for inflammatory pain.  When Theramine was given in combination with the low dose of either product the results were even more beneficial.  Incorporating the use of Theramine into a clinical pain management protocol, allows physicians the flexibility to use less of a narcotic or NSAID pain reliever and potentially eliminate their use all together.

The two studies comparing the medical food Theramine and a non-steroidal anti-inflammatory medication, Theramine was shown to be more effective than low dose NSAIDs in treating low back pain.  Clinical data indicates significant reduction in back pain with the administration of Theramine alone, and as an adjunct therapy to a low dose NSAID, while administration of a low dose NSAID had no appreciable effect on pain. The use of Theramine as either a standalone or adjunct therapy can significantly improve pain perception.

Theramine is encapsulated with a patented technology that promotes the rapid cellular uptake and conversion of milligram amounts of amino acids and nutrients into the specific neurotransmitters responsible for modulating pain and inflammation.  This patented technology allows Theramine to be effective without losing efficacy over time.

Two multicenter double blind trials have established the safety and efficacy of Theramine in the treatment of chronic back pain. Pain fell by 63% with administration of Theramine and an NSAID as measured by the Roland- Morris Index (Figure 1), and by 62% as measured by The Oswestry Disability Index.

Pain Scale Graph

Traditional pain medication will always have its place in therapeutic treatment and, if used properly, is very effective.  However, physicians, insurance companies, employers and patients are requesting safer, more effective alternatives to treat pain without harmful and costly side effects. The rapidly increasing population of patients 65 years of age and older is a major concern for both physicians and insurance companies as the pain-related costs to overall U.S. health care expenses are likely to rise proportionally as well. The economic impact of pain is certain, as are the physical, emotional, and social impact for millions of people. Reducing the burden of treating chronic pain is a societal necessity, a medical challenge, and an economic requirement.

#medicalfoods #NSAIDs #theramine

The Nutritional Needs of Autism Spectrum Disorders (ASD) May Not Be Met By Diet and Supplements Alone

While autism is a complex neurodevelopmental disorder influenced by genetic and environmental factors, researchers and families are increasingly focusing on the nutritional deficiencies associated with the disorder. Researchers are finding specific nutritional insufficiencies and metabolic abnormalities associated with ASD while parents aggressively try a variety of diets and supplements despite a lack of formal data.

There are currently no safe and effective treatment options for the three core characteristics of ASD, so many parents seek out alternative methods for managing the symptoms of the disease. In many cases, certain foods such as casein (milk protein) and gluten (wheat protein) are excluded from diets in an attempt to modify behavior. This approach, although sometimes effective, does raise concerns about potential nutritional deficiencies that can affect brain and body development. Others provide supplements without any assurance that the nutrients are adequately absorbed. Scientists working with Medical Foods are convinced that by offering a combination of amino acid precursors to specific neurotransmitters, provided under a physician’s supervision, there might be a solution. Based on positive preliminary investigational results, they are designing clinical studies to prove their hypothesis.

The history of nutrition and autism begins with the knowledge that vitamins, minerals and amino acids are critical to human health and that poor diet is a major contributing factor to many child health problems, including rickets (calcium/vitamin D deficiency), anemia (low iron), hypothyroid (low iodine), and scurvy (vitamin C deficiency). Research has demonstrated that there are nutritional deficiencies associated with developmental disabilities such as attention deficit disorder and intellectual development. Those with ASD have the same needs for calcium and protein and in addition were found to have more essential amino acid deficiencies consistent with poor protein nutrition than an age/gender matched control group.[i] Those on restricted diets tended to have lower plasma levels of essential acids including the neurotransmitter precursors tyrosine and tryptophan than both controls and children with autism on unrestricted diets.  A 2013 study of 55 children with ASD found Low levels of biotin, plasma glutathione, and plasma tryptophan and several other measures; and also high levels of oxidative stress markers and plasma glutamate.[ii] Work continues examining the role of glutathione – a small peptide derived from the amino acids glutamic acid, glycine and cysteine and the body’s chief detoxifier.

