Guaifenesin protocol
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2008-07-01T18:19:48Z
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[[Image:Guaifenesin.svg|thumb|[[Guaifenesin]]]]
'''Guaifenesin protocol''' is an experimental, alternative treatment for [[fibromyalgia]] proposed in the 1990s by Dr [[R. Paul St. Amand]]. The proposed treatment involves three parts: titrating to the proper [[guaifenesin]] dosage, avoiding [[salicylate]]s, and following a [[low carbohydrate diet]] if the patient is [[hypoglycemic]]. [[Guaifenesin]] has not been approved by the [[Food and Drug Administration|FDA]] for the treatment of fibromyalgia, and the protocol has not been shown to be effective in clinical trials as of 2008. It has been adopted by many due to anecdotal evidence of success; however a clinical study in 1996 has cast doubt on the effectiveness of Guaifenesin.<ref name="Bennett">{{cite journal |author=Bennett RM, De Garmo P, Clark SR |title=A Randomized, Prospective, 12 Month Study To Compare The Efficacy Of Guaifenesin Versus Placebo In The Management Of Fibromyalgia |journal=Arthritis and Rheumatism |volume=39 |pages=S212 |year=1996 |url=http://www.myalgia.com/guaif2.htm |format=reprint |doi=10.1002/art.1780391004}}<br/>Lay summary and report:
* {{cite web |author=Melissa Kaplan |work=Chronic Neuroimmune Diseases |title=Is One Placebo Better Than Another? -- The Guaifenesin Story
|url=http://www.anapsid.org/cnd/drugs/guai2.html |date=April 19, 2007 |publisher=Fibromyalgia Network}}</ref>
==Treatment details==
===Guaifenesin dosage===
The dosage is individually determined by slowly [[titration|titrating]] the dosage up until a worsening of symptoms is noticed and there is a decrease of the [[lesion]]s that can be palpated in the [[muscle]]s. Patients begin with 300 [[Milligram|mg]] twice a day and increase from there. The guaifenesin should be pure guaifenesin and not a preparation including other medications.
===Avoiding salicylic acid===
[[Salicylic acid]] in even tiny amounts blocks guaifenesin from binding in the [[kidney]]s. It is present in many drugs such as [[aspirin]], Salsalate, Disalcid, Anacin, and Excedrin. Plants produce salicylic acid, so [[herbal medicine|herbal medications]] must be avoided as well as plant oils, gels and extracts in [[cosmetics]] and any product that touches the skin. These ingredients include [[aloe]], [[castor oil]], [[camphor]], and [[Mentha|mint]]. Any plants can be eaten, however, because the small amount of salicylic acid present in food is broken down in the [[digestive system]] and tagged with [[glycine]] by the [[liver]] before reaching the kidneys.
===Treating hypoglycemia===
Many symptoms of [[hypoglycemia]] (or perhaps more aptly titled Carbohydrate Intolerance) are similar to fibromyalgia, and while leaving hypoglycemia untreated will not hinder the reversal of the disorder with guaifenesin, the symptoms will continue to plague the patient. The only treatment is a life-long avoidance of [[Sucrose|simple sugars]], [[caffeine]], [[starch]]y foods, and any other foods that cause [[insulin]] spikes.
==Theory of fibromyalgia cause==
This theory involves [[phosphate]] accumulation in cells that eventually reach a level to impede the [[Adenosine triphosphate|ATP]] process, possibly caused by a kidney dysfunction or missing [[enzyme]] that prevents the removal of excess phosphates from the blood stream. This theory posits that fibromyalgia is an [[Genetic disorder|inherited disorder]], and that phosphate build up in cells is gradual (but can be accelerated by [[Physical trauma|trauma]] or [[illness]]). [[Calcium]] is required to buffer the excess phosphate when it enters the cells. The additional phosphate slows down the ATP process; however the excess calcium prods the cell to action. The causative mechanism in the kidneys is unknown.
The phosphate build-up theory is said to explain the myriad symptoms present in fibromyalgia and provides an underlying cause, but remains theoretical; there is no clinical evidence that the phosphate build-up theory is correct, or that Guaifenesin protocol is effective.
Results of the only reported randomized clinical trial in 1996 found that guaifenesin had no significant effects on pain, other symptoms, or laboratory measures (serum and urinary levels of uric acid and phosphate) over 12 months in a sample of people diagnosed with fibromyalgia syndrome,<ref name="Bennett"/> The lead author of the study has suggested a number of reasons why some patients may have previously reported benefits on this protocol, concluding "Dr. St. Amand has unknowingly used guaifenesin as a powerful focus in a program of cognitive behavioral therapy, in which his empathy, enthusiasm and charisma were the real instruments in effecting a beneficial change."<ref>{{cite web |author=Robert Bennett |title=Speculation as to the mechanism whereby some of Dr. St. Amand's fibromyalgia patients experienced improvement while taking guaifenesin |url=http://www.myalgia.com/Treatment/guaifspe.htm |date= |publisher=Fibromyalgia Information
Foundation |accessdate=2008-01-06}}</ref> Dr. St. Amand has noted that the study did not control for salicylate use, and therefore did not study the protocol as a whole. He has recommended a follow-up study be conducted which controls for all elements of the protocol.<ref>St. Amand, R. Paul. [http://www.fibromyalgiatreatment.com/Research_Oregon.htm "A Response To The Oregon Study's Implication"], Clinical Bulletin of Myofascial Therapy, Vol. 2(4) 1997. c 1997 by The Haworth Press.</ref>
==History==
This theory arose when Dr. St. Amand noticed that patients with fibromyalgia symptoms had an increase of [[calculus (dental)|tartar]] on the [[teeth]] in the form of calcium phosphate. Crystals are also often found on [[urinalysis]] which further points to calcium phosphate, and muscle [[biopsies]] show an increase of phosphate in the [[cytosol]]. Lesions of muscles, [[tendon]]s, and [[ligament]]s can be felt by a method of palpation called mapping developed by Dr. St. Amand. These lesions are thought to be contracted cells forming a spastic area caused by an excess of calcium in the cytosol of the cells.
The treatment was discovered serendipitously when the physician found that [[uricosuric]] drugs for treating [[gout]] also coincided with relief of fibromyalgia symptoms. Guaifenesin is mildly uricosuric but, unlike standard uricosuric drugs, has almost no side effects. Dr. St. Armand therefore began to study whether guaifenesin might relieve the symptoms of fibromyalgia while causing fewer side effects than other uricosuric drugs had caused.
==References==
{{reflist|2}}
==External links==
* [http://www.fibromyalgiatreatment.com/index.htm Guaifenesin Protocol Main Page]
* [http://stuff.mit.edu/people/london/guai.html The Truths and Myths of the use of Guaifenesin for Fibromyalgia]
* [http://www.fmnetnews.com/resources-alert-product6.php Consumer Alerts: Guaifenesin - Is One Placebo Better Than Another?]
* [http://www.myalgia.com/guaif2.htm Clinical trial details]
[[Category:Alternative medicine]]