Fibromyalgia and Mitochondrial Dysfunction

Dr Myhill on Fibromyalgia and Mitochondrial Dysfunction

ProHealth.com
by Sarah Myhill, MD*
December 21, 2011

Dr. Sarah Myhill is a UK-based physician with a special interest in fatigue and nutrition. Her pioneering research (“Chronic Fatigue Syndrome and Mitochondrial Dysfunction”) suggests the cells’ energy generating mitochondria are dysfunctional in ME/CFS – a situation that can produce various symptom clusters, including: a) blood flow/vascular abnormalities such as orthostatic intolerance, b) the widespread pain and sensitization most typical of fibromyalgia syndrome, and c) fatigue, exhaustion & brain fog. This information is excerpted with kind permission from (DrMyhill.co.uk).*

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Fibromyalgia – Possible Causes and Implications for Treatment

The word ‘fibromyalgia’ just refers to a symptom - it means pain in the muscles. It occurs very commonly with chronic fatigue syndrome [ME/CFS] because I suspect the underlying causes are similar.

How Energy is Produced in Cells

All cells require energy in order to work. There are two ways that they can get their energy.

Energy Production Using Oxygen. Normally, energy is supplied to cells by mitochondria (little organelles within cells) which supply energy in the form of Adenosine Triphosphate (ATP) via a process called Oxidative Phosphorylation. This process requires oxygen, is extremely efficient, and is the way in which the vast majority of energy is produced the vast majority of the time. You might enjoy watching a very interesting presentation on oxidative phosphorylation (which starts with NADH and Ubiquinol CoQ-10) - published on the website of Purdue University, Indiana.

Energy Production Using Sugar. The second way in which cells can get energy is through Glycolysis.  From an evolutionary point of view this is a very much more primitive way of supplying energy. It does not require oxygen, it just needs sugar. It is extremely inefficient and the result of glycolysis is the production of large amounts of lactic acid.

All athletes recognize the moment when they switch from aerobic metabolism (requiring oxygen) via mitochondria to anaerobic metabolism (glycolysis) resulting in a build up of lactic acid. It is this build up of lactic acid that causes the pain, heaviness, feeling exhaustion, deadened muscles, and muscles will not work or go any faster sensation.

I am also interested in this idea because in horses there is a condition known as azoturia (tying up), which does not have an obvious human parallel. I suspect, however, that this parallel is fibromyalgia. This condition occurs in some susceptible horses when there is a huge build up of lactic acid in their muscles which causes extremely severe muscle damage, massive amounts of pain and distress and in severe acute cases the horse can die from it.

So What Goes Wrong in Fibromyalgia?

I suspect that in fibromyalgia there is an inappropriate switch from aerobic mitochondrial production of energy (via oxidative phosphorylation) to glycolysis (very inefficient anaerobic production of energy, not requiring oxygen, but with a large build up of lactic acid).

Lactic acid in the short term causes immediate muscle pain. Normally this is remedied by the person slowing down or stopping because of that pain, cells switch back into aerobic metabolism and the lactic acid is quickly cleared away and got rid of. All athletes know that when they stop running the horrible painful sensation in their legs will be gone within a few seconds or minutes.

This does not happen in fibromyalgia because:

• The sufferer can't make ATP quick enough to shunt lactic acid back to acetate (via the Cori Cycle, aka Lactic Acid Cycle; more on this below).

• And the sufferer is completely pole axed by ongoing lactic acid burn with inability to move,

• And possibly secondary damage from lactic acid which, for example, is good at breaking down the collagen matrix which holds cells together. That is to say, the lactic acid may cause microscopic muscle tears, which would present as local areas of soreness and would trigger a process of healing and repair by the immune system.

There would also be excessive release of free radicals as the immune system repairs. This may well cause further muscle damage and - in people with poor antioxidant system - this is a disease amplifying process. Some sufferers find vitamin B-12 helpful, possibly because it is acting as a scavenger of free radicals.

1. The most obvious reason for this of course is mitochondrial failure, which I believe is a major cause of chronic fatigue syndrome.