Understanding the nutritional status of ASD means not just looking at diet and intake, but also examining digestion, absorption, metabolic processing, metabolic demand, metabolic turn over rate and elimination. Each of these plays a role in nutritional insufficiency and altered metabolic turnover rates. For example, the use of nutritional supplements without taking into account the processing capacity of receptors involved in the metabolism of these nutrients or their ability to get beyond the blood brain barrier can result in uneven absorption or simply generate a nutrient-rich urine without clinical benefit or long-term improvement in behavior.Female_Scientific_Research

Scientists at Targeted Medical Pharma, a Los Angeles based biotechnology company are convinced that the patented technology behind their medical foods, Targeted Cellular Technology (TCT) addresses these issues. TCT is an integrated molecular system that facilitates the uptake and utilization of nutrients by target cells within the nervous system. This patented five step system consists of (1) specific neurotransmitter precursors such as amino acids and nutrients; (2) a stimulus for the neuronal uptake of these precursors by specific neurons; (3) an adenosine antagonist that blocks the inhibitory effect of adenosine on neuronal activity (adenosine brake); (4) a stimulus to trigger the release of the required neurotransmitters from targeted neurons; and (5) a mechanism to prevent attenuation of the precursor response, a well known phenomenon associated with amino acid, nutrient and drug administration. Use of Targeted Cellular Technology improves the metabolic efficiency of neurotransmitter synthesis, thereby reducing the amounts of precursors needed to correct neurotransmitter imbalances. TCT synchronizes the availability of the neurotransmitter precursor supply with the fluctuating demand for the corresponding neurotransmitters.

A recent investigator initiated clinical observation looked at 26 children who were diagnosed with ASD or suffering from related symptoms including explosive behavior, social isolation, and mood disorder, treated for a time period ranging between 30 days and one year using an amino acid based formulation of TCT based medical foods. The investigator reported significant improvement with regards to decreased disruptive outbursts, improved socialization, improved mood and reduction in drug dose. Scientists hypothesized that nutritional insufficiency and metabolic imbalances that play a role in ASD may be dramatically improved using the approach of certain medical foods. They are now using an autism-specific formulation with milligram amounts of amino acid precursors and other biogenic ingredients designed to correct nutritional deficiencies associated with ASD. They plan test their hypothesis in a placebo-controlled, randomized, double-blind study.


 

[i] Arnold, et al. Plasma amino acids profiles in children with autism: potential risk of nutritional deficiencies. J Autism Dev Disord. 2003 Aug;33(4):449-54.

[ii] Adams, J. Summary of Dietary, Nutritional, and Medical Treatments for Autism. Arizona State University, Autism Research Institute.

A New Approach to Improving Neuropathic Pain

In the United States, approximately 20 million people suffer from neuropathy. The most common form of neuropathy is diabetic neuropathy with over half of diabetes patients living with this condition. Neuropathy may also be caused by poor circulation, herpes outbreaks or can be drug induced.

Neuropathic pain is the result of degeneration of the outer sheathing or myelin sheath of nerve cells. This is analogous to an electrical wire that is covered with insulation, and the insulation is beginning to breakdown. Without insulation the unprotected wire will start short-circuiting. In the same way, when the sheathing of nerve cells degenerate, the signals being transmitted start to  misfire, resulting in the body receiving signals that are interpreted as numbness, heat, cold, tingling and pain in the toes, feet legs, fingers, hands and arms.

Degradation of the myelin sheath results in unusual sensitivity of the neurons and abnormal excitability and heightened sensitivity to stimuli, also known as peripheral sensitization. The heightened sensitivity results in an increased demand and competition for nutrients involved with the pain receptors, particularly arginine, choline, GABA, glutamine, histidine, and serine.

The degradation of nerve pathways increases the turnover rate of the precursors needed for neurotransmitter function.  This results in a reduction in the level of production of neurotransmitters. The nutritional requirements for proper neurotransmitter function are such that they cannot be achieved by the modification of diet alone.

Unfortunately, current neuropathy treatment exists primarily of palliative treatment of symptoms. There are a variety of treatments available that range from pharmaceutical drugs and creams to therapies that stimulate the nervous system.  Antidepressants, especially tricyclics and selective serotonin-norepinephrine re-uptake inhibitors (SNRI’s), have been mainstay treatments for neuropathic pain along with antiepileptic drugs such as Lyrica and Neurontin. Opioid narcotic treatments for neuropathy are used as well but are less favored because of the risk of dependency. Most topical treatments have been largely ineffective at improving symptoms or the disease.

