Thursday, November 29, 2007

Research: Benefit of Ribose in a Patient With Fibromyalgia

01-31-2005 Journal: Pharmacotherapy
Benjamin Gebhart, Pharm.D.; James A. Jorgenson, M.S., FASHP

Abstract and Introduction
Ribose was added to the existing treatment regimen of a woman with fibromyalgia, resulting in a decrease in symptoms. It has been postulated that patients with fibromyalgia may have an alteration in muscle adenine nucleotide metabolism, leading to depleted energy reserves and an imbalance in cellular adenosine-triphosphate:adenosine 5'-diphosphate:adenosine 5'-monophosphate (ATP:ADP:AMP) ratios with an abnormal energy charge. As a key component in adenine nucleotide synthesis, ribose supplementation may be useful in such patients.

Fibromyalgia is a syndrome that is manifested by generalized muscle pain and additional systemic symptoms of fatigue, tenderness and stiffness in multiple joints, sleep disturbance, and alterations in bowel activity.

The specific etiology is unknown; however, changes in muscle histology, energy metabolism, oxygen utilization, and the neuroendocrine stress-response system have been postulated to play a role in the development and persistence of this disorder.[1] Low levels of muscle adenine nucleotides, reflected in depleted energy reserves and an imbalance in cellular adenosine 5'-triphosphate:adenosine 5'-diphosphate:adenosine 5'-monophosphate (ATP:ADP:AMP) ratios with an abnormal energy charge, have been reported.[2-4] The unknown cause and varying presenting symptoms make fibromyalgia a therapeutic challenge for practitioners.[5-7]

The management of patients with fibromyalgia requires the integration of both pharmacologic and nonpharmacologic approaches. Pharmacologic options have included tricyclic antidepressants, selective serotonin receptor antagonists, analgesics, benzodiazepines, antiinflammatory agents, and corticosteroids.[5, 6, 8]

Routine daily exercise programs, dietary modifications, alternative therapies such as biofeedback and hypnotherapy, and nutraceuticals such as S-adenosyl-L-methionine (SAMe) have also been explored.[9] Unfortunately, less than 50% of patients achieve any meaningful relief of their symptoms with use of those therapies.[5]

We describe the case of a patient with fibromyalgia who had symptomatic relief when ribose was added to her existing treatment regimen. There have been anecdotal reports on the benefits of ribose in patients with fibromyalgia in whom conventional therapies have failed; however, to our knowledge, this is the first published case of use of ribose for this syndrome.

Case Report
A 37-year-old woman had daily episodes of intense musculoskeletal pain and stiffness, mental "cloudiness," bouts of diarrhea, and sleep disturbance. As she was a surgeon, these symptoms compromised the skills necessary to perform her daily duties in the operating room. She was diagnosed with fibromyalgia by exclusion of other diseases and syndromes and in accordance with the American College of Rheumatology criteria.[10]

The patient was treated with ibuprofen 800 mg twice/day, valdecoxib 10 mg once/day, diphenhydramine 50 mg-acetaminophen 1000 mg at bedtime, and physical therapy once/day. She stated that this therapeutic regimen had limited benefit and that the adverse effects from these drugs further impaired her ability to perform her operative duties.

Approximately 7 months later, in addition to her regular drug therapy, the patient began taking CORvalen (Bioenergy, Inc., Ham Lake, MN), a ribose-based product. She took 5 g of CORvalen mixed in water twice/day. She experienced no adverse effects, and after 14 days she reported a decrease in her symptoms. Specifically, she noted an improvement in sleep, mental alertness, a marked decrease in joint pain, and normal stools. This trend continued, and after an additional month of CORvalen therapy she reported near-normal functioning with a major reduction in her symptoms.

After another month of taking CORvalen and feeling "normal," the patient elected to discontinue the drug. Within 7 days, she regressed to her initial fibromyalgia state, as reflected in joint pain, sleep disturbance, morning stiffness, trigger-point flares, and diarrhea. She resumed taking CORvalen, at the same dosage as before, and a major reduction in her symptoms again occurred within 14 days. She noted continual benefit for the next month while taking CORvalen. She stopped taking the drug for a second time after this additional 30-day period, and once again she experienced a reemergence of symptoms. When CORvalen was restarted for a third time, the patient's symptoms again subsided.

At the time of this writing, the patient was continuing to take CORvalen and was satisfied that her symptoms had abated.

Ribose is a simple carbohydrate that plays a role in high-energy phosphate and nucleic acid synthesis. After ischemia or hypoxia, myocytes have decreased levels of ATP and total adenine nucleotides. Several days are required for their recovery once normoxia has been reestablished.[11-13] In patients with chronic hypoxic conditions, the cellular energy charge may never be fully regained.[14]

These cells have the capacity to regenerate ATP; however, the pentose phosphate pathway of glucose metabolism utilized in the formation of the ribose that is needed to drive the regenerative process is slow in both heart and skeletal muscle cells due to poor expression of specific rate-limiting enzymes. Supplemental ribose has been shown to enhance the synthesis of adenine nucleotides, rebuilding depressed energy pools in both the heart and skeletal muscle after an ischemic or hypoxic insult.[11, 12] Ribose bypasses the rate-limiting enzymatic steps of the pentose phosphate pathway and accelerates the formation of ATP and subsequent tissue recovery.[15]

Supplemental ribose is initially converted to ribose-5-phosphate, subsequently forming 5-phosphoribosyl-1-pyrophosphate, a molecule key to the synthesis of ATP through the de novo purine nucleotide pathway. The safety of ribose has been investigated in standard laboratory and animal toxicology models and in human studies both subjectively and objectively. Investigators have concluded that ribose is well tolerated at dosages of up to 60 g/day, with no significant adverse effects.[16]

Ribose has been shown to improve the energy recovery time in skeletal muscle and to relieve fatigue, soreness, and stiffness after intense exercise.[12, 13, 17] It also has been reported to have a beneficial effect after high-intensity exercise in sports medicine.

One study concluded that ribose accelerated the replenishment of ATP after intense muscle contractions,[18] and bodybuilders and sprinters have reported subjective and objective benefits during exercise after the administration of ribose.[18-20] However, other reports have shown inconsistent results for ribose in relation to improving short-term anaerobic exercise performance, muscle strength, endurance, or body composition during cycling or resistance training.[20, 21]

Ribose has also been investigated for its potential medical efficacy in both animal studies and human clinical trials. To date, the most promising data have been reported in connection with the application of ribose in cardiovascular disease. Both short-term and long-term animal studies found that the use of ribose after myocardial ischemia resulted in enhanced recovery of ATP along with improved diastolic functional parameters.[22, 23]

Clinical benefits have also been observed. Patients with coronary artery disease or heart failure have decreased myocardial ATP levels. Daily supplemental ribose has been shown to improve cardiac function, increase exercise tolerance, and enhance quality of life in this population.[24]

Patients with fibromyalgia may experience an alteration in physiologic muscle metabolism. It has been found that they reach the anaerobic threshold in their muscles earlier, thereby using less of the available energy-rich phosphate metabolites at maximal work capacity.[25] In another study, patients with fibromyalgia were reported to have a potential abnormality in high-energy phosphate metabolism, as evidenced by significantly lower levels of ATP and ADP in affected muscles as compared with patients without the disease.[2]

Theoretically, the effect of ribose on increasing the muscle energy pool could reduce the metabolic strain in affected muscles and allow patients to assume a more active lifestyle. Considering the known musculoskeletal symptomatology in this syndrome and the reported benefits of ribose in skeletal muscle metabolism and physiology, supplemental ribose appears to have aided our patient in improving her quality of life.