If mitochondria cannot supply sufficient energy to cells, cells will switch into glycolysis with a resultant build up of lactic acid. In the heart, this switch into anaerobic metabolism because of mitochondrial failure will present with angina (chest pain). There are many causes of mitochondrial failure (see handout - causes of CFS, mitochondrial failure and mitochondrial function test) such as:

• Lack of nutrients for mitochondria to work (D-ribose, magnesium, vitamin B3 (niacin), co-enzyme Q10 and acetyl L-carnitine). [Note: A trial due to start in early 2012 at Columbia University will test the ability of selected nutraceuticals to help manage lactate levels and other aspects of mitochondrial dysfunction in ME/CFS.]

• Toxic stress (which is blocking oxidative phosphorylation, or blocking translocator protein function),

• Poor antioxidant status (so mitochondria are damaged by biochemical activity),

• Poor hormonal control (poor levels of thyroid or adrenal hormones) and so on.

2. Lack of oxygen to muscles may be another reason for the switch to glycolysis.

A fascinating paper in the Lancet by John Yudkin explains how a high carbohydrate diet could cause high blood pressure. [As a long-time professor of nutrition and dietetics at the University of London, he was an early advocate of low carb Atkins-type diets]. Dr. Yudkin demonstrated that high levels of sugar in the blood were very damaging to muscles, and the body compensates for this by shutting down the blood supply to muscles when blood sugar levels are running too high.

Whilst this protects muscles from damage by sugar, it restricts oxygen supply to that muscle. One can see how if that muscle were asked to suddenly work quite hard, it would rapidly switch into glycolysis with production of lactic acid.

Therefore I suspect high carbohydrate or high sugar diets are a risk factor for fibromyalgia. In horses with azoturia, a high carbohydrate diet is a known risk factor.

3. Exercise - too much or too little!

Muscles are extremely dynamic organs. Blood is obviously supplied to them by the heart. However, for blood to come out of muscles requires the muscle itself to contract.

Thanks to a serious of valves within veins, when muscles contract they squeeze the blood out of themselves; then as they relax, the muscles fill with blood from the heart; and then as they contract, the blood is pumped out of them again.

Indeed, during exercise, it is this alternate muscle contraction and relaxation that is largely responsible for the circulation of blood through the muscle. That is to say, the muscles like being worked - it is essential for good blood supply and it is essential to move out and excrete toxins (such as lactic acid), which inevitably build up in muscles when they are being used.

The problem for people with fatigue syndromes is that they do not have sufficient energy to exercise their muscles and therefore bring an adequate blood supply to their muscles, and this alone causes muscle problems.

This is compounded in severe CFS where cardiac output is poor because of mitochondrial failure in heart muscle! For example, if there is too much build up of toxins in muscle, the reflex response of that muscle is to go into spasm. If that muscle goes into spasm and remains in spasm (i.e., a cramp), then the circulation is further impaired and there is sudden and quick build up of toxic metabolites, which causes more pain and spasm.

This is exactly what happens in horses with azoturia (hence its other name 'tying up'). There is so much muscle spasm and pain that the horse is literally unable to move and there is a huge amount of tissue damage going on.

Obviously humans do not push themselves to the extremes that horses do and so we do not see this same acute clinical picture, but I suspect the underlying biochemistry is the same.

4. The Cori Cycle (aka Lactic Acid Cycle)

• In converting glucose to lactic acid, 2 molecules of ATP are produced.

• To get rid of lactic acid, it has to be converted back to glucose, but this requires 6 molecules of ATP.

• When energy in the form of ATP is in such short supply, lactic acid hangs around much longer and is more damaging.

Implications for Treatment

1. Treatment of mitochondrial failure as per handout.

My experience so far is that:

• This works reliably well, though it takes months to respond, not weeks.

• But improvement is sustained month on month.

• What gets in the way is allergy - that is to say, tolerating the supplements.

2. Eat a low carbohydrate, low sugar diet.

Most calories should come from protein, fat and complex carbohydrates requiring gut fermentation by probiotics - these ferment carbohydrates into short chain fatty acids, which are the desirable fuel for mitochondria.

