FMS News: A new twist on an old drug

www.news14.com


A new twist on an old drug
Updated: 9/25/2006 9:58:57 AM
By: Casey Taylor, News 14 Carolina

Pamela Kennedy sings every day to the little boy she thought she would never have.
Fibromyalgia affects one in nine people and leaves its victims in constant pain. It's difficult to diagnose, and there is no cure. But there is hope. An ingredient found in a common over-the-counter drug may ease patients' pain.

Pamela Kennedy sings every day to the little boy she thought she would never have.

"With fibromyalgia, I have had pain for the last 15 years in all my joints," she said. "We were trying to have children, but I was never able to conceive."

Kennedy adopted Kenton. She lovingly takes care of him while living every minute with muscle aches and fatigue.

"It's really hard, especially because he's not walking and he's heavy,” she said. “I take pain pills all day."

The pills help relieve nerve cells that are highly sensitive.

“These patients with minor activities experience significant pain," Dr. Roland Staud, a rheumatologist at the University of Florida in Gainesville, said.


Dextromethorphan is an ingredient commonly found in cough syrup, but doctors found it also targets nerve cells.
A new twist on an old drug may help. Dextromethorphan is an ingredient commonly found in cough syrup, but doctors found it also targets nerve cells.

"The activity of these nerve cells is significantly decreased, resulting in less amplification of pain," said Staud.

He says, however, the levels found in cough syrup are not strong enough. They studied a special dose that needs to be taken to feel a difference -- about four to five-times stronger than what you can buy over the counter.

“If they could find something where I could be lucid all day, be a good mom, that would be very good," Kennedy said.

At high doses, dextromethorphan causes problems related to memory and confusion. The drug is still being studied and isn't available to the public yet.




Contact Information



Mike Garrison
Director of Broadcast News
University of Florida Health Science Center
Gainesville, FL 32611
mgarriso@vpha.health.ufl.edu
www.news.health.ufl.edu









Research Summary



BACKGROUND:

Fibromyalgia is an incurable illness that causes widespread muscle aches, stiffness, fatigue and sleep disturbances. An estimated 10 million Americans suffer from the condition, most of them women. Current treatment strategies include pain medication, exercise, stretching, sleep management, and psychological support.

THE CAUSE:

The underlying cause of fibromyalgia remains unknown, but in the past 25 years substantial progress has been made toward understanding the mechanisms behind specific features of fibromyalgia. Rheumatology expert Roland Staud, M.D., a University of Florida associate professor, says, "One [mechanism] is central sensitization, a feature of many chronic pain conditions in which the central nervous system -- the brain and spinal cord -- somehow magnifies pain signals to abnormally high levels." Central sensitization is associated with wind-up, a phenomenon in which repeated touches -- even handshakes or pats on the back -- generate lingering pain that increases with each new contact.

NEW HOPE:

Dextromethorphan, an over-the-counter medication that silences coughs, may help fibromyalgia patients quiet over-reacting nerves that amplify ordinary touches into agony. A University of Florida study documents, for the first time, that dextromethorphan temporarily reduces the intensity of fibromyalgia "wind-up," a snowballing pain response to minor, repetitive physical contact.

WHAT IS IT?

Dextromethorphan is popular in cold remedies because it elevates the threshold for the coughing reflex but does not cause physical addiction, according to the U.S. Drug Enforcement Administration. But fibromyalgia patients should not resort to self-medicating by taking cough syrups for pain, Staud cautioned. "Like every medication, dextromethorphan has side effects," he said. "At high doses, patients can have problems related to memory and confusion."

THE STUDY:

Though the UF study did not establish guidelines for using dextromethorphan clinically, it suggests the drug may eventually be an option for treating fibromyalgia and other conditions involving heightened pain sensitivity. Dr. Staud, the study's principal author says: "I think it's one piece of the mosaic. We currently have no single therapy in chronic pain that has a big effect. So what this really means for chronic pain patients is that they need to use a whole host of different interventions to decrease the pain they have. And in this, dextromethorphan may have a role in the future." In the current study, researchers worked with 14 women with fibromyalgia and 10 women who did not have the disease, using mechanical devices that tapped the participants' hands repeatedly. One part of the study involved contact with a heated probe, the other used a small rubber-tipped peg. The intensity of the heat or pressure of the stimulation was individually adjusted so that all participants reported feeling the same degree of pain.

Researchers then gave each participant a capsule containing 60 milligrams of dextromethorphan, 90 milligrams of dextromethorphan, or a placebo containing none of the drug, and asked them to rate the amount of pain they experienced when the stimulation was repeated.

