Doctors, Prolotherapy, and Fibromyalgia

Another pain patient told me I should try prolotherapy (after I said that I’m not interested in trying more alternative therapies), and that was a new term for me.  When I looked it up, I learned prolotherapy was just a fancy term for acupuncture and injections.  And I learned another new term, “biopuncture.”  I think you’d be surprised at what doctors are injecting these days to treat pain, all in the race away from opioids.

I found some of this information in the linked article, which I thought was interesting.  But even more interesting was the comment section, which is an inside view of what doctors think about fibromyalgia, written about a year ago.  It’s long, but it’s a good read.

And the entertaining part is from Stephen S. Rodrigues, MD, an acupuncturist I’ve run into before in the comment section.  I feel bad for Dr. Rodrigues, trying so hard to legitimize his practice. I’m sure he helps some patients or else he wouldn’t have a practice at all.

Of course, even a year ago, alternative treatments like acupuncture were barely mentioned to pain patients. But because of the drug war, now legal drug dealers (medical doctors) have to push non-drug treatments like prolotherapy.  And yet, not all these treatments are drug-free. Many injections include pain medications and steroids.  Short-term doses, which is why patients have to keep going back for more.

But hey, if they work for you, that’s great.  I can’t remember how many injections I had in total before I gave up on this avenue of treatment.  I’ve even had needles stuck in my ears (areas that are supposed to correspond to painful areas all over the body, like reflexology for the ears).

Sticking a painful sight with a needle isn’t new, but I can’t believe all the drugs they use now.  In the comment section, someone mentioned injections with blood platelets.  Um, okay, if that works for you.  Just note the possible complications.

https://www.sciencebasedmedicine.org/prolotherapy/

FIBRO

Laurenak to Windriven • a year ago
This will only be anecdotal but I just wanted to let you know that Fibromyalgia is definitely very real and debilitating and not just drug seeking behaviour. I was diagnosed during my third year of university studying an applied science degree in speech pathology, was very active at the gym and was the healthiest I’d been in years. The pain slowly crept through my body until it was hard to get out of bed in the morning due to the crippling pain and fatigue yet I still completed my degree with a distinction average and currently work full time in a private practise with a large caseload of children. Thankfully I found a decent rheumatologist (after a year of misdiagnoses, MRIs, surgery and various medications) who started me on Cymbalta (an antidepressant) and it has done wonders for the pain. I have never taken opiates and hopefully never will but I still battle every day with this condition. While I’m sure there are whiners and drug seekers out there (just with any chronic condition), there are many more of us who suffer quietly. Just wanted to share my experience.

FIBRO AND NARCAN

CHotel to Windriven • a year ago
Not necessarily. It would almost definitely decrease your pain tolerance while in your system, but it wouldn’t necessarily induce any pain. It doesn’t affect all opioid receptors, mainly has mu-receptor activity while having low affinity for kappa and delta receptors (though it is active there), so you’d still have active endogenous opioids floating around to some degree. Something would still have to cause the pain, which is one reason why there is likely a muscle/connective tissue component to the syndrome as well. Go for a hike until you get a little sore all over, then take a shot of narcan, that would probably be a more accurate representation of the syndrome from what I understand of it.

I believe that it is likely a real condition, but I also hold very little hope that we’ll fully understand the pathophysiology of it due to its being co-opted by drug seekers. It may even be a multitude of conditions with similar presentation, since it is likely a diagnosis of exclusion, which would explain why there are so many proposed causes and treatments with little consensus.

Andrey Pavlov CHotel • a year ago
I am not an expert on this, but to my knowledge CHotel is correct. It does affect kappa and delta opioid receptors but has a much lower affinity. It does not affect endogenous opioids at all. So it would not induce pain but it would prevent the ability to endogenously reduce induced pain. Meaning that if I punch you in the arm after I give you nalaxone it will hurt hurt more than it normally would. However, the main effect would be that it would hurt longer than it normally would.

There is also some indirect evidence of this in some trials with septic patients. Administration of nalaxone increases their blood pressure. I am not super familiar with that literature and it is pretty small, but it seems that this is thought to be because the pain response is heightening and pain causes the increase in BP. Which renders it horribly unethical to use as a pressor.

…I cannot think of an ethically valid way to argue that sensitizing a patient to pain (even if that is not ultimately the direct causal mechanism of increasing BP, it is still a known and expected effect) is justifiable short of imminent death and a last ditch effort. Even if they were well sedated, we could expect it to increase their post-recovery pain and perhaps even trigger lasting hyperalgesia.

In other news, I just got done making another batch of no-bake chocolate and peanut butter cookies, and they didn’t turn out very well.  Sometimes, life just sucks. 🙂

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