3. The muscle problem.

There is a fine balance to be judged here! When the muscle is in acute spasm and in pain, the worst thing you can possibly do is to exercise it because it will simply make everything much worse. However, the muscle does require blood circulation in order to heal and repair, and this can be encouraged by:

• Muscle relaxants (such as diazepam),

• Improving trace mineral status (imbalance of magnesium, calcium, sodium and potassium can cause a tendency to cramp and muscle spasm),

• Heat (to improve blood supply),

• And ideally massage or toning tables. The idea here is that the muscle is gently and rhythmically squashed, which therefore improves the circulation of the muscle, but without the muscle having to do any work.

• Painkillers may be helpful because the body's response to pain is muscle spasm.

However, if the muscle feels completely fine and is not painful at all, then it should be exercised gently on a daily basis. Obviously, the more exercise one can tolerate the better, but as soon as it switches into pain, you must stop or you simply make the situation much worse.

Gentle daily use of the muscles, therefore, improves the circulation and helps the muscle to clear toxic metabolites which trigger the above problems. This may be why yoga or Pilates exercises are often helpful in fibromyalgia.

However, do not use painkillers to allow exercise - this may make things much worse!

4. Improve antioxidant status.

As soon as muscle starts to become painful and release toxic metabolites, there is secondary muscle damage by free radicals. Having good antioxidant status helps protect against this secondary damage. The obvious antioxidants to measure which I check on a regular basis are: Co-enzyme Q10, glutathione peroxidase, and superoxide dismutase. [See "A Primer on Antioxidants and Free Radicals."]

There is one antioxidant which has been trialed in horses with good results called astaxanthin, and the dose for humans would be 4mg daily. [See “Astaxanthin – A little-known but power-packed nutrient.”]

5. Iodine deficiency.

This may present with fibromyalgia. [See “Iodine – What is the correct daily dose?”]

Physical Therapy for chronic pain

KALISPELL, MT., (PRWEB) December 19, 2011 

While many people associate physical therapy solely with injury rehabilitation, Professional Therapy Associates analyzed its physical therapy services to determine the percentage of patients undergoing rehabilitative therapy versus other forms of treatment. The Northwest Montana physical therapy practice found that approximately half of its patients are receiving treatment for injury, illness or post-surgery rehab, while the remaining half are using physical therapy to address a variety of other conditions or attain health, fitness and lifestyle goals.

“Physical therapy is widely recognized for its effectiveness in helping patients recover and regain full mobility after an injury, severe illness or surgery. However, it’s a common misconception that physical therapy is only used for rehabilitative purposes – statistically, one in two patients visit us for reasons other than rehab,” said Blaine Stimac, owner and CEO of Professional Therapy Associates. “Our physical therapists are experts at rehab therapy, but they also treat patients for conditions ranging from chronic pain, arthritis and repetitive strain to headaches, sleep problems and balance issues. They also provide strength, flexibility and endurance training to athletes and individuals looking to improve their overall health and fitness.”

Physical therapists undergo extensive training in biomechanics and the musculoskeletal system, which is why they are qualified to help patients increase mobility, alleviate pain and improve fitness. Stimac elaborated on some of the physical therapy services his team provides beyond injury and surgery rehabilitation:

• Back Pain – “Many people immediately think of chiropractors when they have back pain, but physical therapy can effectively treat back pain as well as pain in adjacent areas, such as the neck, shoulders and hips,” explained Stimac. “Some people find that their back pain returns even after being treated by a chiropractor. This often happens when a chiropractor is correcting the issuing but not providing the necessary stabilization. This is where a physical therapist can help.”
• Arthritis – Stimac notes that individuals with arthritis often have stiff joints because they avoid movements that may exacerbate their pain. However, by not moving or exercising those joints, arthritis sufferers often find the pain and stiffness only get worse. Physical therapists can teach patients exercises that will minimize pain and stiffness, and strengthen muscles that support the joints.
• Desk Pain – Professionals who work with computers or at a desk often suffer from a host issues as a result of sitting for hours in a fixed position and performing repetitive movements. Physical therapy can assist with many different types of work-related pain – from back pain and neck stiffness to headaches and repetitive stress injuries. Not only will physical therapists help to ease patients’ pain, but they will also demonstrate how to avoid related problems in the future.
• Sleep-Related Issues – According to Stimac, many individuals experience fatigue or have difficulty sleeping as a result of chronic pain. Conversely, there are others who may sleep well but in awkward positions that cause neck and shoulder pain during their waking hours. He explains that physical therapists are skilled in determining the cause of such conditions, and can provide treatments, exercises and advice that will help resolve the issue.