Fibromyalgia presents a continuing therapeutic challenge. Ribose is a naturally occurring carbohydrate with documented medical benefits in patients with cardiovascular disease. To our knowledge, this is the first report to suggest its potential benefit in a patient with fibromyalgia, who had had suboptimal results with conventional therapies. We are designing a trial using objective outcome measures to further evaluate the effectiveness of this product in patients with fibromyalgia

Pharmacotherapy 24(11):1646-1648, 2004. © 2004 Pharmacotherapy Publications
1. Olson NJ, Park JH. Skeletal muscle abnormalities in patients with fibromyalgia. Am J Med Sci 1998;315:351-8.
2. Bengtsson A, Henriksson KG, Larsson J. Reduced high-energy phosphate levels in the painful muscles of patients with primary fibromyalgia. Arthritis Rheum 1986;29:817-21.
3. Eisinger J, Plantamura A, Ayavou T. Glycolysis abnormalities in fibromyalgia. J Am Coll Nutr 1994;13:144-8.
4. Park JH, Phothimat P, Oates CT, Hernaz-Schulman M, Olsen NJ. Use of P-31 magnetic resonance spectroscopy to detect metabolic abnormalities in muscles of patients with fibromyalgia. Arthritis Rheum 1998;41:406-13.
5. Leventhal LJ. Management of fibromyalgia. Ann Intern Med 1999;131:850-7.
6. Friedberg F, Jason LA. Chronic fatigue syndrome and fibromyalgia: clinical assessment and treatment. J Clin Psychol 2001;57:433-55. Lash AA, Ehrlich-Jones L, McCoy D. Fibromyalgia: evolving concepts and management in primary care settings. Medsurg Nurs 2003;12:145-59, 190.
7. Briley M, Moret C. Fibromyalgia syndrome: an overview of potential drug targets. Drugs 2003;6:668-73.
8. Holdcraft LC, Assefi N, Buchwald D. Complementary and alternative medicine in fibromyalgia and related syndromes. Best Pract Res Clin Rheumatol 2003;17:667-83.
9. Wolfe F, for the American College of Rheumatology. Criteria for the classification of fibromyalgia: report of the multi-center criteria committee. Arthritis Rheum 1990;33:160-72.
10. St Cyr J, Bianco R, Schneider J, et al. Enhanced high energy phosphate recovery with ribose infusion after global myocardial ischemia in a canine model. J Surg Res 1989;42:157-62.
11. Hellsten Y, Skadhauge L, Bangsbo J. Effect of ribose supplementation on resynthesis of adenine nucleotides after intense intermittent training in humans. Am J Physiol Integr Comp Physiol 2004;286:R182-8.
12. Williamson DL, Gallagher PM, Goddard MP, Witter J, Trappe S. Effects of ribose supplementation on adenine nucleotide concentration in skeletal muscle following high-intensity exercise [abstr]. Med Sci Sport Exer 2001;33(5 suppl).
13. Ingwall JS. ATP and the heart. Boston: Kluwer Academic, 2002:55-95.
14. Pauly DF, Pepine CJ. D-ribose as a supplement for cardiac energy metabolism. J Cardiovasc Pharmacol Ther 2000;5: 249-58.
15. Pliml W, von Arnim T, Stablein A, Hoffman H, Zimmer HG, Erdmann E. Effects of ribose on exercise-induced ischaemia in stable coronary artery disease. Lancet 1992;340:507-10.
16. Butler T, St Cyr J. Use of ribose to prevent cramps and soreness in muscles. U.S. patent 6159943. December 12, 2000.
17. Zarzeczny R, Brault JJ, Abraham KA, Hancock C, Terjung R. Influence of ribose on adenine salvage after intense muscle contractions. J Appl Physiol 2001;91:1775-81.
18. Van Gammeren D, Antonio J, Falk D. The effects of four weeks of ribose supplementation on body composition and exercise performance in healthy, young, male recreational bodybuilders: a double-blind, placebo controlled trial. Cur Therapeut Res 2002;63:486-95.
19. Berandi JM, Ziegenfuss TN. Effects of ribose supplementation on repeated sprint performance in men. J Strength Cond Res 2003;17:47-52.
20. Falk DJ, Heelan KA, Thyfault JP, Koch AJ. Effects of effervescent creatine, ribose, and glutamine supplementation on muscular strength, muscular endurance, and body composition. J Strength Cond Res 2003;17:810-16.
21. Schneider J, St Cyr J, Mahoney J, Bianco R, Ring W, Foker J. Recovery of ATP and return of function after global ischemia [abstr]. Circulation 1985;72(4 pt 2):III-298.
22. Zimmer HG. Normalization of depressed heart function in rats by ribose. Science 1983;220:81-2.
23. Omran H, Illien S, MacCarter D, St Cyr J, Luderitz B. D-ribose improves diastolic function and quality of life in congestive heart failure patients: a prospective feasibility study. Eur J Heart Failure 2003;5:615-19.
24. Lund E, Kendall SA, Janerot-Sjoberg B, Bengtsson A. Muscle metabolism in fibromyalgia studied by P-31 magnetic resonance spectroscopy during aerobic and anaerobic exercise. Scand J Rheumatol 2003;32:138-45.
Source: MedScape

Tuesday, November 20, 2007

Vitamin D Inadequacy May Exacerbate Chronic Pain

Vitamin D Inadequacy May Exacerbate Chronic Pain

Newswise — Approximately one in four patients who suffer from chronic pain also have inadequate blood levels of vitamin D, possibly contributing to their ongoing pain, according to a new study. Patients lacking sufficient vitamin D also required higher doses of morphine for a longer period of time.

Researchers recorded the serum vitamin D levels of 267 adults undergoing outpatient treatment for chronic pain, as well as their pain medication (morphine) dose and duration of use, and physical and general health functioning.

