Category Archives: Musculosceletal

musculosceletal conditions

Fibromyalgia: drug treatment in vain?

Journal Watch okt 2020
Evidence is insufficient to support most treatments for fibromyalgia, according to a meta-analysis in JAMA Internal Medicine.

Researchers examined data from over 220 randomized trials among nearly 30,000 people with fibromyalgia. High-quality evidence suggested a statistically significant benefit for cognitive behavioral therapy for improving pain in the short term. High-quality evidence also favored antidepressants and central nervous system depressants for improving pain in the medium term, antidepressants for improving quality of life (QOL) in the short term, and antidepressants and central nervous system depressants for improving QOL in the medium term.

However, none of these outcomes met the researchers’ criteria for a clinically important benefit. In addition, high- or moderate-quality evidence did not support any treatment for pain or QOL in the long term.

The researchers conclude, “Clinicians should be aware that current evidence for most of the available therapies for the management of fibromyalgia is limited to small trials of low methodological quality.”

Low back and radicular pain: is treatment futile?

“New guidelines, several meta-analyses and a few new studies show that neither medication nor nonpharmacologic approaches confer much benefit” (JWatch.org jan 2018)

A few studies have been done on Gabapentin and Pregabalin for back pain with radicular pain and not been found to have any effect. One study with Pregabalin titrated to 600mg and continued for 8 weeks was ineffective. It had the same effect as “sugar” pills.

Six studies of gabapentin versus placebo or pregabalin against another analgesic in pat. with LBP (about 500 pat) showed no clinically meaningful benefits and substantial side effects.

Diazepam as extra medication in 114 pat. w LBP who were given naproxen did not improve pain or function at 1 week.

NSAIDS (ex. naproxen, ibuprofen) have also been in the storm of questioning their effect and shown to have only modest effect in LBP w/wo radicular pain. One would need to treat 6 patients for 1 to have benefit.

Nonpharmacological treatments:
1. intradiscal steroids in pat. w MRI evidence of vertebral endplate inflammation: after 1 mo some improvement, after 3 mo worse, after 12 mo no difference.
2. Radiofrequency denervation for pat. w pain from facet joints, SI joints or intervert discs showed no incremental benefit when added to typical exercise therapy.
3. Spinal manipulation a meta analysis of 26 randomised trials for acute LBP showed statistically significant but modest benefit að 6 weeks with a high frequency of moderate side effects.

So: drugs dont work, injections and denervations dont work, manipulation seems to help a little bit but you pay a considerable sum of money and waste time doing repeated manipulations.

It may be considered a relief that you dont need to take any medication, you dont need to go to the doctor, physiotherapist or chiropractor, you just wait for a few weeks knowing that there is sound reason to expect spontaneous recovery.
If the back pain is chronic, which indeed is a very common condition; medication with pain medication is not advisable as the risk of addiction is considerable and the effect is small according to research.

Note: these are not to be considered guidelines for every back pain situation!

Fibromyalgia, treatment with hyperbaric oxygen

People with post traumatic brain damage and fibromyalgia who were treated in pressure chamber had much lesser symptoms of muscle pains.A change in brain activity could also be demonstrated.

A possible explanation is that the pressure induces neuroplasticity that repairs deranged function. Quality of life in people who have had stroke has even been seen.

The hypothesis was that the treatment would correct the abnormal brain activity that is seen in fibromyalgia a disease that causes muscle pain in many parts of the body.

Total freedom from symptoms
For two months patients with fibromyalgi got treatment in a pressure chamber and and all patients but three had lesser pain. A change in activity in certain areas of the brain that are connected to pain impulses could also be seen.

“We have seen that where fibromyalgia has been caused by traumatic brain injury a total regress of symptoms was seen that kept after the treatment. If the reason for the fibromyalgi was another for example an infection a follow up treatment is probably necessary said the doctor Shai Efrati chief for Sago, center for hyberbaric medicine and research in Israel and one of the authors of the study in a press release from Rice University in Texas.

48 women with fibromyalgia took part in the prospective clinical study. All got treatment in pressure chamber at 2 athmospheric pressure for 90 minutes 5 days a week for 2 months. For study og brain activity a SPECT was used.

As the study was small the scientists point out that more studies need to be done to verify the results.