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As a rheumatologist interested in fibromyalgia
(FM) for more than 10 years, I've found it challenging to help
restore function and pain relief in these sufferers of widespread pain
and fatigue. The complexity of FM warrants a combination of
medications and interpersonal psychotherapy. Once medically
stabilized, most clinicians recommend physical therapy and aerobic
reconditioning.
At the September 2004 American Academy of Pain Management meeting in
San Antonio, I was intrigued by a seminar about the FDA-approved
modality of Alpha-Stim microcurrent therapy and cranial
electrotherapy stimulation (CES) from Electromedical Products
International inc. in Mineral Wells, Texas.
Alpha-Stim taps into endogenous microcurrent circuits in the body and
brain, analogous to acupuncture. This prompts restorative effects in
the nervous system. The Alpha-Stim 100 combines transcranial
electrotherapy stimulation to the subcortical brain with microcurrent
therapy to the body.
FM treatment targets three areas. Clinicians first try to restore
sleep quality by using combinations of short-acting agents tailored to
patients' needs, such as difficulties with sleep initiation, nocturia
and restless legs. Second, they prescribe antidepressants, titrated to
alleviate morning stiffness and fatigue-the somatic components of comorbid depression. Finally, clinicians suppress structural (often
spinal) or inflammatory (arthritic) pain generators with
.analgesics--typically opioids and nonsteroidal anti anti-inflammatory agents.
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While I'm impressed with the clinical progress in a majority of my
patients using these three steps, patients tend to poorly tolerate
medications, and sustained clinical responses are often elusive.
Adding microcurrent technology to therapy plans may help dramatically.
In the last four months, my practice has trained approximately
200 patients in this modality, with a high acceptance rate. Most
patients derive good to excellent benefits. The following examples
illustrate these good results.
Case #1. A.H. is a 40-year-old disabled Medicaid
recipient with fibromyalgia complicated by chronic lumbar strain,
ankle osteoarthritis, depression and obstructive sleep apnea. She
rated her pain and fatigue 9 out of 10 on a visual analogue scale
(VAS). She also described fairly global difficulties with daily living
skills and up to six hours of morning stiffness.
For spine and ankle relief, A.H. took low-dose escitalopram, celecoxib
and transdermal fentanyl (Duragesic) in 150 mcg doses, every two days.
In mid-December, she received her first microcurrent treatment to the
ankles, which reduced her pain rating from 10 to 6 in three minutes.
Her spine pain rating plummeted from 8 to 0. A.H. found the cranial
electrotherapy stimulation so relaxing
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she returned in two days to pay for the unit. She also showed no
resistance when we reduced her opioid dose by half.
Case #2.
C.R. is a 45-year-old man who reported widespread pain complicated by
chronic lumbar strain, lumbar spinal stenosis, knee osteoarthritis and
painful venous stasis edema. Treatment for his fatigue and stiffness
included a combination of mood stabilizing agents, including 80 mg of
ziprasidone daily and 600 mg of quetiapine at bedtime. For spine and
leg pain relief, C.R. took approximately 480 mg of continuous-release
oxycodone daily.
Within one week of initiating Alpha-Stim therapy to his spine and legs
along with follow-up CES treatment, C.R. found his continuous-release
oxycodone unnecessary and oversedating for the first time in years.
Low dose, short-acting oxycodone is now ample for liberal activity. In
addition, during his initial office treatment, C.R.'s trapezius pain
rating dropped from 8 to 3 on a VAS.
There's been variable acceptance regarding the safety of using opioid
analgesics to treat noncancer pain. In FM patients, the risk-benefit
ratio becomes even more complicated. Given that Alpha-Stim raises
serotonin and norepinephnne levels, and has a neutralizing effect on
somatic pain generators, I predict this therapy will become a
mainstream modality for reducing medication reliance and enhancing
function in patients with FM. Combining Alpha-Stim with comprehensive
physical therapy and aerobic conditioning will further the chances of
treatment success.Stephen E. Plotnick M.D. is a
board-certified rheumatologist with a private practice in Virginia
Beach, VA |
Finding Hope