Of the patients tested, 26 percent had vitamin D inadequacy. Among these patients, the morphine dose was nearly twice that of the group with adequate vitamin D levels. In addition, the vitamin D inadequacy group used morphine for an average of 71.1 months versus 43.8 months. The vitamin D deficient group also reported lower levels of physical functioning and had a poorer view of their overall health.

It has long been known that inadequate levels of vitamin D can cause pain and muscle weakness, according to the study author, W. Michael Hooten, M.D., medical director, and anesthesiologist at Mayo Comprehensive Pain Rehabilitation Center, Rochester, Minnesota. Previous studies also have suggested that pain-related symptoms of vitamin D inadequacy respond poorly to pain medications.

However, “this is the first time that we have established the prevalence of vitamin D inadequacy among a diverse group of chronic pain patients,” Dr. Hooten said.
“The implications are that in chronic pain patients, vitamin D inadequacy is not the principal cause of pain and muscle weakness, however, it could be a contributing but unrecognized factor,” Dr. Hooten said.

Vitamin D inadequacy can be “easily and inexpensively” treated “with essentially no side effects” using a prescription supplement, once or twice a week for four to six weeks, Dr. Hooten said. Further study is needed to determine whether treating inadequate vitamin D levels will result in improvements to the overall general health for patients with chronic pain.

Founded in 1905, the American Society of Anesthesiologists is an educational, research and scientific association with 41,000 members organized to raise and maintain the standards of the medical practice of anesthesiology and improve the care of the patient.

Tuesday, November 13, 2007

Cell Phones and Cancer

Dear Reader, (
This hurts me just as much as it may hurt you. I confess, I'm a pretty regular cell phone user, so I've been disturbed by studies and reports that suggest a possible link between cell phone use and cancer. What's been missing is an analysis of long-term cell phone studies – something that's been hard to come by because cell phone use has been a widespread phenomenon for only slightly more than a decade.But now those first long-term studies are in, an analysis has been done, and the results are disturbing to say the least.

------------Calling out around the world----------------------

An x-ray creates ionizing radiation – a type of radiation that can increase cancer risk by disrupting normal DNA activity in your body's cells. Cell phones and microwave ovens emit non-ionizing radiation that does not affect DNA. So in theory, cell phones don't cause cancer – not by prompting DNA damage at any rate.But a 2005 study in Turkey showed that long-term exposure to radiofrequency electromagnetic fields (RFEMF) from cell phones could increase free radical levels in the brain, raising the risk of brain cancer. Again – nothing conclusive, just theory.

Which brings us to this new study from researchers at Sweden's Örebro University.
The Örebro team examined two cohort studies (in which medical records for subjects who used cell phones were compared to the records of subjects who didn't use cell phones) and 16 case-control studies (in which cell phone use among subjects with cancer was compared to cell use among healthy subjects). All of the subjects who used cell phones had used them for 10 years or more. The studies were conducted in the U.S., Japan, Denmark, Finland, Sweden, Germany, and Britain.

Analysis of the research produced these results:
Most of the studies found a link between cell use and increased tumor risk
Several studies found that cell phone users had an increased risk of malignant gliomas – cancers of the cells that protect nerve cells

Several studies found a link between cell phone use and a higher rate of acoustic neuromas – a benign tumor of the auditory nerve, which often results in deafness and balance problems
Tumors are more likely to occur on the side of the head that the cell handset is used
One hour of cell phone use per day significantly increases tumor risk after ten years or more

-----------The good with the bad-------------

There is a ray of good news here.
Professor Kjell Hansson Mild (one of the authors of the study) told the UK newspaper The Independent, that newer cell phones emit less radiation compared to phones that were on the market in the 90s.

But that's about it for the good news. The Independent also reports that previous research conducted by Professor Mild and his colleague Professor Lennart Hardell showed that consistent use of cordless phones present about the same risk as cell phones in the development of malignant glioma and acoustic neuromas.

The professors note that greatest risk is among children due to the relative thinness of their skulls and the fact that their brains and nervous systems are still growing.

And there's one more disturbing development. When I checked the web site for the American Cancer Society, I found a page titled "Do Cell Phones Cause Cancer?" Here's what the ACS has to say: "This represents a legitimate area of scientific controversy and should not be dismissed as a myth."

Uh oh. When an organization as seriously mainstream as the ACS doesn't rubber-stamp the cell/cancer link as bunk, you know someone in the medical establishment is nervous about this topic. Where to get Electropollution protection

Saturday, November 10, 2007

D-Ribose Offers New Option for Boosting Energy

Press Release
D-Ribose Offers New Option for Boosting Energy
MINNEAPOLIS, MN, October 8, 2007—Now, millions of people worldwide who rely on the medical expertise of Andrew Weil, MD, can learn about the benefits of D-ribose at

In a Q &A, Dr. Weil, America's trusted health advisor, explains the science behind this breakthrough, natural supplement. D-Ribose, a naturally occurring five-carbon sugar, is made by the body to synthesize many important compounds, including DNA, RNA, and most importantly, ATP, the "energy currency" of the cells. ATP is critical to health and maintaining normal energy-dependent body functions. Ribose is the essential component in the making of ATP. Weil says, "Because ATP is rapidly used by muscles in high intensity workouts and because RNA is important in protein synthesis, ribose supplements and energy drinks containing ribose are being promoted for energy enhancement and better exercise performance."

Visitors to Dr. Weil's site also will discover other life enhancing benefits associated with D-ribose. For example, Dr. Weil says that "emerging evidence does suggest that they [ribose supplements] benefit patients with congestive heart failure . . . In a study at the University of Bonn, ribose appears to improve heart function and quality of life among these patients by increasing levels and availability of ATP."

In addition to its restorative properties for heart health Dr. Weil points out that "ribose may ease the pain and fatigue of patients with fibromyalgia and chronic fatigue syndrome. Referencing a study published last year in the Journal of Alternative and Complementary Medicine, Dr. Weil says that "patients who took five grams of ribose three times a day for an average of 28 days reported less muscle soreness and stiffness, better ability to overcome fatigue, and simply feeling better." He also indicates that "further studies suggest that ribose may also help improve exercise tolerance in high intensity activities."

Dr. Weil recommends for those who find ribose beneficial that they limit their intake to no more than five grams three times a day. Although ribose is made naturally inside the body, its production is slow and limited by several enzymes that are in short supply in heart and muscle cells. Normally, this is not a problem except when hearts or muscles are challenged by the stress of exercise or lack of oxygen due to cardiovascular disease, circulatory disorders, chronic fatigue syndrome or fibromyalgia. If the energy metabolism process isn't working properly, it drains energy reserves and depletes the cellular energy pool. This frequently leads to pain, soreness, stiffness and an overall feeling of fatigue. Supplementing these stressed cells with D-ribose restores cellular energy.

