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The Metabolic Treatment
of Fibromyalgia
by Dr. John C. Lowe
Readers' Comments
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Caveat Emptor:
Different T3 Protocols
(January 10, 1997)
Summary: Fibromyalgia Research Foundation studies have shown that the use of
T3, within the context of a metabolic rehabilitation program, can effectively improve or
relieve some patients' fibromyalgia. Our studies do not provide evidence that other T3
treatment protocols are effective. Yet, some clinicians have referred to FRF studies as
proof of the effectiveness of their untested T3 protocols.
"Recently, news was released that
researchers at the Fibromyalgia Research Foundation (FRF) had completed blinded efficacy
studies of metabolic therapy for fibromyalgia. Since then, FRF has received word from
several sources that some people have perceived that our studies also vindicate various
T3-based treatment protocols that have not been subjected to experimental scrutiny. I've
been notified by reliable sources that several clinicians not affiliated with FRF are
planning fibromyalgia treatment centers where T3 will be used to treat fibromyalgia
patients. The T3-based protocols these clinicians will reportedly use are not the
same as the one tested and endorsed by FRF researchers.
"I must emphasize that our recent blinded studies demonstrated the effectiveness of
only one specific treatment protocol. I developed this protocol, through interaction with
several medical colleagues, over a 10-year period. During the evolution of the protocol,
we eventually abandoned all other variations of the treatment. There was one reason we
abandoned the other variations: they were either comparatively or completely ineffective
in the treatment of fibromyalgia. Among these abandoned protocols are the very ones some
people presently perceive to be vindicated by the FRF-sponsored blinded efficacy studies.
"I encourage patients to be vigilant for several reasons. A clinician may promote T3
treatment for fibromyalgia, possibly referring to FRF-sponsored studies for evidence of
efficacy, yet use a different protocol--one that has not been scientifically
tested.
Patients should bear in mind that:
1) The treatment protocol my colleagues and I developed and clinically tested does not
involve the use of T3 exclusively. About half of our fibromyalgia patients initially use
T4.
2) The effective protocol involves treatment procedures in addition to the use of thyroid
hormone, and for some patients, procedures other than thyroid hormone.
3) Treatment is individualized and often altered based on the patient's changing scores on
five measures of fibromyalgia status and the results of physical examinations. Scores from
test results are posted to five different line graphs so that changing fibromyalgia status
can be visually inspected by the patient and the clinician. These objective measures and
graphic displays of fibromyalgia status are crucial to an optimal therapeutic
outcome. The physical exam assesses indirect "perpheral indices" of tissue
metabolic status, such as the speed of the relaxation phase of the Achilles reflex, the
resting heart rate, and voltage changes on the EKG.
4) None of the following are used to titrate thyroid hormone dosages: basal body
temperature, blood tests for serum thyroid hormone or TSH levels. For some patients,
although certainly not all, the basal body temperature may be one index of metabolic
change, although it is not sufficiently reliable in many patients. Regardless, if
treatment is to be effective, temperature change must not be considered a goal of therapy,
but rather one of several physiological indicators of a patient's response to metabolic
treatment.
"I suggest that patients scrutinize information on the treatment protocol they are
considering, especially if it is represented as the protocol tested by FRF researchers.
This is important, because ineffective treatments are costly and disheartening to
fibromyalgia patients. If fibromyalgia patients are to use metabolic therapy, I believe
they should have the opportunity to undergo the treatment regimen that has been developed
specifically for fibromyalgia and shown under experimental conditions to be effective for
that condition. If a patient chooses to undergo an untested treatment, the clinician
providing the treatment is ethically responsible for forthrightly representing it as
untested--and not representing it, implicitly or explicitly, as the FRF protocol or
a version of it."
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