Treatment that addresses the distinctive nutritional needs of adults suffering from neuropathic pain rather than treating symptoms alone is a rapidly expanding field of interest for podiatric medicine.  The unique nutritional needs that arise in patients suffering from neuropathic pain cannot be satisfied through a conventional diet or through supplementation (i.e., use of a dietary supplement).

An open-label pilot study of an amino acid-based oral formulation was shown to reduce symptoms of pain and numbness related to peripheral neuropathy by supplying amino acids and other dietary factors which support induction, maintenance, and enhancement of the specific neurotransmitters involved in pain. Use of neurotransmitter precursors in a patented Targeted Cellular Technology system allows for smaller amounts of amino acids to be rapidly utilized by target cells making daily dosing more feasible and efficient.  Supplying the nutrients involved with the various pain signaling pathways in a targeted delivery system  can synchronize the availability of the precursor supply with the fluctuating demand for the corresponding neurotransmitters resulting in reduced pain, inflammation and numbness.

Neuropathic pain may not be completely preventable. Controlling blood sugar levels if you have diabetes, smoking cessation, alcohol moderation and regular exercise can help. In many cases a prescription nutrition program that addresses the increased requirements of the disease is needed for optimal clinical results and increased patient satisfaction.

Sleepless in America

Eighty three percent of Americans say they do not always get a good night’s sleep on a regular basis, according to the 2013 Rx Sleep Survey conducted by Harris Interactive. The results also revealed that forty-eight percent of Americans say stress and anxiety prevent them from getting a good night’s sleep on a regular basis.  There are gender differences with more women than men are likely to have difficulty falling and staying asleep and to experience more daytime sleepiness. According to the Harris survey more women (88 percent) than men (78 percent) suffer from lack of sleep or sleep disorders, Fifty-six percent of women say anxiety and stress are the leading reasons for lack of restful sleep, compared to 40 percent of men. For all the other top reasons Americans do not always get a good night’s sleep more woman than men report:

  • Inability to turn off thoughts (16% more women than men)
  • Pain (13% more women than men)
  • Being overtired (22% more women than men)
  • Background noise (25% more women than men)
  • Children or pets (33% more women than men)

It is unclear why more women than men report sleep disorders. It is possible that women may require more sleep than men or that they may simply have greater physiological consequences to lack of sleep than men. Pregnancy and menopause too can dramatically alter sleep patterns. What is known is that the consequences of too little sleep on women are dangerous. According to a recent study conducted by Duke University, women who get too little sleep have a higher risk of developing heart disease, depression or other psychological problems. They are also more likely to develop blood clots which put them at greater risk for stroke.

Regarding treatment, the results revealed that while overall 25 percent of Americans would be willing to take a prescription sleep aid to improve sleep quality, the majority of Americans (71 percent) would rather use other means to get a good night’s rest. When it comes to treatment for sleep disorders the gender disparities continue.  More women (29 percent) than men (20 percent) would be willing to take a prescription sleep aid. The survey also found that women (68 percent) are less inclined than men (75 percent) to use other means than prescription sleep aids to help them sleep. These results are supported by research on inflammatory markers showing that women experience chronic pain more frequently, with greater intensity and longer duration than do men.  Having more pain during the day, the ease and facility of pharmaceutical solutions may be most appealing to women.

According to the CDC, the number of prescriptions for pharmaceutical sleep aids has increased dramatically in the past 10 years with more than 9 million Americans or 1 in 25 are using such aids.  While not a cause of death, recent studies suggest that patients taking prescription drugs for sleep were nearly five times as likely as non-users to die over a period of two and a half years. Sleep drugs have very serious side effects which can impair daily function and overall quality of life. The popular misconception of these drugs is that they improve overall sleep quality, when in reality they often interfere with a patient’s ability to achieve meaningful restorative sleep and normal physiologic function. The FDA recently ordered a label change for the popular sleep drug zolpidem (ambien) because women are more susceptible to next-morning impairment. With issues such as addiction, rebound insomnia, morning grogginess and memory loss, many providers are encouraging both men and women to seek alternatives to prescription drugs for sleep.

Alternatives to Prescription Sleep Drugs

There are many non-pharmacologic therapeutic options for patients affected by sleep disorders including educating patients about sleep, sleep hygiene, aerobic exercise and cognitive behavioral therapy. One new and rapidly expanding field of treatment is the use of medical foods to manage the specific amino acid and neurotransmitter deficiencies associated with sleep disorders. Medical foods are a well defined FDA regulatory category established by the Orphan Drug Act of 1988. Medical foods work on a different pathway from other prescription drugs and contain ingredients that are Generally Recognized as Safe (GRAS) by the FDA.