The ribose Q&A appeared on Dr. Weil's home page ( on October 5 through and October 7, 2007. After that, visitors can find the information by conducting a search on the site for "ribose.”
Bioenergy Inc.—The Ribose Company— is a privately held, Minneapolis-based life sciences company whose core technology lies in the development and commercialization of products based on the physiological benefits of D-ribose in health and wellness. Bioenergy's clear mission is to develop products that increase the quality of its customers' lives by improving their metabolic health. Bioenergy Life Science, Inc., its subsidiary, markets ribose-based products to the functional food and clinical nutrition markets. Bioenergy Life Science products include Bioenergy RIBOSE™ , a functional ingredient in the active lifestyle market; Corvalen®, and CorvalenM®, clinical nutrition products giving metabolic support to patients with heart and muscle disease.

Bioenergy Ribose is non-GMO certified. The product is also manufactured under the supervision of the Kashruth Division of the Orthodox Union. Toll-free order line is 1-866-267-8253.

Friday, November 9, 2007

Lyme Disease

The Treatment Guidelines for Lyme Disease are now published in the National Guideline Clearinghouse™.

Highlights of Guidelines
Since there is currently no definitive test for Lyme disease, laboratory results should not be used to exclude an individual from treatment.

Lyme disease is a clinical diagnosis and tests should be used to support rather than supersede the physician’s judgment.

The early use of antibiotics can prevent persistent, recurrent, and refractory Lyme disease.
The duration of therapy should be guided by clinical response, rather than by an arbitrary (i.e., 30 day) treatment course.

The practice of stopping antibiotics to allow for delayed recovery is not recommended for persistent Lyme disease. In these cases, it is reasonable to continue treatment for several months after clinical and laboratory abnormalities have begun to resolve and symptoms have disappeared.

Diagnostic Concerns
The most important method for preventing chronic Lyme disease is recognition of the early manifestations of the disease.

Atypical Early Presentations
Early Lyme disease classically presents with a single erythema migrans (EM or "bull’s-eye") rash. The EM rash may be absent in over 50% of Lyme disease cases, however. Patients should be made aware of the significance of a range of rashes beyond the classic EM, including multiple, flat, raised, or blistering rashes. Central clearing was absent in over half of a series of EM rashes. Rashes can also mimic other common presentations including a spider bite, ringworm, or cellulitis.

Physicians should be aware that fewer than 50% of all Lyme disease patients recall a tick bite. Early Lyme disease should also be considered in an evaluation of "off-season" onset when flu-like symptoms, fever, and chills occur in the summer and fall. Early recognition of atypical early Lyme disease presentation is most likely to occur when the patient has been educated on this topic.

New Chronic Lyme Disease Presentations
A detailed history may be helpful for suggesting a diagnosis of chronic Lyme disease. Headache, stiff neck, sleep disturbance, and problems with memory and concentration are findings frequently associated with neurologic Lyme disease. Other clues to Lyme disease have been identified, although these have not been consistently present in each patient: numbness and tingling, muscle twitching, photosensitivity, hyperacusis, tinnitus, lightheadedness, and depression.

Most patients diagnosed with chronic Lyme disease have an indolent onset and variable course. Neurologic and rheumatologic symptoms are characteristic, and increased severity of symptoms on wakening is common. Neuropsychiatric symptoms alone are more often seen in chronic than acute Lyme disease. Although many studies have found that such clinical features are often not unique to Lyme disease, the striking association of musculoskeletal and neuropsychiatric symptoms, the variability of these symptoms, and their recurrent nature may support a diagnosis of the disease.

The Limitations of Physical Findings
A comprehensive physical examination should be performed, with special attention to neurologic, rheumatologic, and cardiac symptoms associated with Lyme disease.
Physical findings are nonspecific and often normal, but arthritis, meningitis, and Bell’s palsy may sometimes be noted. Available data suggest that objective evidence alone is inadequate to make treatment decisions, because a significant number of chronic Lyme disease cases may occur in symptomatic patients without objective features on examination or confirmatory laboratory testing.

Factors other than physical findings, such as a history of potential exposure, known tick bites, rashes, or symptoms consistent with the typical multisystem presentation of Lyme disease, must also be considered in determining whether an individual patient is a candidate for antibiotic therapy.

Sensitivity Limitations of Testing
Treatment decisions should not be based routinely or exclusively on laboratory findings. The two-tier diagnostic criteria, requiring both a positive enzyme-linked immunosorbent assay (ELISA) and western blot, lacks sensitivity and leaves a significant number of individuals with Lyme disease undiagnosed and untreated. These diagnostic criteria were intended to improve the specificity of tests to aid in identifying well-defined Lyme disease cases for research studies. Though arbitrarily chosen, these criteria have been used as rigid diagnostic benchmarks that have prevented individuals with Lyme disease from obtaining treatment. Diagnosis of Lyme disease by two-tier confirmation fails to detect up to 90% of cases and does not distinguish between acute, chronic, or resolved infection.

The Centers for Disease Control and Prevention (CDC) considers a western blot positive if at least 5 of 10 immunoglobulin G (IgG) bands or 2 of 3 immunoglobulin M (IgM) bands are positive. However, other definitions for western blot confirmation have been proposed to improve the test sensitivity. In fact, several studies showed that sensitivity and specificity for both the IgM and IgG western blot range from 92 to 96% when only two specific bands are positive.

Lumbar puncture has also been disappointing as a diagnostic test to rule out concomitant central nervous system infection. In Lyme disease, evaluation of cerebrospinal fluid is unreliable for a diagnosis of encephalopathy and neuropathy because of poor sensitivity. For example, pleocytosis was present in only one of 27 patients (sensitivity 3%) and with only seven cells. The antibody index was positive (>1) in only one of 27 patients (sensitivity 3%). An index is the ratio between Lyme ELISA antibodies in the spinal fluid and Lyme ELISA antibodies in the serum. The proposed index of 1.3 would be expected to have even worse sensitivity.

Several additional tests for Lyme disease have been evaluated. These include antigen capture, urine antigen, and polymerase chain reaction. Each has advantages and disadvantages in terms of convenience, cost, assay standardization, availability, and reliability. These tests remain an option to identify people at high risk for persistent, recurrent, and refractory Lyme disease but have not been standardized.

Seronegative Lyme Disease
A patient who has tested seronegative may have a clinical presentation consistent with Lyme disease, especially if there is no evidence to indicate another illness.

Although many individuals do not have confirmatory serologic tests, surveillance studies show that these patients may have a similar risk of developing persistent, recurrent, and refractory Lyme disease compared with the seropositive population.

Continued Importance of Differential Diagnosis
The differential diagnosis of Lyme disease requires consideration of both infectious and noninfectious etiologies. Among noninfectious causes are thyroid disease, degenerative arthritis, metabolic disorders (vitamin B12 deficiency, diabetes), heavy metal toxicity, vasculitis, and primary psychiatric disorders.