THE RESULTS:

With the heat stimulus, 90 milligrams of dextromethorphan reduced wind-up pain, but 60 milligrams was no more effective than the placebo. With the pressure stimulus, 90 milligram and 60 milligram doses were equally effective, reducing wind-up pain.

Psychiatric ills common in adults with fibromyalgia

Psychiatric ills common in adults with fibromyalgia
By Amy Norton
Wed Sep 20, 11:52 AM ET



Many people with the chronic pain disorder fibromyalgia have also suffered from depression, anxiety or other psychiatric conditions at some point in their lives -- suggesting, researchers say, that the disorders have some common causes.

In a study of 336 adults with and without fibromyalgia, researchers found that those with the condition were substantially more likely to have ever had depression, bipolar disorder or an anxiety disorder. They also had higher rates of eating disorders and substance abuse problems.

In most cases, the psychiatric condition preceded the development of fibromyalgia, making it unlikely that the mood disturbances were simply a reaction to having chronic pain.

Fibromyalgia is a syndrome marked by widespread aches and pains, fatigue and sleep problems, among other symptoms; the cause is unknown, and there are no medications specifically approved for the condition. Treatment usually involves a combination of approaches, such as painkillers, antidepressants, behavioral therapy or exercise therapy.

The new findings, published in the Journal of Clinical Psychiatry, are based on a comparison of families with members affected by either fibromyalgia or rheumatoid arthritis, another condition marked by chronic pain.

Between both groups of families, there were 108 adults, nearly all women, with fibromyalgia and 228 without the condition.

Overall, those with fibromyalgia were almost three times more likely to have ever had major depression and nearly seven times more likely to have suffered an anxiety disorder. They also had a two to three times greater risk of eating disorders and substance abuse problems, and a much higher risk of bipolar disorder.

The associations between fibromyalgia and these psychiatric conditions suggest that there is some "shared vulnerability" at work, according to study chief Dr. Lesley M. Arnold, an associate professor of psychiatry at the University of Cincinnati College of Medicine.

"We are not saying that fibromyalgia is a psychiatric disorder," Arnold told Reuters Health.

Rather, some people may be vulnerable to developing both fibromyalgia and certain psychiatric disorders -- possibly because of genes, Arnold explained, or because of environmental factors such as chronic stress. But no one yet knows for certain.

Still, the evidence suggests that people with fibromyalgia should be screened for psychiatric disorders, according to Arnold. Even when people aren't currently suffering any psychiatric symptoms, their mental health history can influence how their fibromyalgia is treated, she noted.

For example, Arnold explained, medication with both antidepressant and pain-relieving effects might be the first choice for people with a history of depression. Another option is cognitive behavioral therapy, which addresses harmful thought patterns and behaviors; this approach, Arnold said, might help fibromyalgia patients with a history of depression or anxiety disorders.

SOURCE: Journal of Clinical Psychiatry, August 2006.

Nasal spray effective for cluster headaches

Nasal spray effective for cluster headaches
Mon Sep 25, 4:53 PM ET



The migraine medication zolmitriptan when administered as a nasal spray appears to be a safe and effective treatment of acute cluster headache, European researchers report.

The study shows that nasal zolmitriptan, which is known by the brand name Zomig, "provides a further, much-needed, evidence-based and effective option to treat acute cluster headache -- the worst such pain known," senior author Dr. Peter J. Goadsby told Reuters Health.

Dr. Goadsby of the National Hospital for Neurology and Neurosurgery, London and colleagues note in the Archives of Neurology that cluster headache "is the most painful form of primary headache, typically characterized by attacks of usually excruciating unilateral pain lasting 15 to 180 minutes."

Oral zolmitriptan is known to be an effective treatment for migraine headache and there is preliminary evidence that the new intranasal formulation may be helpful for treating cluster headache.

To investigate further, the researchers conducted a study involving 92 patients with cluster headache. Without knowing the order of treatment, the participants treated one headache with 5 milligrams of zolmitriptan nasal spray, another attack with 10 milligrams, and a third with an inactive "placebo" nasal spray.

The team found that headache relief rates 30 minutes after treatment were 40 percent for the low-dose zolmitriptan, 62 percent for the high-dose zolmitriptan, and 21 percent for placebo.

Goadsby noted there is increasing interest "in this highly disabling, important form of primary headache." Patients should know, he added, that "work is being done on their condition."

SOURCE: Archives of Neurology, September 2006.