Rather than focusing on a single receptor site or molecule, medical foods work on multiple pathways providing depleted cells with the amino acids and specific nutrients that are needed to help fall asleep and achieve restorative sleep, many of which cannot be replaced by simple dietary alterations or supplements alone. For example, insomnia is often a co-morbidity of anxiety and of chronic pain. These specific conditions alter the metabolic processes of the nervous system resulting in a relative nutritional deficiency. Correcting the nutritional deficiencies is an approach that has shown to be effective with minimal to no side effects. The management of sleep is a complex process that is influenced by other diseases and conditions, and even gender. Talk to your healthcare professional about alternatives to prescription drugs for sleep.

 

 

 

 

 

 

 

The Rising Healthcare Costs of Pharmaceuticals

Prescription drug use and abuse in the United States, continues to rise at an alarming rate as consumers continue to rely on pharmaceuticals for managing disease symptoms. A recent Mayo Clinic study reports that nearly 70% of all Americans have used at least one prescription drug and more than half receive at least two prescriptions, a percentage that has grown over the last decade. A startling 13% of Americans are on painkilling opiods. Increased prescription writing for pharmaceuticals unfortunately results in more side effects, polypharmacy, fatal overdoses and frequent abuse. According the Centers for Disease Control and Prevention (CDC) The overall impact on healthcare expenditures on prescription drugs reached $259 billion in 2010, and accounted for 12 percent of the total personal health care expenditures and is expected to double over the next decade.

This dramatic increase in prescription drug use can be attributed to a number of factors. For example,  as the average lifespan of people increases so to does the incidence of chronic disease, many of which are conditions requiring more treatments and drugs for longer periods of time; patients expect that they will always receive a prescription when they go to a physician’s office which encourages doctors to overprescribe; hospitals and emergency rooms with little time for alternative treatments, want to help patients by giving them prescriptions to treat them expediently for pain, sleep and other issues; and since women on average visit a doctor more frequently than men do, women are often prescribed a narcotic or anti-anxiety drug more often than most men.

generic pills and bottleIncreased prescribing of drugs unfortunately results in more side effects and even fatal overdoses. According to the CDC, from 1999 to 2010, the number of fatal overdoses has increased fivefold among women and tripled among men. When abuse of prescriptions is considered, the problem can be described as epidemic.  Data from the National Survey on Drug Use and Health (NSDUH) show that nearly one-third of people aged 12 and over whom used drugs for the first time in 2009 began by using a prescription drug non-medically.

These escalations continue to put stress on America’s health care system.  Many studies point to the economic impact associated with the increased use of pharmaceuticals. In a recent study released by the Worker’s Compensation Research Institute, the average cost of treating an injured worker without an opiate is $13,000, compared to an average cost of $117,000 for a patient prescribed a long-acting opiate like OxyContin.  According to the Express Scripts 2012 Workers’ Compensation Drug Trend Report for each dollar spent on abused drugs, an additional $41 is used for associated medical treatment.

It’s no secret that more Americans want medical alternatives without the harmful side effects associated with certain pharmaceuticals.  Consumer demands have shifted away from traditional pharmaceuticals to natural alternatives such as plant based pharmaceuticals and more recently medical foods.  In fact, seventy-one percent of sleep-deprived Americans would rather use other means than pharmaceutical drugs to help them sleep, according to a 2013 Harris interactive Rx Sleep Survey.

In one pharmacoeconomic analysis published in the Journal of Pharmacy Research, it was determined that the actual cost of using the non-opiate pain medication, Theramine®, a prescription medical food with minimal side effects is considerably lower when compared to the total impact of NSAIDs.  Medical foods, once a novelty, are becoming mainstream for a variety of diseases. Since drugs and medical foods work along different pathways in the body, medical foods are often recommended as a complementary or adjunct medication to a reduced dosage of a drug, thereby minimizing the potential of harmful side effects associated with traditional, high dose medications. Medical foods offer an important alternative to traditional pharmaceuticals ultimately improving patient outcomes and reducing healthcare care costs.