“When patients come to us with chronic pain or other complaints, we’ll identify the underlying cause, alleviate their pain or discomfort, and show them how to fix whatever is creating the problem in the first place,” said Stimac. “I would encourage anyone experiencing pain, stiffness or limited mobility to schedule a physical therapy evaluation. Montana residents can request a free consultation at any of our four Flathead Valley physical therapy clinics if they’d like to learn more about our treatments and explore whether physical therapy is the right choice for them.”

For additional information on Professional Therapy Associates – including details on its rehabilitative treatments and other physical therapy services, as well as contact information for its clinics in North Kalispell, Downtown Kalispell, Whitefish and Columbia Falls – please visit http://www.ptflathead.com.

About Professional Therapy Associates and Blaine Stimac

Professional Therapy Associates (PTA) is an established provider of physical therapy in Montana. Founded in Kalispell in 1988, the practice has expanded to include four convenient locations throughout Flathead Valley. In addition to its flagship Kalispell North facility, PTA also has clinics in Downtown Kalispell (Flathead Health and Fitness), Whitefish (The Wave) and Columbia Falls (Columbia Falls Clinic). Owner and CEO Blaine Stimac is a licensed Physical Therapist in Montana, and holds a Master of Science in Physical Therapy from the University of Montana. He and his team offer a full range of services, including manual physical therapy, sports medicine, therapeutic exercise and biofeedback, as well as treatment for back and neck injuries, motor vehicle injuries and work-related injuries. For more information, visit http://www.ptflathead.com.

New TMJ study may answer questions about pain

A new study about painful jaw problems could lead to a better understanding of chronic pain and pain disorders.

The results, recently published in the Journal of Pain, provide insights into potential causes of temporomandibular joint and muscle disorders, known as TMJ. Researchers believe their work, the first large scale study of its kind, could lead to new methods of diagnosing facial pain, predicting who is susceptible to them and new treatments.

TMJ is not a single condition, but rather a group of conditions, categorized by acute pain in the jaw joint and chronic pain in the facial area. This cluster of jaw problems is the second most common occurring musculoskeletal condition that can lead to disability, trailing only chronic lower back pain. TMJ radiates through the jaw and muscles, causing pain and tightness in the jaw, neck, and ear. Symptoms include aching facial pain, difficulty chewing, ear aches, pain and tenderness in the jaw, headache, jaw locking, and an uncomfortable or uneven bite.

Researchers with the Orofacial Pain Prospective Evaluation and Risk Assessment study (OPPERA) followed an initial group of 3,200 pain-free people, aged 18 to 44, between three and five years. They found that chronic pain TMJ increased with age in women but not in men. This finding overrode assumptions that pain was greatest in childbearing years for women but decreased with age. The study also found genetic factors that were linked to chronic TMJ. These genes were identified, resulting in the possibility of creating drugs for these and other chronic pain conditions that are related to TMJ.

“This novel study will also allow us to learn more about pain disorders in general, and will improve our ability to diagnose and treat chronic pain conditions across the board,” said Dr. William Maixner, program director for the study and director of the Center for Neurosensory Disorders at the University of North Carolina at Chapel Hill School of Dentistry. “OPPERA is allowing us to study potential biological, psychological and genetic risk factors over a longer period of time, so we will be able to better evaluate the association of these factors.”