Infectious causes can mimic certain aspects of the typical multisystem illness seen in chronic Lyme disease. These include viral syndromes, such as parvovirus B19 or West Nile virus infection, and bacterial mimics, such as relapsing fever, syphilis, leptospirosis, and mycoplasma.
The clinical features of chronic Lyme disease can be indistinguishable from fibromyalgia and chronic fatigue syndrome. These illnesses must be closely scrutinized for the possibility of etiological Borrelia burgdorferi infection.

Clinical Judgment
Clinical judgment remains necessary in the diagnosis of late Lyme disease. A problem in some studies that relied on objective evidence was that treatment occurred too late, leaving the patient at risk for persistent and refractory Lyme disease.

As noted, time-honored beliefs in objective findings and two-tier serologic testing have not withstood close scrutiny. Lyme disease should be suspected in patients with newly acquired or chronic symptoms (headaches, memory and concentration problems, and joint pain). Management of patients diagnosed on the basis of clinical judgment needs to be tested further in prospective trials, and diagnostic reproducibility must be verified.

Testing for Coinfection
Polymicrobial infection is a new concern for individuals with Lyme disease, and coinfection is increasingly reported in critically ill individuals. Although B. burgdorferi remains the most common pathogen in tick-borne illnesses, coinfections including Ehrlichia and Babesia strains are increasingly noted in patients with Lyme disease, particularly in those with chronic illness. Bartonella is another organism that is carried by the same ticks that are infected with B. burgdorferi, and evidence suggests that it is a potential coinfecting agent in Lyme disease.
Recent animal and human studies suggest that Lyme disease may be more severe and resistant to therapy in coinfected patients. Thus, concurrent testing and treatment for coinfection is mandatory in Lyme disease patients.

Treatment Considerations
Since Lyme disease can become persistent, recurrent, and refractory even in the face of antibiotic therapy, evaluation and treatment must be prompt and aggressive.

Prompt Use of Antibiotics
Although no well designed studies have been carried out, the available data support the prompt use of antibiotics to prevent chronic Lyme disease. Antibiotic therapy may need to be initiated upon suspicion of the diagnosis, even without definitive proof. Neither the optimal antibiotic dose nor the duration of therapy has been standardized, but limited data suggest a benefit from increased dosages and longer treatment, comparable to the data on tuberculosis and leprosy which are caused by similarly slow-growing pathogens.

Choosing an Antibiotic
In acute Lyme disease, the choice of antibiotics should be tailored to the individual and take into account the severity of the disease as well as the patient’s age, ability to tolerate side effects, clinical features, allergy profile, comorbidities, prior exposure, epidemiologic setting, and cost.
Conversely, persistent and refractory Lyme disease treatment is more likely to include intravenous and/or intramuscular antibiotics. The choices depend in part on the patient’s response to antibiotic therapy and on the success of antibiotics in treating other Lyme disease patients.

Therapy usually starts with oral antibiotics, and some experts recommend high dosages. The choice of antibiotic therapy is guided by weighing the greater activity of intravenous antibiotics in the central nervous system against the lower cost and easy administration of oral antibiotics for B. burgdorferi.

Oral Antibiotic Options
For many Lyme disease patients, there is no clear advantage of parenteral therapy. Along with cost considerations and pressure to treat patients with Lyme disease with the least intervention, there is growing interest in the use of oral therapy.

First-line drug therapies for Lyme disease may include (in alphabetical order): oral amoxicillin, azithromycin, cefuroxime, clarithromycin, doxycycline, and tetracycline. These antibiotics have similar favorable results in comparative trials of early Lyme disease.

Intravenous Antibiotic Options
It is common practice to consider intravenous antibiotics upon failure of oral medications in patients with persistent, recurrent, or refractory Lyme disease, and as the first line of therapy for certain conditions, (i.e., encephalitis, meningitis, optic neuritis, joint effusions, and heart block).

Ideally, the intravenous antibiotic should be selected on the basis of in vitro sensitivity testing or clinical experience. Intravenous antibiotics are also justified by concern for penetration into the central nervous system.

Until recently, ceftriaxone, cefotaxime, and penicillin were the only intravenous antibiotics routinely studied for use in Lyme disease. Intravenous imipenem, azithromycin, and doxycycline have an adequate antispirochetal spectrum of activity and may represent suitable alternative therapies. However, the latter two drugs are often considered for intravenous use only if they are not tolerated orally.

Intramuscular Antibiotic Options
Intramuscular benzathine penicillin (1.2 to 2.4 million units per week) is sometimes effective in patients who do not respond to oral and intravenous antibiotics. If intramuscular benzathine penicillin is used, long-term therapy may be necessary due to the low serum concentration of this form of penicillin. Benzathine penicillin has mainly been used in patients who have had multiple relapses while receiving oral or intravenous antibiotic therapy or who are intolerant of oral or intravenous antibiotics.

Combination Antibiotic Treatment
Combination therapy with two or more antibiotics is now increasingly used for refractory Lyme disease and has also been given as initial therapy for some chronic presentations.
This approach is already used for another tick-borne illness, babesiosis. Oral amoxicillin, cefuroxime, or (more recently) cefdinir combined with a macrolide (azithromycin or clarithromycin) are examples of combination regimens that have proven successful in clinical practice, although controlled clinical trials are lacking in persistent, recurrent, and refractory Lyme disease.

Combination therapy in patients with Lyme disease raises the risk of adverse events. This risk must be weighed against the improved response to combination therapy in Lyme disease patients failing single agents.

Sequential Treatment
Clinicians increasingly use the sequence of an intravenous antibiotic followed by an oral or intramuscular antibiotic. In two recent case series that employed combination therapy and sequential therapy, most patients were successfully treated. A logical and attractive sequence would be to use intravenous therapy first (e.g., intravenous ceftriaxone), at least until disease progression is arrested and then follow with oral therapy for persistent and recurrent Lyme disease.

Increasingly, clinicians recommend that certain drugs used for Lyme disease be given at higher daily doses: for example, 3,000–6,000 mg of amoxicillin, 300–400 mg doxycycline, and 500–600 mg of azithromycin. Some clinicians prescribe antibiotics using blood levels to guide higher doses. Close monitoring of complete blood counts and chemistries are also required with this approach.

With higher doses, there may be an increase in adverse events in general and gastrointestinal problems in particular. Acidophilus has reportedly reduced the incidence of Clostridium difficile colitis and non-C. difficile antibiotic-related diarrhea.

Serious adverse effects of antibiotics, however, were less common than previous estimates. In a recent clinical trial of chronic Lyme disease, the overall serious adverse event rate was 3% after three months of antibiotics, including 1 month of intravenous antibiotics. Clinicians who have experience with higher dose antibiotic therapy must balance the benefit of higher drug levels achieved with this therapy against the modest risk of gastrointestinal and other side effects.

