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The Metabolic Treatment
of Fibromyalgia
by Dr. John C. Lowe
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A Case-Control Study
!
A case-control study of metabolic therapy for
fibromyalgia: long-term follow-up comparison of treated and untreated patients.
John C. Lowe, MA, DC,
Alan J. Reichman, MD, Jackie Yellin, BA: Clinical
Bulletin of Myofascial Therapy, 3(1):65-79, 1998.
Abstract. The long-term effectiveness of metabolic
therapy for fibromyalgia syndrome (FMS) involving the use of exogenous thyroid hormone was
evaluated. Twenty treated FMS patients were compared with 20 matched evaluated but
non-treated FMS patients. Treated patients successfully underwent metabolic therapy and
were released as significantly improved or recovered between 1991 and 1995. Untreated
patients were evaluated during this same time frame, but were not able to undergo
treatment because of insufficient or absent insurance coverage. Patients were contacted by
mail; they each filled out and returned a questionnaire with forms used to evaluate FMS
status. Treated patients were matched with untreated patients based on time since initial
evaluation, sex, and thyroid status. In each group, 10 (50%) patients had been classified
as euthyroid, 6 (30%) as primary hypothyroid, and 4 (20%) as central hypothyroid. Of
treated patients, all but 1 euthyroid patient used T3, and all but 1 hypothyroid patient
used T4.
Both groups were compared at baseline and follow-up using chi square analysis for
discontinuous variables. These included age, employment, thyroid status, duration of
illness, and use of medications and other forms of treatment. Groups were also compared
using analysis of variance for continuous variables at baseline and follow-up. These
included pain distribution by the percentage and the ACR methods, mean symptom intensity,
and scores on the Fibromyalgia Impact Questionnaire (FIQ) and Zung's Self-Rating
Depression Scale (Zung's). Because some patients were not available for physical
examination at follow-up, mean algometer scores of tender points for the two groups were
compared only for the initial evaluation. There were no significant differences at
baseline between treated and non-treated groups.
At follow-up, Wilcoxon Matched Pairs Signed Rant Test showed that treated patients had
decreased their use of antidepressants and NSAIDs; untreated patients had increased their
use of antidepressants and anxiolytics. Comparison of baseline measures with follow-up
measures for each group by t-tests showed that treated patients improved on all FMS
measures, while untreated patients improved on none. Multivariate analysis of variance
showed significant differences between the two groups on FMS measures (F=<0.0005).
Univariate analysis of variance revealed that at follow-up, compared to the untreated
group, the treated group significantly improved specifically in pain distribution via the
ACR method (F=0.0002) and in pain distribution via the percentage method, mean
symptom intensity, FIQ, and Zung's (F=<0.00005).
We conclude that at 1-to-5 year follow-up, the FMS status of euthyroid and hypothyroid
patients who underwent metabolic therapy, including the use of exogenous thyroid hormone,
significantly improved compared to matched untreated FMS patients. The continuation of
improved FMS status for 1-to-5 years effectively rules out a placebo effect as the
mechanism of improvement.
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