While trauma is often the cause of TMJ, there are many times when the cause isn’t clear. The Mayo Clinic states that some of the reasons for jaw pain, tightness, and clicking include the disk eroding out of alignment, a damaged joint, arthritic damage to the cartilage of the joint and fatigued muscles that should be stabilizing the joint. Simply put, even every day occurrences such as grinding your teeth at night or clenching your jaw may lead to the condition.

Perhaps the most outstanding finding in the study was finding a range of biological and psychological factors that contribute to the pain of the condition. People with TMJ are more sensitive to pain, even just mildly painful stimulation, than those that do not have the condition. They have a higher heart rate that increases greater during stress. They are also more aware of their body’s sensations than those without TMJ. These findings may conclude that TMJ is partially connected to the ability to suppress pain and the perception of pain.

Why the focus on medical cannabis?

I know it seems like I've been posting a lot about medical cannabis lately, but there are several studies being publicized at this time.  I believe, if it works, it works, so I have no problem with publicizing these studies and writing about medical cannabis.  I will soon be focusing on other areas of treatment of chronic pain, and have in my past posts.  A number of topics can be found in the archives.

Cannabis and California’s Physicians: A New Perspective

The following statement appears in the December edition of San Francisco Medicine, the journal of the San Francisco Medical Society.

Time for New Perspectives

CANNABIS AND CALIFORNIA’S PHYSICIANS


Steve Heilig, George Fouras, Donald Abrams, and David Pating

There has long been a “drug war” surrounding marijuana, not only in terms of the plant’s legal status but also in words.  As the California Society of Addiction Medicine observes, “Reasonable dialogue regarding marijuana use has historically proven extraordinarily difficult.”  The result is a longstanding stalemate and various symptoms of “reefer madness,” but with a growing consensus that our nation’s marijuana policy has not served us much better than the failed experiment with alcohol prohibition many decades ago.

Most recently, there was this headline: “California Medical Association calls for legalization of marijuana.” It was a cover story in the Sunday Los Angeles Times in October. As the CMA is a large, mainstream medical society, this caused quite a stir.

The four authors of this article served as San Francisco’s representatives on the CMA’s “Technical Advisory Committee” (TAC) tasked with drafting “a comprehensive white paper recommending policy on marijuana legalization and appropriate regulation and taxation.”  The TAC was “selected to represent CMA in the areas of science, ethical affairs, public health, addiction medicine, and expertise in the use of cannabis.”  We met five times; the deliberations were sometimes contentious but each member agreed sufficiently to endorse a final report to the CMA board of trustees.

Our 14-page report, titled “Cannabis and the Regulatory Void”, was submitted to the CMA’s Board of Trustees and approved, unanimously, in October. Reactions from all sides were immediate.  The CMA was called “irresponsible” and at least one opponent utilized the cliché “What are they smoking?”  But there has also been much positive response as well, with editorials saying we took “a bold step” towards “a prescription for the medical pot mess” and that that the CMA’s “traditionally conservative doctors” are “simply acknowledging the obvious: Our current laws and the resulting war on drugs aren’t working.

“1. Impact on Cannabis use:  The primary concern regarding “legalization” or any lessening of legal penalties regarding cannabis is that it might increase use, particularly among teens.  We share such concerns, especially in light of growing evidence regarding negative effects on neurodevelopment.  But there is no good evidence that laws have much effect on use; in fact, long evidence is that our punitive approaches have little deterrent effect.  Thus we should seek approaches which maximize knowledge about the impacts of cannabis use, and which do not worsen the problem by criminalizing otherwise law-abiding people, kicking kids out of schools to no productive end, wasting resources, and hampering research.  Evidence-based drug education is difficult but likely to be at least as effective as legal approaches – and likely more so.

2. Resources and costs:  Enforcing largely futile laws is expensive, especially when prison is involved.  Appropriate treatment and education is far more cost-effective. While our report recommends an approach closer to that taken towards alcohol, at least for adults, we have no illusion that such an approach is easy or ideal, or that the taxation we endorse will be a simple matter or yield massive funding.  But we are confident that it will be more cost-effective than longtime, failed “drug war” or prohibition-type policies.  And very importantly, the funds saved and generated should be directed towards treatment of addiction.