Duration of Therapy
Because of the disappointing long-term outcome with shorter courses of antibiotics, the practice of stopping antibiotics to allow for a delayed recovery is no longer recommended for patients with persistent, recurrent, and refractory Lyme disease. Reports show failure rates of 30–62% within 3 years of short-course treatment using antibiotics thought to be effective for Lyme disease. Conversely for neurologic complications of Lyme disease, doubling the length of intravenous ceftriaxone treatment from 2 to 4 weeks improved the success rate from 66 to 80%.

The management of chronic Lyme disease must be individualized, since patients will vary according to severity of presentation and response to previous treatment.

Concurrent risk factors (i.e., coinfections, previous treatment failures, frequent relapses, neurologic involvement, or previous use of corticosteroids) or evidence of unusually severe Lyme disease should lead to the initiation of prolonged and/or intravenous antibiotic treatment. Physicians should always assess the patient’s response to treatment before deciding on appropriate duration of therapy (i.e., weeks versus months).

Empiric Treatment
The importance of establishing the diagnosis of Lyme disease is heightened in light of increasing concern about antibiotic overuse. After an appropriate history, physical examination, and laboratory testing are completed, empiric antimicrobial therapy should be initiated on the basis of clinical clues, the severity of the patient’s acute illness, underlying disease, and the likelihood of B. burgdorferi infection. The International Lyme and Associated Diseases Society (ILADS) working group recommends that empiric treatment be considered routine for patients with a likely diagnosis of Lyme disease.

Persistent Lyme Disease
Persistent Lyme disease is more resistant to treatment and more likely to produce a relapse. Although persistent Lyme disease may resolve without additional therapy, many experts believe that this condition should be treated with repeated and prolonged antibiotics. Physicians should extend the duration of antibiotics to prevent or delay recurrent and refractory Lyme disease.

Recurrent Lyme Disease
Despite previous antibiotic treatment, Lyme disease has a propensity for relapse and requires careful follow-up for years. The data suggest that failure to eradicate the organism may be the reason for a recurrence of symptoms. Early and aggressive treatment with antibiotics is indicated for recurrent Lyme disease. The ultimate impact from retreating each episode of recurrent Lyme disease is currently unclear.

Refractory Lyme Disease
Refractory Lyme disease is a devastating condition that usually affects patients with persistent symptomatology and long-term disability. Prompt and aggressive institution of antibiotic therapy may be essential to prevent refractory disease. Increasing evidence shows that antibiotics have a beneficial effect on the course of refractory Lyme disease even in cases where the patient is intolerant of antibiotics or when a previous regimen has failed. Several months of therapy are often required to produce clear evidence of improvement. During this time, symptomatic treatment may be combined with antibiotic treatment.

Treatment Failure
When patients fail to respond or their conditions deteriorate after initiation of empiric therapy, a number of possibilities should be considered other than Jarisch-Herxheimer reaction. These include adverse events that limit treatment, allergic history to medication, inappropriate or inadequate dosing regimen, compliance problems, incorrect medication, immune sequelae, and sequestering of the organism (e.g., in the central nervous system). An alternative diagnosis or coinfection should also be considered.

Symptomatic Treatment
Although there may be a potential role for symptomatic treatment in chronic Lyme disease, this approach has little support due to the strong possibility of persistent infection. Owing to the potential hazard of immunosuppression and the poor outcome in one study, steroid therapy is not recommended. Surgical synovectomy is associated with significant morbidity and does not address neurologic presentations; it should be reserved for knee pain failing antibiotic treatment. Intra-articular steroid injection may be useful as a temporizing procedure in patients with persistent knee pain but this runs the risk of masking persistent infection.
Symptomatic therapy (particularly anti-inflammatory medications, tricyclic antidepressants, selective serotonin re-uptake inhibitors, and hydroxychloroquine) may be useful in concert with antibiotics and in individuals failing antibiotics.

Hyperbaric oxygen therapy (HBOT) is under study but is not recommended for routine therapeutic use. Other treatments, including cholestyramine (CSM), antifungal therapy, and antiviral agents require further study.

Since patients are becoming more interested in alternative therapies (e.g., traditional Chinese medicine, anti-oxidants, hyperthermia, bee venom, naturopathy and homeopathy), physicians should be prepared to address questions regarding these topics.

The outcome of treating fibromyalgia secondary to Lyme disease with nonantibiotic regimens has been poor. The most encouraging clinical trial showed success in only one of 15 patients and only modest improvement in 6 of 15 individuals with fibromyalgia despite 2 years of treatment.
Antibiotic therapy has been much more effective than supportive therapy in symptomatic patients with fibromyalgia secondary to Lyme disease.

Fibromyalgia treatment alone without antibiotics raises the risk of conversion to refractory chronic Lyme disease and/or exacerbation of an undiagnosed persistent infection and is not recommended. Increasingly, clinicians do not feel comfortable treating fibromyalgia in Lyme disease without antibiotics.

Decision to Stop Antibiotics
Several studies of patients with Lyme disease have recommended that antibiotics be discontinued after 30 days of treatment. Complicating the decision to stop antibiotics is the fact that some patients present with disease recurrence after the resolution of their initial Lyme disease symptoms. This is consistent with incomplete antibiotic therapy. Although the optimal time to discontinue antibiotics is unknown, it appears to be dependent on the extent of symptomatology, the patient’s previous response to antibiotics, and the overall response to therapy (see below).

Rather than an arbitrary 30-day treatment course, the patient’s clinical response should guide duration of therapy. Patients must therefore be carefully evaluated for persistent infection before a decision is made to withhold therapy.

The decision to discontinue antibiotics should be made in consultation with the patient and should take into account such factors as the frequency and duration of persistent infection, frequency of recurrence, probability of refractory Lyme disease, gains with antibiotics, the importance to the patient of discontinuing antibiotics, and potential for careful follow-up.
The ideal approach would be to continue therapy for Lyme disease until the Lyme spirochete is eradicated. Unfortunately there is currently no test available to determine this point. Therefore, the clinician must rely on the factors outlined above to decide on the length of antibiotic therapy for chronic Lyme disease.

Alternative Antibiotics
There is compelling evidence that Lyme disease can result in serious and potentially refractory illness. Use of alternative antibiotics to treat early Lyme disease with erythema migrans is generally not indicated unless coinfection is suspected.

The ILADS Working Group believes that the risk of alternative antibiotics is acceptable in selected Lyme disease patients presenting with chronic Lyme disease. Alternative antibiotics include less commonly used oral antibiotics (cefixime, cefdinir, metronidazole) and intravenous antibiotics (imipenem, azithromycin). The role of alternative antibiotics in low-risk patients is less certain and there is less consensus among the guideline developers as to whether the potential benefits outweigh the risks.