Opioid Receptors Impaired in Fibromyalgia Patients

µ-Opioid Receptors Impaired in Fibromyalgia Patients

Chronic idiopathic pain associated with fibromyalgia is complex to manage and is often associated with other co-morbidities such as depression. A recently published University of Michigan study looked closely at µ-opioid receptor availability in fibromyalgia patients, providing sound physiologic data confirming the widespread consensus that the inability of these patients to process pain signals effectively is largely due to the inability of receptors in key areas of the central nervous system to bind to analgesic opioids.

The clinical management of fibromyalgia is very complex and requires a multi-modal approach to pain management that is specific to the individual patient.  Narcotic pain medications are largely ineffective at mitigating idiopathic pain in fibromyalgia patients and often lead to many more serious side-effects that can exacerbate and prolong the condition. The widespread use of narcotics to manage non-malignant chronic pain is a serious problem in the United States and there is no medical evidence showing that these drugs actually work to treat the chronic pain of fibromyalgia. The study’s results are further evidence for clinicians that the use of non-narcotic interventions for pain management of fibromyalgia are more effective treatment options.

Medical foods are a good example of a therapeutic alternative for the treatment of fibromyalgia.  These prescription-only medications treat the nutritional deficiencies in chronic disease and not just the symptoms.  Patients diagnosed with fibromyalgia, for example, may have an increased need for precursors of the neurotransmitters nitric oxide, GABA (gamma-amino butyric acid), serotonin, and acetylcholine.  These include amino acids and nutrients such as arginine, glutamate, tryptophan, acetyl-L-carnitine, and choline. The clinical dietary management of fibromyalgia contains the specific elements the body requires to stimulate production of the neurotransmitters required to support effective pain control.

As a practicing board-certified rheumatologist and internist, I have prescribed medical foods to patients for the treatment of fibromyalgia for a number of years.  Healthcare providers and patients interested in a more efficacious treatment for fibromyalgia with little or no side effects should familiarize themselves with the class of medications regulated by the FDA as medical foods.

The Nutritional Management of Disease

The connections among nutrition, disease prevention, and health maintenance are established and well accepted.  However, the nutritional aspects of certain disease states are less well understood. Patients suffering from PTSD, depression, Fibromyalgia, peripheral neuropathy, obesity, hypertension, pain syndromes, and even cognitive impairment often have metabolic abnormalities that affect how nutrients and amino acids are metabolized. Disease, exposure to certain toxic chemicals, stress, and even some pharmaceuticals can alter the nutritional requirements of an individual and exacerbate or prolong their condition (1) (2) (3). For patients suffering from disordered metabolic processes associated with a disease or toxic exposure, the modification of dietary intake is insufficent to meet the body’s increased demand for certain nutritional components.  Recognizing and correcting these deficits with specific formulations is an integral part of the medical management of certain disease states and potentially the most important component of clinical care.

The distinctive nutritional needs associated with a disease reflect the total amount needed by a healthy person to support life or maintain homeostasis, adjusted for the distinctive changes in the nutritional needs of the patient as a result of the effects of the disease process on absorption, metabolism and excretion. Medical foods such as Theramine® which is specifically formulated to address the altered metabolic processes associated with pain and inflammation, go beyond simple dietary interventions, and are specifically formulated to meet the distinctive nutritional requirements of a specific disease that cannot be met with a simple dietary shift. The increased nutritional requirements of a disease can be the result of inadequate ingestion of nutrients, malabsorption, impaired metabolism, loss of nutrients due to diarrhea, increased nutritional turnover rates inherent in certain disease states, or the impact of drug therapies. The nutritional requirements of an individual suffering from a disease can be considerably different from those of a healthy individual. Recognizing and managing these increased nutritional requirements is an integral part of the medical management of complex clinical conditions.

 

1. Blunted Circadian Variation in Autonomic Regulation of Sinus Node Function of Veterans with Gulf War Syndrome. Haley, RW et al. 2004, The American Journal of Medicine, pp. 469-478.
2. Perfusion deficit to cholinergic challenge in veterans with Gulf War Illness. Liu, P et al. 2011, NeuroToxicology, pp. 242-246.
3. Gulf War illness: Effects of repeated stress and pyridostigmine treatment on blood-brain barrier permeability and cholinesterase activity in rat brain. Amourette, C et al. 207-214, 2009, Vol. 203.