3. Medical Marijuana: We join the many experts and organizations holding that cannabis be placed in a less restrictive category that would facilitate more research.  And while we support some legal medical use of cannabis such as allowed since 1996 in California, we note that a decriminalization approach would have the salubrious effect of lessening or even eliminating the need for physicians to serve in the oft-uncomfortable “middle man” role of “gatekeeper” for medical use of cannabis – and also allow for more rigorous regulation of questionable practices at “cannabis dispensaries.”

An ever-growing roster of medical, legal, political, and other authorities of all political stripes feel that the time has come for a serious change in our drug laws, especially with respect to cannabis.  We have joined them, as has the CMA.

Interestingly enough, another new CMA policy was independently adopted this year, which could have served as a preamble to our own report:

MEDICAL VS. LEGAL SOLUTIONS TO DRUG ABUSE: CMA encourages the federal government to re-examine the enforcement- based approach to illicit drug issues (“war on drugs”) and to prioritize and implement policies that treat drug abuse as a public health threat and drug addiction as a preventable and treatable disease.

We agree, and know that many others do as well.  We hope our elected leaders will listen.

***Steve Heilig is with the San Francisco Medical Society and editor of the Cambridge Quarterly of Healthcare Ethics.  George Fouras is a child and adolescent psychiatrist and President of the San Francisco Medical Society; Donald Abrams is chief of Hematology-Oncology at San Francisco General Hospital and a leading medical cannabis researcher at the University of California, San Francisco; David Pating is an addiction psychiatrist and past-president of the California Society of Addiction Medicine. Their opinions here are their own and not necessarily representative of their affiliated organizations.
For more information:
The California Society of Addiction Medicine:
http://www.csam-asam.org/

Speaking out against a stigma

Terry Bremner smokes his marijuana pipe in Halifax parking lots and quiet woods, even though he is legally allowed cannabis to dull the pain of fibromyalgia.

Until now, his two adult sons didn't know. Nor did his neighbours, or the parents of the preteen football players he coaches.

But he thinks it's time to speak up against the stigma that lumps medical users with recreational ones.
As president of the Chronic Pain Association of Canada, headquartered in Edmonton, Bremner, 50, visits chronic pain sufferers across the country talking about marijuana as a medical option, especially for those who experience side-effects from strong opioids.

"I was begging for pain meds," said Bremner, who was 34 and working in St. Albert when he was in a head-on collision in 1995. Doctors didn't diagnose him with a mild traumatic brain injury and fibromyalgia until two years later.

Bremner tried Tylenol 3s, morphine, Demerol and Prozac. A psychiatrist suggested shock treatment.
Instead, Bremner started sneaking off for a joint, which helped interrupt his fixated thoughts of pain, his worries about making ends meet and his fight for benefits.

When Bremner moved back to Nova Scotia in late 1997 with his wife and two children, he couldn't find a doctor willing to take on his complex needs. Initially he turned to the streets to get his small supply.
His supplier got busted.

Then, his wife found out. "She wasn't impressed," he said.

At least not until he discovered the compassion club in Halifaxthat sold marijuana illegally to people with documented health problems - and then only in clandestine handovers.

Bremner could only afford 10 grams a month, and would quickly run out. He enrolled in a two-year study to try the government's marijuana. "It was total garbage," he says, but it was free.

Eventually, Bremner got his federal licence to use the drug. He has been waiting two months for a renewal. Then he will once again order his supply from Victoriabased MedMe, a company that supplies multiple strains of marijuana.

Bremner looks for the right combination of Sativa strains, to boost energy, and Indica strains, to bring sleep and relaxation. Some types help with chronic pain; others work better for patients with cancer, HIV or other severe diseases. Health Canada's one-size-fitsall approach simply isn't adequate, Bremner said.
His wife now understands the medical need. Bremner plans to explain it soon to his two sons.

"I have been asked to be a voice" for chronic pain sufferers, Bremner said. "Maybe it will attract more attention to help more individuals, people like myself who need this medication."