Therapy for Coinfection
Therapy for polymicrobial infection in Lyme disease is a rapidly changing area of clinical practice. Uncomplicated Lyme disease may be managed without addressing coinfection by means of standard oral or parenteral antibiotic therapy. Some but not all experts recommend therapy for subclinical or chronic coinfection with Ehrlichia, Babesia, or Bartonella on the basis of their belief that responses are more prompt with this approach.

The dose, duration, and type of treatment for coinfections have not been defined. Published reports of coinfection are limited to a small number of patients treated in open-label, nonrandomized studies. Doxycycline has been indicated for Ehrlichia. A recently published randomized trial determined that treatment of severe Babesia microti with the combination of atovaquone and azithromycin was as effective as the use of standard oral therapy with clindamycin and quinine.

The decision to use alternative antibiotics should be based on the individual case, including a careful assessment of the patient’s risk factors and personal preferences. Patients managed in this way must be carefully selected and considered reliable for follow-up. Further controlled studies are needed to address the optimal antimicrobial agents for coinfections and the optimal duration of therapy.

Evidence-based guidelines for the management of Lyme disease. Expert Rev Anti Infect Ther 2004;2(1 Suppl):S1-13. [66 references]

Thursday, November 8, 2007

The SHIN Approach and Treatment Protocol

Understanding The SHIN Approach to CFS/FM Treatment

In his 30 years of clinical experience, and in his landmark study on Effective Treatment of CFS/FM, Dr Teitelbaum has found that his SHIN approach to treating CFS/FM is successful in the vast majority of patients. The SHIN Treatment Protocol is a list of the more common treatments for CFS/FM.

SHIN represents four areas of health issues that need to be addressed when creating a treatment program.
These health issues and their roles in treating CFS/FM are as follows:
  • S = SLEEP: Get adequate sleep, preferably eight to nine hours a night. Sleep replenishes the body's energy and heals its muscles. Inadequate sleep will leave you exhausted and in pain.
  • H = HORMONES: Get tested for hormone deficiency and treated if needed. Hormone deficiencies can contribute to fibromyalgia and chronic fatigue syndrome.
  • I = INFECTIONS: Get treatment when symptoms of infections occur. The lack of restorative sleep in CFS/FM leads to dysfunctional immune systems. Underlying viral, bacterial, bowel, sinus and yeast infections are common and can be a contributing cause or result of CFS/FM.
  • N = NUTRITONAL SUPPLEMENTS: Optimal nutritional supplementation is essential. Many nutrients can be depleted as a result of CFS/FM. B-12, magnesium, Acetyl L Carnitine and glutathione, as well as your basic A, B, C and D vitamins need to be supplemented at a level that your average over the counter multivitamin cannot provide.

See the SHIN Treatment Protocol that Dr. Teitelbaum used in his own practice and his study. This protocol is used worldwide by practitioners who want to effectively treat CFS/FM, as well as patients who want to start natural remedies on their own. You can print it and use this as a guide with your practitioner to tailor your treatment regimen to your specific symptoms. Click here to see the SHIN Treatment Protocol

What to Expect

It takes an average of six weeks to begin to feel the benefits of your treatment. During this time, you should chart important information about your treatment progress, such as dates when you start or stop individual treatments, and their effects. For most of you, CFS/FM took months to fully manifest. It can also take several months to get well.

Although the SHIN protocol gives you the fastest path to healing, keep in mind that total recovery can take several months to over a year. You should remain on the treatment program until you are feeling consistently well for six months or more (with no back-sides). After that, you can taper off the program by discontinuing one treatment every one to two weeks. The gradual tapering is recommended so that you can make sure a particular treatment is no longer needed.

Although it isn't usually necessary, any or all of the treatments can be used forever without harm. Many patients choose to continue several treatments long term after stopping the majority of them. Reading your body’s signals and taking your practitioner’s advice are your best tools in determining which treatments should be continued to remain well.

What is Chronic Fatigue Syndrome and Fibromyalgia?

Chronic fatigue and immune dysfunction syndrome (abbreviated CFIDS or CFS) is a group of symptoms associated with severe, almost unrelenting fatigue. The predominant symptom is fatigue that causes a persistent and substantial reduction in activity level. Despite constant exhaustion, those with CFS are further frustrated by the fact that they cannot sleep.

The fatigue has one of two starting patterns. The first is gradual in onset, usually correlating with a period of severe physical or emotional stress. The second possibility is sudden onset, starting with a “drop dead flu” from which a person never fully recovers. In this case, a patient can almost always pinpoint the exact date that their illness began.

Other common symptoms include:
  • Insomnia
  • Disabling fatigue
  • Achiness
  • Difficulties with short-term memory
  • Concentration
  • Brain fog (trouble finding words and orientation confusion)
  • Increased thirst
  • Bowel disorders
  • Recurring infections
  • Exhaustion after minimal exertion
  • Weight gain
  • Low libido

CFS’s sister illness, Fibromyalgia syndrome (abreviated FMS or FM), is characterized by muscle pain. The painful muscles can be all over the body, or may be painful only at specific spots in the body. These painful areas can remain consistent or be transient. FM pain is caused by a shortening, or tightening of the muscles. These muscles need restorative sleep and optimal nutrition, among other things, in order to relax and heal (see the SHIN approach).

Since CFS/FM sufferers rarely achieve restorative stage 3 and 4 sleep, these muscles stay knotted and painful. For most sufferers, FM and CFS are the same illness. However, some people have fatigue without pain, and others have pain without fatigue.

What Causes CFS
CFS and FM are caused by hypothalamic dysfunction. The hypothalamus is the body’s master gland, which is likened to the main circuit in your home’s breaker box. The hypothalamus is weakened by long term exposure to physical or emotional stress, or a “drop dead flu”, which will cause it to “blow”. When the main fuse blows, all of the systems regulated by the hypothalamus malfunction. These systems include the glands (affecting the thyroid, adrenals, and sex hormones), the autonomic system (which regulates body temperature, blood pressure, and the anti diuretic hormone), and the sleep center.

People with CFS/FM typically suffer from a combination of different problems. The pattern can include infections (viral or bacterial), insomnia and hormonal problems, a combination Dr. T refers to as the "autoimmune triad".

Other possible underlying issues include:

  • Immune system dysfunction
  • Mild, chronic low blood pressure
  • Low blood sugar (hypoglycemia)
  • Iron deficiency anemia

Wednesday, November 7, 2007

Fibromyalgia is the result of a mismatch between sensory and motor systems, new research suggests

BATH, England, Oct. 31, 2007 - The unexplained pain experienced by patients with Fibromyalgia is the result of a mismatch between sensory and motor systems, new research suggests.

In a study published in the journal Rheumatology*, researchers asked patients to look at a reflection of one arm whilst moving their other in a different direction which was hidden behind the mirror. This created a mismatch between what the brain sees via sensory input and what it feels through the motor system that controls movement.

