The following is an overview of drug treatments that may be used as part of a treatment plan for environmental illnesses. Not all will apply to every illness, pain medications for example, are more likely to be required by fibromyalgia patients, whereas chronic fatigue syndrome patients tend to have less severe pain and may be able to cope with it using non-drug therapies. It should be remembered that none of the drugs described below offer a cure for environmental illnesses but they can be very helpful for relieving troubling symptoms like pain and insomnia, and may therefore contribute to the healing process. All drugs come with possible side-effects so these should be considered and discussed with your physician before you embark on any drug therapy.
Pain Medication (Analgesics) - With pain being a predominant symptom of environmental illnesses, especially fibromyalgia, it's not surprising that pain medications are one of the most commonly prescribed treatments. Pain medications often used include over the counter drugs such as aspirin and acetaminophen (paracetemol). When these are not effective, doctors may prescribe more powerful medications such as narcotics (opiates), codeine, Vicodin, Darvocet, Oxycontin and Percocet. Alternatively, a drug called Ultram may be given which works in a different way to the narcotics. These medications are not a cure and will not directly treat the causes of fibromyalgia but they can be important for bringing temporary relief from the pain. Patients should however bare in mind that narcotic medications have potential for adverse side effects including drowsiness, difficulty with concentrating, and addiction.
Anti-Inflammatory Medications - Inflammation as a result of infection, allergy or immune dysfunction is widespread in environmental illnesses, so anti-inflammatory medications may be helpful. These include aspirin, nonsteroidal anti-inflammatories (NSAIDs) such as ibuprofen, Naprosyn, Lodine, Daypro, and the newer Cox-II inhibitors, and corticosteroids such as prednisone or dexmethasone. A number of these are available over the counter such as aspirin and ibuprofen but others such as Cox-II inhibitors and steroidal drugs require a prescription. Anti-inflmmatory medications may be less effective than the analgesics at reducing pain in fibromyalgia due to the fact that the illness isn't a true inflammatory disease. They may however be useful in treating that flares up after excessive physical activity, in which case they should be used only as needed. Although sometimes helpful, anti-inflammatory medicines have a number of potential side-effects including gastrointestinal bleeding, and in the case of steroidal drugs, immune-suppression. Given the immunological abnormalities seen in environmental illnesses it is probably wise to keep their use to a minimum.
Sleep Medications - With sleep disturbances being so common amongst environmental illness sufferers and a good nights sleep essential to how you feel the following day, sleep medications can play a vital role in treatment. Sleep medications include benzodiazepines like diazepam (Valium) and the hypnotic non-benzodiazepines such as Ambien. The most common reported concern about using sleep medications, especially benzodiazepines, is the potential for addiction. Most people however require very low dosages and may be able to take them only when needed, rather than every night. Ambien is said to be less addictive but can cause rebound insomnia when a patient stops taking it. If you do suspect you may have a problem speak to your doctor and seek information on addiction and rehabilitation immediately. A newer sleep medication is called Sonata and this is not habit forming and doesn’t cause rebound insomnia. All the types of sleep medication mentioned are short acting, which means they will help you get off to sleep but their effects will have worn off by the morning, thus there is no "hangover" feeling. Klonopin, a benzodiazepine, is reported by prominent physicians such as Dr. Paul Cheney and Dr. Jacob Teitelbaum, to be one of the most effective sleep medications. It is known to help patients reach the all important "stage 4" sleep in which the body does most of its repair and recharging work.
Anti-Depressants - These medications can help patients in a number of ways including treating pain, mood disturbances and sleep disturbances. The antidepressant medicines include tricyclics such as amitriptyline, nortriptyline and doxepin, selective serotonin reuptake inhibitors (SSRI's) such as Prozac, Zoloft and Paxil, and finnally, newer medications with different actions such as venlafaxine (serotonin and norepinephrine reuptake inhibitor) and reboxetine (norepinephrine reuptake inhibitor). The tricyclic medicines are often effective, but frequent side effects include dry mouth and drowsiness, which can defeat the object of taking them in the first place. Sleep disturbances can often be helped by using low doses but it's often best to trial other sleep medications that don't have the potential for inducing daytime drowsiness. Studies have shown thatstudies have s low doses of tricyclic antidepressants can benefit fibromyalgia patients by decreasing pain, inducing muscle relaxation and improving mood (Karette et al, 1986, Goldenberg et al, 1986).
Muscle Relaxants - Muscle relaxants can sometimes decrease pain in sufferers of fibromyalgia and other environmental illnesses. Medicines in this family include Flexeril, Soma, Skelaxin, and Robaxin. The most common side effect is drowsiness, although Soma and Skelaxin cause less of it. Physicians such as Dr. J. Goldstein, who has worked extensively with chronic fatigue syndrome, fibromyalgia and irritable bowel syndrome patients, believes that rather than acting directly to "relax" muscles, medications such as these act through a central neurological mechanism to reduce muscle pain and other symptoms.
Anti-Anxiety Medications - As well as depression, anxiety is a common problem and can exacerbate all other symptoms, so it is important that it is treated. A range of different medications such as antidepressants and muscle relaxants can treat anxiety. Benzodiazepines such as Klonopin, Ativan, and Xanax, are also commonly used. As we've already discussed, these medications are also used to treat sleep disturbances so they have more than one benefit. Again, Klonopin is regarded as a particularly useful medicine. Dr. Mark J. Pellegrino, believes it is especially useful in the evening, especially when there are leg symptoms (pain, restless leg syndrome, jerking of the legs called myoclonus) that interfere with sleep. He states that "low dose Klonopin therapy is one way to improve the balance of the inhibitory receptors (GABA) and the excitatory receptors (NMDA) in the central nervous system. Most fibromyalgia patients have too much activity in the excitatory receptors (MMDA receptors), and Klonopin can increase the pain inhibitors’ activity to achieve a more normal balance, improving sleep and reducing pain".
Trigger Point Injections for Fibromyalgia - As well as oral medications, doctors sometimes give their fibromyalgia patients trigger point injections. Trigger points are specific areas of extreme sensitivity on the body. When touched, these trigger points can cause pain, restrict motion, and increase muscle stiffness. Trigger points are often described as tight bands or knots in the soft tissue just beneath the skin. Trigger point injections target these areas with certain drugs, generally pain killers and anti-inflammatories, to reduce the severity of symptoms.
Potential Dangers of Medication Use
Obviously, when choosing to take any medication the possible side-effects should be taken into account. The dangers of addiction and dependence should also be discussed with your doctor. It should also be noted that all medications increase the detoxification burden, which is an important consideration in environmental illness patients; studies have repeatedly shown patients have increased free radical production and low levels of detoxification enzymes such as glutathione with which to defend against them.
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