Researchers seek Chronic Fatigue patients for study

Participants needed to take part in study, the first to look in-depth at vision problems caused by the disorder 

Researchers from the University of Leicester have launched a new study into vision problems suffered by patients with Myalgic Encephalopathy (ME) or Chronic Fatigue Syndrome (CFS). People who suffer from ME/CFS typically experience a range of symptoms which may include extreme tiredness, painful joints, headaches and digestive problems.

The team from the University of Leicester's School of Psychology is undertaking the first study to look in-depth at visual issues in ME/CFS patients. The researchers hope that collecting medical evidence of such symptoms could aid in the diagnosis and treatment of ME/CFS.

There is little consensus on the cause of ME/CFS or on how to treat patients with the condition. Although vision problems are widely reported by ME/CFS sufferers, research in this area is scarce and little formal evidence of such issues has been documented.

The researchers are actively looking to recruit participants to take part in the study.
Steve Badham, who is running the study, said: "This project provides us with an excellent opportunity to study the link between vision and ME/CFS. Understanding this relationship will allow us to better differentiate between ME/CFS and other conditions, and to learn more about the symptoms that patients are suffering from."

The University of Leicester team hopes to investigate a range of basic visual problems commonly reported by ME/CFS sufferers, such as hypersensitivity to light and difficulties focussing on and tracking objects.

ME/CFS affects around 250,000 people in the UK alone. The main symptom is persistent fatigue and tiredness that doesn't go away with rest and has no obvious cause. Sufferers may also experience other symptoms and can find themselves unable to work or take part in activities. Gathering hard evidence of the symptoms and effects of ME/CFS can aid in treatment and diagnosis and help raise the profile of this debilitating illness.

The diagnosis of ME/CFS has been a controversial one for many years, because the cause of the condition is currently unknown. Suggested treatments for ME/CFS include psychological interventions such as behavioural therapy, and medication such as painkillers and low dose antidepressants. There is no known cure for ME/CFS.

The researchers are looking for anyone with a medical diagnosis of ME or CFS to get in touch if they wish to help out with the study. Participants will take part in the study at the University, involving visual tests and tasks on a computer. You can contact Steve Badham by email (sb569@le.ac.uk) or telephone (0116 229 7081) for more information about volunteering. Even if you don’t think you suffer from a vision problem, you may still be eligible to take part.

Pot, narcotics OK to treat chronic pain

Inhaled marijuana appears to be a safe and effective treatment for chronic pain when used in addition to narcotics like morphine and oxycodone, according to a small UCSF study that is the first to look at the combined effects of the two classes of drugs in humans.

The study, published in this month's edition of Clinical Pharmacology and Therapeutics, was designed primarily to look at whether taking marijuana with narcotics is safe, and researchers reported that there were no negative side effects from combining the drugs.

Overall, the 21 men and women in the study reported a roughly 25 percent reduction in pain after inhaling vaporized marijuana several times a day for five days.

If the results can be backed up in further studies, marijuana could prove an important means of augmenting the effects of narcotic drugs for the millions of people who suffer from chronic pain associated with cancer, AIDS and a variety of other conditions, said study author Dr. Donald Abrams, a UCSF professor and chief of the hematology-oncology division at San Francisco General Hospital.
"If we can get funded, we should do a study now with pain as the endpoint" and not just safety, Abrams said.

He added that scientists don't yet understand how, exactly, marijuana and opiates interact in humans, but "our results support that the relationship between cannabis and opiates is synergistic."

Multiple studies of medical marijuana have shown that the drug can be beneficial in treating pain. A drug called Sativex that combines the two main compounds of marijuana - cannabidiol (CBD) and delta-9 tetrahydrocannabinol (THC) - is currently in clinical trials for treatment of pain in cancer patients in the United States, and is already used in Europe and Canada.

Stands to reason

With what's already known about marijuana's pain-relieving effects, it's not surprising that the drug, when used with narcotics, would increase pain relief, said researchers not associated with the new study.