Of the 29 patients involved in the study, 26 reported feeling a transient increase in pain, temperature change or heaviness in their hidden limb - all symptoms of a ‘flare up’ of their condition. This suggests that a mismatch between sensory and motor neurons could be at the root of the Fibromyalgia – a condition affecting one in 100 people in the UK at some stage of their lives.

“The chronic pain experienced by people with Fibromyalgia is hard to understand because there are no obvious clinical signs that pain should be experienced,” said Dr. Candy McCabe, one of the researchers involved in the University of Bath and Royal National Hospital for Rheumatic Diseases study. “We have shown that by confusing the motor and sensory systems we can exacerbate the symptoms felt by people diagnosed with the condition. This adds to a growing body of evidence that many of the symptoms of this common disorder may be perpetuated, or even triggered, by this sensory-motor conflict.

“We have had some success to date in using a similar technique to help alleviate the symptoms of this kind of chronic pain. This works by helping the brain to see a limb moving freely without pain – although in reality it is a reflection of their pain-free limb.”

Volunteers in the study were asked to perform a series of bilateral upper and lower limb movements with a mirror in front of them at a right-angle. This meant that one limb was obscured from view behind the mirror whilst they could clearly see the other limb and its reflection. They first carried out the same movements with both limbs, and then made different movements. This enabled the researchers to see [the effect of] confusing what the brain could see with what it could feel.

“Nearly all of the group reported an increase in the sensations connected with their condition in the hidden limb,” said Dr. McCabe, who works in the University's School for Health. “This provides strong evidence that sensory-motor conflict is at the heart of this condition. Some clinicians do not recognize Fibromyalgia as a diagnosis because of a lack of clinical reason for the pain.

“It is often considered to be a reflection of anxiety or attention seeking behavior which, for people with the condition, can be very hard to deal with. Nevertheless, Fibromyalgia is one of the most common conditions seen by rheumatologists. Hopefully we are beginning to understand more about the condition, and taking steps toward how it might be treated in the future.”

People with Fibromyalgia complain of widespread pain, multiple tender points, stiffness, sleep disturbance and fatigue. Around nine out of ten of those affected by Fibromyalgia are women. In most cases it develops between the ages of 30 and 60, but it can develop in people of any age, including children and the elderly. There are around 14,700 new cases in the UK each year.

Note: The Royal National Hospital for Rheumatic Diseases NHS Foundation Trust…[home of a Specialist CFS/ME Service for Children and Young Adults] is a national specialist rehabilitation and rheumatology hospital based in Bath. Offering services to adults, children and young people, the trust has expertise general and complex: rheumatological and musculoskeletal conditions, neurological rehabilitation, pain management, management programs for people who suffer from chronic pain and Chronic Fatigue Syndrome / ME.

___* This press release refers to the article “Somaesthetic disturbances in Fibromyalgia are exaggerated by sensory-motor conflict: Implications for chronicity of the disease,” published in the October issue of the journal Rheumatology.
You can find a summary abstract of the article at and the full text is available free at

Thursday, November 1, 2007

Make Back Pain Disappear Without Drugs or Scalpel

Make Back Pain Disappear Without Drugs or Scalpel

Luckily I've never suffered a serious bout of back pain -- and staying strong in the hope I won't have problems like that is one reason I am so committed to fitness. Even so, though, the truth is that most of us (80% by some estimates) will have back pain at some time or another -- whether from over-exertion, injury or simply a result of the aging process. Chronic back pain is frustrating, not only because of how badly it hurts but also because it can be difficult to cure. It is the fifth most common reason for doctor visits.

A particularly common cause of such pain is a herniated disk, also referred to colloquially as a "slipped disk." For a long time, the usual mainstream medical solutions were surgery, physical therapy and/or pain medication, all of which take a long time and may not work for everyone. So I was very interested to learn about a non-surgical, non-invasive treatment for herniated disks called spinal decompression.

Visualize the disks in your back as being like hard donuts filled with a jelly-like material in the center. With age, the strong fibrous cartilage (the donut) can weaken, allowing the jelly-like material (nucleus pulposus) to bulge, which in and of itself is not painful. But more seriously, with a herniated disk the hard tissue has actually torn or ruptured, causing this material to ooze and press on spinal nerves. This causes pain that can range from mild to horrible.

One of the first devices used for spinal decompression was approved by the FDA in 1995. Because spinal decompression requires special expertise and pricey equipment, few chiropractors have offered this treatment -- but numbers are growing as training and better insurance reimbursement becomes more commonplace, I was told by Steven Shoshany, DC, a New York City-based chiropractor who specializes in spinal decompression.

Here's how it works: The patient lies on a comfortable table made specifically for this purpose, comfortably strapped down with a pelvis and torso harness that resembles a girdle. Calling it a "high-tech traction device," Dr. Shoshany explained how it works. "Slowly and comfortably, almost imperceptibly, the machine creates traction by pulling and holding for one minute. Then, intermittently, it releases. It is believed that this creates a negative pressure, or a vacuum within the disk, which then draws back the herniated-disk material which was displaced." With less pressure inside the disk, and thus less on the spinal nerves, pain often decreases or might even disappear -- sometimes instantaneously. To "fix the hold," however, numerous sessions may be required.

This technique also allows nutrient-rich fluid to go to the area where there is less pressure, stimulating the healing process. Most patients either sleep or watch a DVD during the treatment, Dr. Shoshany told me. Each session takes about 30 minutes and a typical treatment program may take between 20 to 30 sessions.

Critics contend that there are no long-range, well-designed studies looking at efficacy over time, but there has been some research on the treatment and the results are promising. In one study published in 2001 in Neurological Research, researchers reported that a spinal decompression therapy called VAX-D produced a success rate of 68.4%, compared with 0% for a placebo therapy in treatment of chronic low back pain. Another study from a team of researchers at the University of Illinois and Rome found a 71% success rate for treatment of herniated disk and other causes of low back pain, with "success" defined as a reduction in pain to 0 or 1 on a scale of 0 to 5.

Dr. Shoshany noted that some people get much more benefit from spinal decompression than others, and it is not an option for everyone. "It's not a good choice for a person who has metal implants in the spine," he warned. It's better for people with a single-disk herniation than those who have herniation in several or all of them. Also, people who are morbidly obese and/or who smoke likely won't find much relief from spinal decompression either.

The procedure is thought to be safe, though there is no hard science supporting its efficacy. If you do decide to seek out this somewhat unconventional form of treatment, it's safest and best to do so with the oversight of your orthopedic surgeon, who can help you ascertain whether it might work in your case.

For more information on spinal decompression, go to

Source(s): Steven Shoshany, DC, a New York City-based chiropractor who specializes in spinal decompression. He can be reached through his Web site,