"There's already tons of data on cannabinoid pain relief and opiate pain relief, and it only makes sense that you'd get more pain relief from two drugs instead of one," said Dr. Daniel Nomura, an assistant professor in the nutritional sciences and toxicology department at UC Berkeley.

Abrams himself pointed out that because his study is small, and because all of the patients knew they were inhaling marijuana and therefore could have experienced some pain relief from a "placebo effect," it would be premature to start widely prescribing cannabis to pain patients. Still, the results were promising enough that he intends to attempt a second study to look more closely at pain relief.

But getting another study off the ground will be tough. The bar has been set high for acceptable uses of medical marijuana, Abrams said, and getting money and other resources - notably, the drug itself - to conduct research can be very difficult. Abrams' study was funded by the National Institute on Drug Abuse, which also supplied the marijuana.

The patients in Abrams' study were taking twice-daily doses of either morphine or oxycodone to treat chronic pain associated with a variety of conditions, such as arthritis, neuropathy, cancer and multiple sclerosis.

Patients stayed at San Francisco General Hospital during the study. They inhaled vaporized marijuana three times a day, for about 10 minutes at time. On the first day of the study, the mean pain score, on a scale of 0 to 100, was 39.6; after five days of marijuana therapy, their mean pain score was 29.1.

Ideal outcome

The hope, Abrams said, is that marijuana could someday be used either in conjunction with narcotics or as a replacement for narcotics to help curb some of the side effects associated with those medications.
Glenn Osaki of Pleasanton, a patient of Abrams who used to take drugs like morphine and oxycodone daily, said he's been off narcotics since July 2010, after he started using medical marijuana to combat pain associated with colon cancer.

"I was out of it most of the time from the opiates," said Osaki, 53. "It was hard having a decent quality of life, and I was just trying to figure out a way to manage my pain."

Medical marijuana has only one side effect he doesn't care for: the high.

"I used to smoke pot when I was a kid, just goofing around," he said. "The stuff nowadays is pretty strong, so that is one thing I don't really like now."

At UC Berkeley, Nomura agrees. He and other biologists are studying ways to tap into the useful effects of cannabis without the drug high that comes with it.

"Obviously medicinal marijuana is still widely used. There are really undisputed beneficial effects," Nomura said. "But in terms of moving forward with drug development, we need to develop safer drugs that don't make you high."

Read more: http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2011/12/06/MN9V1M98G6.DTL#ixzz1fui1kNdS

Cannabis slows cancer in test tube

Marijuana Ingredients Slow Invasion by Cervical and Lung Cancer Cells

By Daniel J. DeNoon

Dec. 26, 2007 -- THC and another marijuana-derived compound slow the spread of cervical and lung cancers, test-tube studies suggest.

The new findings add to the fast-growing number of animal and cell-culture studies showing different anticancer effects for cannabinoids, chemical compounds derived from marijuana.

Cannabinoids, and sometimes marijuana itself, are currently used to lessen the nausea and pain experienced by many cancer patients. The new findings -- yet to be proven in human studies -- suggest that cannabinoids may have a direct anticancer effect.

"Cannabinoids' ... potential therapeutic benefit in the treatment of highly invasive cancers should be addressed in clinical trials," conclude Robert Ramer, PhD, and Burkhard Hinz, PhD, of the University of Rostock, Germany.

Might cannabinoids keep dangerous tumors from spreading throughout the body? Ramer and Hinz set up an experiment in which invasive cervical and lung cancer cells had make their way through a tissue-like gel. Even at very low concentrations, the marijuana compounds THC and methanandamide (MA) significantly slowed the invading cancer cells.

Doses of THC that reduce pain in cancer patients yield blood concentrations much higher than the concentrations needed to inhibit cancer invasion.

"Thus the effects of THC on cell invasion occurred at therapeutically relevant concentrations," Ramer and Hinz note.
The researchers are quick to point out that much more study is needed to find out whether these test-tube results apply to tumor growth in animals and in humans.

Ramer and Hinz report the findings in the Jan. 2, 2008 issue of the Journal of the National Cancer Institute.